Hand-assisted laparoscopic live donor nephrectomy using newly produced LAP DISC: initial three cases

BACKGROUND: A new abdominal sealing device, called the LAP DISC, was used for the first time in hand-assisted laparoscopic live donor nephrectomy (HALDN) on three donors. The LAP DISC is made of three layers of rings connected by a rubber membrane, which covers the peritoneum and abdominal wall. The upper ring can adjust to the surgeon's hand size for insertion. METHODS: The LAP DISC was seated through an approximately 7-cm midline incision under the xiphoid process. The laparoscopic port was inserted through the LAP DISC, and thereafter, pneumoperitoneum was established. Three trocars were then placed under direct vision. The surgeon's left arm was inserted into the LAP DISC and used for manual retraction, dissection, and hemostasis. In the three operations, the kidneys were removed through the LAP DISC. RESULTS: The total warm ischemic times of the kidney were 15, 8, and 4 minutes, and the total operative times were 323, 195, and 240 minutes, respectively. After the subsequent transplantation into the recipient, the kidneys produced clear urine immediately on reperfusion. The recipient creatinine fell to 4.2, 5.6, and 3.9 mg/mL on postoperative day 1. All three donors resumed consistent oral intake within 24 hours after surgery and returned to normal, nonstrenuous activity by postoperative day 6. CONCLUSION: The LAP DISC device is excellent for HALDN and may increase the number of surgeons and donors who select HALDN.     

Hand-assisted retroperitoneoscopic live donor nephrectomy in comparison to open and laparoscopic procedures: a prospective study on donor morbidity and kidney function

BACKGROUND: Living donor nephrectomy (LDN) is a unique surgical challenge where surgery is performed on a healthy individual. A new hand-assisted retroperitoneoscopic nephrectomy (HARS) technique was compared to transperitoneal laparoscopic nephrectomy (LAP) and open nephrectomy (OPEN). The aim was to examine the perioperative and postoperative morbidity, and the effects of the different surgical techniques with regard to renal function. METHODS: Donors (n=36) were divided into three groups (HARS, LAP and OPEN) according to surgical technique. During the operations, renal function, hormone output, warm ischemia time (WIT) and operating time were recorded. Renal function, complications, convalescence and allograft outcome were followed postoperatively for one year. RESULTS: OPEN and HARS groups showed similar operation times: 150 (95-218) minutes and 145 (124-225) minutes, respectively. LAP procedures took longer: 218 (163-280) minutes. OPEN had the shortest WIT at 91 (55-315) seconds; LAP had the longest WIT at 207 (100-319) seconds, with HARS at 180 (85-240) seconds. In all groups, glomerular filtration rate and urine production were decreased during surgery. Endoscopic techniques had a higher catecholamine release, and OPEN donors showed higher serum aldosterone. Endoscopic techniques showed shorter convalescence and less postoperative pain compared to OPEN. HARS had a smaller rise in creatinine than LAP, and HARS recipients a better creatinine clearance than the other groups in the early posttransplantation period. CONCLUSIONS: Evaluation of HARS shows that the operation is quick, the donors experience little pain, and recovery time is short. The renal function for donors and recipients is somewhat favorable to open surgery and transperitoneal laparoscopic approaches.     

手助腹腔镜活体供肾切取术21例报告

目的评价手助腹腔镜活体供肾切取术(HLDN)的手术效果和近期疗效。方法回顾性分析2004年4月至2005年7月采用HLDN方法获取活体供肾21例的临床资料。供者男13例,女8例。年龄31～60岁,平均43岁。其中18例供者为血缘关系亲属供肾,3例为非血缘关系夫妻供肾。通过受者移植后肾功能恢复情况,评价HLDN的效果。结果手术皆取左肾,手术时间100～150 min,失血量30～100 ml。供肾热缺血时间2～3 min,冷缺血时间45～60 min。平均供肾动脉长度2.3 cm,静脉长度3.5 cm。HLDN手术全部成功,无中转开放,无手术并发症,术后6～7 d出院。21例受者肾移植后未发生肾功能延迟恢复,术后1周内肾功能均达到正常值。结论HLDN结合了腹腔镜活体供肾切取术和开放手术活体供肾切取术的优点,既保证了对供者的微创,又保证了供肾质量,有利于推动活体供肾移植的开展。     

