LAPDOCTOR: TELL ME HOW DIFFICULT WILL BE MY DONOR

Background: Laparoscopic donor nephrectomy (LDN) is currently the gold standard technique for living donor nephrectomy. It is usually a straightforward operation, however, in some instances it can unexpectedly turn into a technically difficult procedure. There are no objective criteria for predicting the potential difficulty of LDN. Our aim was to validate the efficacy of a newly developed scoring system (LAPDOCTORLAParoscopic DOnor nephreCTomy scORe) for preoperative assessment of the potential technical difficulty of LDN. Materials and methods: We developed a score based on 11 parameters that in a previous pilot analysis on 78 living donors showed a significant correlation with the difficulty of the operation as perceived by the operating surgeon (BMI, male sex, abdominal girth at the umbilicus, on the 9th rib and on the anterior iliac spine, thickness of anterior and posterior perirenal fat, density of anterior perirenal fat and at the superior and inferior pole, periumbilical fat density). Each operation was graded according to the score as standard, moderately difficult, very difficult. In the present analysis we attempted the preliminary internal validation of LAPDOCTOR in 20 prospective LDNs. The scores obtained with LAPDOCTOR were blindly compared with the difficulty grades assigned by the operating surgeon. Results: LAPDOCTOR showed a correspondence of 66.6% with the surgeon’s grading and a Pearson correlation coefficient of 0.65 (standard 55.5% vs 44.4%, moderately difficult 33.3 % vs 44.4%, very difficult 11.1% vs 11.1%) with a standard deviation of 0.5 for standard and moderately difficult interventions and 0 for the very difficult cases. Conclusions: LAPDOCTOR is a very promising tool which could predict LDN difficulty and might help the surgeon in making a better evaluation of the operative risk of a living donor. These results are currently undergoing further validation in a prospective national multicentric study.