Lapdoctor: Multicentre Validation of a Scoring System for Preoperative Evaluation of Difficulty of Laparoscopic Donor Nephrectomy

Abstract

We previously developed and validated LAPDOCTOR (LAParoscopic-Donor-nephreCTomy-scORe), a novel scoring system for the preoperative assessment of the difficulty of living donor nephrectomy (LDN). To prove its significance, we extended our investigation to a prospective, multicenter, national study. Difficulty was assessed by the operating surgeon using a scale from 1 to 3 (1-standard, 2-moderately difficult, 3-very difficult) based on eight parameters: availability of laparoscopic space, mobilization of the colon, kidney, gonadal, adrenal and renal vein, renal artery, and ureter. Donor CT-scans were blindly reviewed by a radiologist, and the LAPDOCTOR scores were compared with the difficulty levels assigned by the surgeon to investigate the match rates. One hundred eighty-five donors were enrolled, with a mean age of 54 years (range 24-77), BMI 25 kg/m2 (range 17-35), and male/female 59/126. LDN was blindly scored as standard in 45% of the cases, moderately-difficult in 52%, and very-difficult in 3%. The agreement between the LAPDOCTOR and expert donor surgeons' rate in categorizing LDN into risk groups had a QWK of 0.711 (95% CI 0.577-0.844) with p < 0.001. The LAPDOCTOR enables precise preoperative determination of the difficulty of LDN, particularly in very difficult cases, and assessment of surgical risk in living kidney donors.

Clinical trial notation: https://ClinicalTrials.gov, Identifier NCT05769686.

Keywords: laparoscopic donor nephrectomy score LDKT; living donor nephrectomy; minimal invasive; precision medicine; risk assessment.

FIGURE 1

Axial CT images showing the radiological parameters considered. (A) Upper renal fat tissue density (just above the kidney, ROI of 0.5 cm2). (B) Pre-renal fat tissue thickness (at the middle third of the kidney, from the kidney to the bowel). (C) Retro-renal fat tissue thickness (at the middle third of the kidney, from the kidney to the muscle). (D) Lower renal fat tissue density (just below the kidney, ROI of 0.5 cm2). (E) Abdominal wall fat tissue thickness (at 1 cm from the navel). (F) Abdominal circumference (at the antero-superior iliac spine). (G) Oblique muscles density (ROI of 0.5 cm2). (H) Abdominal circumference (at the navel). (I) Abdominal circumference (at the 12th rib).

FIGURE 2

Agreement rate for level of difficulty between LAPDOCTOR score and Donor Surgeon’s score: excellent concordance in risk group classification by a QWK of 0.711 (95% CI 0.577–0.844), p < 001.