Right laparoscopic live donor nephrectomy: a single institution experience

BACKGROUND: Laparoscopic live donor nephrectomy (LLDN) is increasingly used by transplantation centers worldwide. As in open live donor nephrectomy, the left kidney is preferred for LLDN; however, not all potential donors have anatomy conducive to left nephrectomy. The purpose of our study, therefore, was to report on a large, single-institution experience with right LLDN performed using a hand-assisted, transperitoneal approach. METHODS: We performed a retrospective review of 40 consecutive patients who underwent transperitoneal right hand-assisted LLDN at our institution. Information on donor age, relation to recipient, and indication for right-sided donation was collected. Surgical demographics included operative time, warm ischemia time, and estimated blood loss. Recipients were followed for graft loss and for long-term renal allograft function. RESULTS: The indications for right-sided donor nephrectomy were a difference in split renal function of greater than 10%, multiple left renal vessels, and right renal cysts. The mean surgical time in our series was 115.8 min, with a mean estimated blood loss of 85.7 mL and a warm ischemia time of 116.0 seconds. Surgical and postoperative complications were limited. Mean serum creatinine levels in the recipients were 1.6 mg/dL on day 7, 1.4 mg/dL on day 30, and 1.4 mg/dL at 1 year after transplantation. CONCLUSIONS: Right LLDN using a hand-assisted, transperitoneal technique was performed with minimal morbidity and favorable graft function. We believe that offering hand-assisted LLDN to patients with an indication for right-sided donation can safely and effectively increase the pool of donor organs available to patients with end-stage renal disease.     

Retroperitoneoscopic live donor nephrectomy in a patient with a double inferior vena cava

BACKGROUND: Vascular anomalies are considered a contraindication for laparoscopic live donor nephrectomy. We report a successful hand-assisted retroperitoneoscopic live donor nephrectomy from a donor with a double inferior vena cava. MATERIALS AND METHODS: A 37-year-old woman wanted to donate a kidney to her 44-year-old boyfriend who had hypertensive nephropathy. Preoperative donor imaging showed a double inferior vena cava. Each renal vein drains into the ipsilateral inferior vena cava division, making the left renal vein short. A single renal artery, vein, and ureter were noted on both sides. A hand-assisted retroperitoneoscopic left nephrectomy was performed. Blood loss was minimal and the warm ischemia time was 2 minutes. Renal transplantation was performed with good initial perfusion and urine output. Cold ischemia and rewarming time was 25 minutes. RESULTS: The donor postoperative period was uneventful with infrequent need for pain relief. The donor was discharged in good condition 3 days postoperatively. The donor's kidney functions were within the normal range at follow-up 4 months postoperatively. The recipient was discharged in good condition 7 days postoperatively. The recipient is alive with good graft function and unremarkable complications at 4 month follow-up. CONCLUSION: Although vascular anomalies present a surgical challenge, we have shown the feasibility of performing hand-assisted retroperitoneoscopic live donor nephrectomy in a donor with a double vena cava and short renal vein. With comprehensive preoperative assessment, laparoscopic live donor nephrectomy can be done safely in donors with anatomical anomalies. This may increase the number of living donor kidney transplants as it offers lower postoperative morbidity and economic disincentives for potential donors.     

Living donor of the kidney—open—video

Background and aims Living donor nephrectomy (LDN) has evolved a variety of different surgical techniques. Minimal invasive strategies were introduced to benefit the healthy donors. This paper attempts to identify the best possible practise in live kidney donation with special respect to donor safety. Materials and methods We present a single-centre experience of 173 live kidney donations and describe the surgical technique of open retroperitoneal donation in detail and by video sequences. Additionally, the evidence for donor safety (mortality and morbidity) and the integrity of the graft function are reviewed, comparing different surgical techniques for LDN. Results Focussing on maximal donor safety, a retroperitoneal access seems mandatory. Very detailed informed consent, including the offer for different retrieval techniques, has led to a total of 163 open and 10 hand-assisted retroperitoneal live kidney donations at our institution. Published and own data reveal longer operating and warm ischaemic times for minimal invasive kidney removal when compared with open technique. Adequate perioperative analgesia (peridural catheter) provides comparable patient comfort, duration of hospital stay, complications and graft function although there are some procedure-associated risks for minimal invasive techniques. Conclusion The special ethical situation of live donation necessitates maximal donor safety. Although open antero-lateral incision and retroperitoneal access does provide some inconveniences for the surgeon, we are convinced that this and the hand-assisted retroperitoneal approach are the only two options for LDN. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Early and late residual renal function and surgical complications in living donors: a 15-year experience at a single institution

