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Background: To determine predictive formulas for operation time and surgical difficulty in laparoscopic living-donor kidney transplantation. Methods: We retrospectively analyzed data for 222 living donors aged >20 years and recorded factors affecting operation time from patients' CT images and medical records. We used the factors significantly affecting operation time to create a formula to predict operation time and designed a model to predict surgical difficulty based on the standardized partial regression coefficient, β. We also analyzed the relationship between surgical difficulty (high vs low) and operation time. Results: This study involved 111 pure retroperitoneoscopic donor nephrectomies (PRDN) and 111 hand-assisted laparoscopic donor nephrectomies (HALDN). Patients' mean age was 55.7 years, and 59.5% were women; 5.0% underwent right nephrectomy, and 77.0% vs 23.0% had single- vs multiple renal arteries. The average estimated kidney graft weight was 160.0 g, and actual average graft weight was 155.3 g. The following factors were significantly correlated with operation time in the regression analysis: number of renal arteries, Mayo adhesive probability score, estimated kidney graft weight, right nephrectomy, and operation type (PRDN). These five factors were used to create the operation time prediction equation and difficulty scoring system. The multiple r2 value was 0.40 for the operation time prediction equation. Receiver operating characteristic curve analysis of the difficulty scoring system revealed the following: sensitivity: 78.0%, specificity: 64.9%, and c-statistic: 0.76 (95% confidence interval: 0.70 to 0.83). Conclusions: The equation to predict operation time and the surgical difficulty prediction model created in this study are easy to calculate and are accurate. Both may help in selecting an appropriately skilled surgeon and in improving safety in living-donor kidney transplantation. [ABSTRACT FROM AUTHOR]

Introduction: We previously reported that the outcomes of pure retroperitoneoscopic donor nephrectomy are superior to those of hand‐assisted retroperitoneoscopic donor nephrectomy. Consequently, we introduced pure retroperitoneoscopic donor nephrectomy in our hospital. Here, we compared perioperative outcomes between hand‐assisted intra‐abdominal laparoscopic donor nephrectomy and pure retroperitoneoscopic donor nephrectomy. Methods: We retrospectively reviewed data from 315 living‐donor kidney transplantation procedures performed between October 2015 and December 2020 (213 involving hand‐assisted intra‐abdominal laparoscopic donor nephrectomy, October 2015 to June 2019; 102 involving pure retroperitoneoscopic donor nephrectomy, May 2019 to December 2020). After propensity score matching, 90 transplantations were included in each group (n = 180 overall). Results: Donors in the pure retroperitoneoscopic donor nephrectomy group had longer warm ischemia times (P <.001), lower serum C‐reactive protein concentrations and white blood cell counts on postoperative day 1 (P <.001 and P <.001, respectively), and shorter postoperative stays (P <.001) than donors in the hand‐assisted intra‐abdominal laparoscopic donor nephrectomy group. Five (5.6%) modified Clavien‐classifiable complications occurred in the hand‐assisted intra‐abdominal laparoscopic donor nephrectomy group; no complications occurred in the pure retroperitoneoscopic donor nephrectomy group (P = 0.008). One recipient in the hand‐assisted intra‐abdominal laparoscopic donor nephrectomy group had donor‐related delayed graft function. There were no significant differences between groups in recipient estimated glomerular filtration on postoperative day 7. Conclusion: The introduction of pure retroperitoneoscopic donor nephrectomy was safe and effective. Moreover, it was less invasive and less harmful for donors, compared with hand‐assisted intra‐abdominal laparoscopic donor nephrectomy; recipient outcomes were equivalent. [ABSTRACT FROM AUTHOR]