Living donation in the field of renal transplantation has increased over time as well as the use of laparoscopic nephrectomy. We present a 15-year experience on 162 living donors (105 women, 57 men; mean age, 46.7 years; range, 31-74 years) who underwent nephrectomy using different surgical approaches as open lombotomic nephrectomy (OLN), open transperitoneal nephrectomy (OTN), and laparoscopic hand-assisted nephrectomy (LHAN). We collected data on residual donor and recipient renal function, as well as early versus late medical and surgical complications. With a mean follow-up of about 8 years, we observed normal residual renal function in all donors and similar results of early and late graft function independent of the surgical procedure. Long-term incidence of hypertension and noninsulin-dependent diabetes in living donors was similar to the general population. OLN and OTN donors showed higher incidences of early and late complications, readmissions, and reoperations than LHAN donors. Our results confirmed that living donor nephrectomy is a safe procedure without serious side effects in terms of renal function and long-term quality of life. LHAN should be the preferred technique because of a lower incidence of early and late complications.     

Use of a minimally invasive donor nephrectomy program to select technique for live donor nephrectomy

BACKGROUND: Live donor nephrectomy (LDN) is a major surgical procedure with an accepted low mortality and morbidity. Minimally invasive donor nephrectomy (MIDN) has been shown to decrease the wound morbidity associated with the lumbotomy of the classic open technique. Transplant programs face the challenge of initiating their MIDN programs without jeopardizing the safety of the donor and the graft quality. We present the experience at the University of Calgary after the initiation of a MIDN program, with a preoperative selective approach using the 3 major techniques for LDN. METHODS: From December 2001 to May 2004, 50 consecutive, accepted, live kidney donors were evaluated and chosen to undergo nephrectomy by an open, laparoscopic, or hand-assisted technique. Patients were chosen for a particular technique based on the criteria of vascular anatomy, size of abdominal cavity, previous surgery, and technical implications for the recipient. RESULTS: A total of 15 open, 11 laparoscopic, and 24 hand-assisted nephrectomies were performed. There were no statistically significant differences in sex, age, or body mass index between the groups. There were statistically significant differences in surgical times (P < .001) and in the number of days spent in the hospital (P < .001). All kidneys had primary function. There were 2 conversions in the hand-assisted group and 1 blood transfusion in the open group. Death-censored graft survival was 100% with an observation time of 20 months (SD +/- 9 months; range = 3-32 months). One graft from the hand-assisted group was lost from patient death with functioning graft 8 months after transplant. CONCLUSIONS: The learning curve for MIDN does not necessarily need to impact donor or recipient outcomes. The initiation of an MIDN program can be implemented safely if the cases are selected carefully and the use of the classic open technique is kept as an alternative.     

Hand-assisted retroperitoneoscopic radical nephrectomy: Initial experience

OBJECTIVES: To report our initial experience of hand-assisted retroperitoneoscopic radical nephrectomy for stage T1 renal tumors. METHODS: The clinical data on 22 consecutive patients who had undergone hand-assisted retroperitoneoscopic radical nephrectomy and 22 who had undergone open radical nephrectomy were reviewed. The operation was performed with a hand placed retroperitoneally through a pararectal longitudal 7-7.5 cm incision using a LAP DISC. RESULTS: The total operating time was between 2.3 and 5.8 h (mean: 3.4 h). The estimated blood loss was between 15 and 650 mL (mean: 170 mL). The complication rate was 9% (2/22). No conversions to open procedure occurred. In comparison to open radical nephrectomy, the operating time was similar (3.4 vs 3.9 h) whereas the estimated blood loss was significantly less in this procedure (170 vs 495 mL). During the convalescence period the patients revealed significantly less postoperative pain, shorter intervals to resuming oral intake and more rapid return to normal activities compared to the open radical nephrectomy patients. CONCLUSION: Hand-assisted retroperitoneoscopic radical nephrectomy is an effective and safe procedure for T1 renal tumors.     

Increased transplantation of kidneys with multiple renal arteries in the laparoscopic live donor nephrectomy era: surgical technique and surgical and nonsurgical donor and recipient outcomes

BACKGROUND: For anatomical and technical reasons, many transplant centers restrict laparoscopic live donor nephrectomy (in contrast with open live donor nephrectomy) to left kidneys. HYPOTHESIS: This change in surgical practice increases procurement and transplantation rates of live donor kidneys with multiple renal arteries (RAs), without affecting donor and recipient outcomes. DESIGN AND SETTING: Retrospective review at an academic tertiary care referral center comparing laparoscopically procured single vs multiple-RA kidney grafts (April 1997 to October 2000). PATIENTS: Seventy-nine consecutive left laparoscopic live kidney donors and 78 transplant recipients. MAIN OUTCOME MEASURES: Donor and recipient complications and postoperative length of stay; cold and warm ischemia time; operating time; short-term and long-term graft function; and survival. RESULTS: We noted multiple RAs in 21 (27%) of all kidneys. The proportion of donors with 1 or more perioperative complications was 19% in the single-RA group vs 10% in the multiple-RA group (P was not significant). For the recipients, we noted no significant differences between groups with respect to surgical complications, quality of early and late graft function, rejection rates, graft losses (all immunologic), and graft survival. Cold and warm ischemia time and length of stay were similar for donors and recipients in both groups. Median operating times were significantly longer for the multiple-RA vs single-RA group (difference, 41 minutes for donors and 45 minutes for recipients; P<.02). CONCLUSIONS: While the introduction of laparoscopic live donor nephrectomy has significantly increased the number of grafts with multiple RAs (compared with historical open controls), this change in practice is safe for both donors and recipients from a patient outcome-based perspective. However, from an economic perspective, the longer operating time associated with multiple-RA grafts provides strong added rationale for optimization of surgical instruments and techniques to make right-sided laparoscopic nephrectomy a routine intervention.     

Comparison of open,laparoscopic, and hand-assisted approaches to live-donor nephrectomy

BACKGROUND: Minimally invasive donor nephrectomy has become a favored procedure for the procurement of kidneys from live donors. The optimal minimally invasive surgical approach has not been determined. In the current work, we compared the outcome of kidneys procured using the traditional open approach with two minimally invasive techniques: the standard laparoscopic procedure and a hand-assist procedure. METHODS: The function of live-donor kidneys procured by open versus minimally invasive procedures was compared (procedures compared were the traditional open donor nephrectomy [ODN], the standard laparoscopic [LAP] approach, and the hand-assisted [HA] laparoscopic technique). The length of donor operation, donor length of stay in the hospital, surgical complications, and cost of hospitalization for three groups of patients were assessed in a series of 150 live-donor nephrectomies. RESULTS: We found that both minimally invasive procedures yielded kidney allografts with excellent early function and a minimum of complications in the donor. The open procedure was associated with a reduced operative time but increased donor length of stay in the hospital. Resource utilization analysis revealed that both minimally invasive techniques were associated with a slight increase in costs compared with the open procedure, despite a shorter hospital stay. CONCLUSIONS: Minimally invasive donor nephrectomy is safe and effective for procuring normally functioning organs for live-donor transplantation. Of the two minimally invasive approaches examined, the hand-assisted technique was found to afford a number of important advantages, including facilitating teaching of residents and students, that it is more readily mastered by transplant surgeons, and that it may provide an additional margin of safety for the donor.     

Hand-assisted laparoscopic live donor nephrectomy in a patient with renal artery aneurysm

Among the transplantation teams there is an increasing interest in laparoscopic live donor nephrectomy. For technical reasons, the use of the left kidney is recommended. However, considering the shortage of organ donors, it is likely that right-side laparoscopic live donor nephrectomy will need to be considered in selected donors, even those with vascular anomalies. Here we report the first case of right-side live donor laparoscopic nephrectomy in a patient with a renal artery aneurysm. Arteriography showed a 3-cm saccular aneurysm of the main right renal artery located at the bifurcation of the secondary branches and associated with an inferior polar artery coming directly from the aorta. The patient was placed in the lumbotomy position. An 8-cm midline incision was made above the umbilicus to insert the HandPort system (Smith & Nephew S.A., 72019 Le Mans Cedex2, France). Four additional trocars were introduced. Dissection of the renal artery was carried out beyond the level of relieving the aneurysm behind the vena cava. The main and polar arteries were clipped, and the renal vein was stapled. The kidney was removed through the HandPort and perfused cold ex vivo. The warm ischemia time for the kidney was 1 min, and the total operative time was 280 min. Vascular abnomalies were corrected ex vivo. The postoperative course of the donor was uneventful. At 6 months after transplantation, the graft function was normal. The hand-assisted approach is of particular value on the right side where the dissection must be carried out behind the vena cava. The HandPort may save few precious minutes over the sac extraction technique of the standard laparoscopic procedure.     

A Necessary Step Toward Kidney Donor Safety: The Transition From Locking Polymer Clips to Transfixion Techniques in Laparoscopic Donor Nephrectomy

Donor safety is of paramount importance in addressing end-stage renal failure through living kidney transplantation. The United States Food and Drug Administration (FDA) issued a Class II recall on the use of Hem-o-lok (Teleflex, Limerick, Pennsylvania, United States) polymer clips on the renal artery in laparoscopic donor nephrectomy (LDN) in June 2006 following 3 reported cases of donor deaths secondary to slipped ligature. The National University Hospital of Singapore made the transition regarding hilar control in minimally invasive donor nephrectomy, from using polymer and titanium clips to transfixion techniques (pure or hand-assisted laparoscopic) via laparoscopic staples or intracorporeal suturing, respectively. This study assessed safety during the transition in arterial transfixion techniques in minimally invasive donor nephrectomy for both donors and recipients. Forty-five consecutive kidney donors underwent donor nephrectomy over a 2-year period starting from June 2010. A total of 37 donors who underwent LDN (pure laparoscopic or hand-assisted laparoscopic) were included in the analysis. Of the 37 patients, 23 kidney donors had renal arterial control using Hem-o-lok while 14 patients from November 2011 onward underwent transfixion of the renal artery. The 2 groups of donor who underwent renal arterial control by either clips ligature or transfixion technique were comparable. The outcomes for the recipients in each group were similar with no statistical difference between postoperative creatinine level, incidence of delayed graft function, or graft survival at 1 year. We conclude that the transition in renal arterial control technique to transfixion techniques in LDN in line with FDA recommendation is feasible and affords equivalent donor and recipient outcomes.     

Can magnetic resonance angiogram be a reliable alternative for donor evaluation for laparoscopic nephrectomy?

BACKGROUND: While hand-assisted laparoscopic donor nephrectomy (HLDN) is less invasive, which can encourage kidney donation, it requires more exact information about the renal vascular anatomy because of its limited visual field during nephrectomy. MRA is also an attractive choice because of its minimal invasiveness; further, it is an outpatient-based procedure, it uses non-nephrotoxic contrast material and it has no radiation. The aim of our study was to evaluate the effectiveness of gadolinium enhanced three-dimensional MRA (GdE-3D MRA) in a group of potential live donors who were candidates for HLDN. METHODS: From September 2002 to December 2004, 40 potential live renal donors were evaluated prospectively with GdE-3D MRA, and this imaging modality was performed before the gold standard, the intra-arterial digital subtraction angiogram (IA-DSA), was carried out. All the images were reviewed in a blinded manner by the attending vascular radiologist. The MRA findings were compared with the DSA findings and the surgical findings as the reference methods. We evaluated the accuracy of MRA for imaging the renal architectures, and especially for imaging the renal accessory arteries and the early branching arteries that are important determinants for selection of the donor kidney. RESULTS: Both the MRA and DSA images showed consistent findings with the surgical findings in 92.5% of the 40 donors. There were no discrepant cases in depicting the main renal artery. MRA showed 100% specificity for imaging both the renal accessory arteries and the early branching arteries, when compared with the surgical findings. The kappa values for the MRA and DSA for the accessory arteries were all 0.66 compared with the intraoperative findings. MRA also depicted one huge renal cyst in one donor and many small renal cysts in the other donors that could not be imaged by DSA. There were no adverse events during the MRA procedure. None of the findings missed by MRA resulted in deleterious consequences at laparoscopic nephrectomy for the donor and graft. CONCLUSIONS: Our limited experience with GdE-3D MRA for imaging the renal structures in kidney donor evaluation for HLDN has been quite satisfactory.     

多层螺旋CT在活体肾移植供肾评估及取肾手术方式选择中的应用

目的 评价多层螺旋CT(MSCT)在活体肾移植供肾及取肾手术方式选择中的应用价值.方法 90例活体肾移植供者接受了MSCT平扫及动脉期、静脉期和排泄期的扫描.采用最大密度投影和容积再现技术进行血管成像,所有MSCT图像均由2位影像医师盲法下独立进行分析和评价.根据重建的CT图像,影像医师与肾移植医师进行讨论,选择左肾还是右肾作为供肾,并确定采用腹腔镜下取肾手术或是开放式取肾手术.结果 90例供者中,78例接受了左肾切取术,其中71例左侧供肾无明显变异者接受了常规腹腔镜下取肾手术,7例两侧肾脏均存在如副肾动脉、多支肾静脉,或者肾静脉位于腹主动脉后方等较明显变异,接受了左肾开放式取肾手术;12例因左肾存在明显变异,接受了右肾切取术,均行手辅助腹腔镜下取肾手术.所有术中记录的肾血管及集尿系统的解剖结构与术前MSCT评价一致,其准确率为100％.2位影像医师在评价肾动脉、肾静脉和集尿系统中显示了很好的一致性.90例取肾手术全部成功,移植术后受者未发生肾静脉血栓形成等血管并发症.结论 MSCT作为活体肾移植供者术前评价“一站式”检查方法,可以为供肾和取肾手术方式的选择提供准确、有价值的信息.     

Laparoscopic live donor nephrectomy in a patient with duplex inferior vena cava

BACKGROUND: Modern imaging, such as CT and MRI, improves the preoperative assessment for variants of renal vasculature. We present a kidney donor with a duplex inferior vena cava. In conjunction with CT and hand-assisted laparoscopic surgery, live donor nephrectomy was performed successfully. METHODS: A 35-year-old woman wished to donate a kidney to her son. Preoperative CT showed normal functional kidneys without uretal duplication. A duplex inferior vena cava was noted below the level of the left renal vein. A hand-assisted transperitoneal laparoscopic left nephrectomy was performed. Blood loss was minimal and the warm ischemia time was 3 minutes. Renal transplantation was performed with good initial perfusion and urine output. RESULTS: The donor was discharged in good condition at 3 days postoperatively. Both donor and recipient are alive with good renal function and without late surgical complications at 9 months. CONCLUSIONS: Live donor nephrectomy is unique as it involves two different patients. Benefits from laparoscopic operation include less pain, shorter hospital stay, earlier resumption of normal food intake, and earlier return to full activity. Graft function was not deleteriously affected and the survival of graft and recipient was not affected. Vascular anomalies, although uncommon, had a significant influence on live renal transplantation. Our patient represents a case of a rare venous anomaly, which has an an incidence rate of 0.5% to 3%. Helical CT with reconstruction of vascular anatomy helped in evaluating donor vasculature. In conjunction with modern imaging techniques and laparoscopic operation, live donor nephrectomy can be performed safely, even in patients with vascular anomalies.     

Laparoscopic hand-assisted living donor nephrectomy: the Calgary experience

Laparoscopic techniques, such as hand-assisted live donor nephrectomy (HALDN), have the potential to increase the number of living kidney donors. For these techniques to be acceptable, however, the standards for donor, recipient, and graft survival achieved by the open technique need to be matched. In this study we present the results of the first 20 HALDN procedures at our center. The 20 donors included nine men and 11 women of mean (+/-SD) donor age 41 (+/-10) years and mean donor weight 78 (+/-13) kg. Mean operative time was 174 (+/-32) minutes. Only one patient required an open conversion to procedure because of venous bleeding. All kidneys were successfully implanted; there were no episodes of primary nonfunction or delayed graft function. There were no surgical complications, either in the donor or the recipient. The range of postoperative stay was 3 to 5 days. One recipient died 62 days after transplant from influenza virus pneumonia. There were no other causes of graft loss. Our preliminary results suggest that HALDN is safe and is associated with short-term donor, recipient, and graft outcomes that are at least comparable to the standard open technique.     

手辅助腹腔镜在亲属活体供肾切取中的应用25例报告

目的 探讨手辅助腹腔镜在亲属活体供肾切取中的应用.方法 回顾性分析25名亲属活体供肾者的资料.25名供者中,男性6名,女性19名,年龄(42±17)岁.23例为亲属血缘关系供肾,2例为夫妻间供肾.分析供者选择手辅助腹腔镜下取肾术的原因、供者的手术时间、供肾热缺血时间、术中出血量、肾脏及周围脏器损伤情况、术后恢复情况及移植肾功能恢复情况,评价手辅助腹腔镜下取肾术的临床应用效果.结果 对25名亲属供者应用手辅助腹腔镜下取肾术均获成功,无中转开放手术;24例取左肾,1例取右肾;手术时间(138±42)min,供肾热缺血时间为(145±22)s,术中出血量(53±32)m1;无供肾损伤,无切口相关并发症,仅有1例发生脾包膜撕裂;术后住院时间为(7.2±1.7)d,供者均满意.调查显示,供者选择手辅助腹腔镜下取肾术的主要原因是手术损伤小、切口对外观影响较小、心理负担轻.亲属活体供肾移植后,仅有1例受者发生移植肾功能恢复延迟,其余受者的血肌酐水平均在1周内下降至正常.结论 手辅助腹腔镜下取肾术综合了传统腹腔镜技术和开放性手术取肾的优点,微创,操作方便,供肾损伤机会少,切口对外观影响较小,供者易于接受.     

Randomized controlled trial of hand-assisted laparoscopic versus open surgical live donor nephrectomy

BACKGROUND: Laparoscopic live donor nephrectomy for renal transplantation is being performed in increasing numbers with the goals of broadening organ supply while minimizing pain and duration of convalescence for donors. Relative advantages in terms of recovery provided by laparoscopy over standard open surgery have not been rigorously assessed. We hypothesized that laparoscopic as compared with open surgical live donor nephrectomy provides briefer, less intense, and more complete convalescence. METHODS: Of 105 volunteer, adult, potential living-renal donors interested in the laparoscopic approach, 70 were randomly assigned to undergo either hand-assisted laparoscopic or open surgical live donor nephrectomy at a single referral center. Objective data and subjective recovery information obtained with telephone interviews and validated questionnaires administered 2 weeks, 6 weeks, and 6-12 months postoperatively were compared between the 23 laparoscopic and 27 open surgical patients. RESULTS: There was 47% less analgesic use (P=0.004), 35% shorter hospital stay (P=0.0001), 33% more rapid return to nonstrenuous activity (P=0.006), 23% sooner return to work (P=0.037), and 73% less pain 6 weeks postoperatively (P=0.004) in the laparoscopy group. Laparoscopic patients experienced complete recovery sooner (P=0.032) and had fewer long-term residual effects (P=0.0015). CONCLUSIONS: Laparoscopic donor nephrectomy is associated with a briefer, less intense, and more complete convalescence compared with the open surgical approach.     

Laparoscopic v laparoscopy-assisted donor nephrectomy in the porcine model

PURPOSE: Laparoscopic donor nephrectomy is an established procedure in the porcine model. We sought to compare intraoperative variables between live laparoscopic (LAP) and laparoscopy-assisted (LAP-A) donor nephrectomy. MATERIALS AND METHODS: Eight domestic pigs underwent either traditional laparoscopic donor nephrectomy (N = 4) or laparoscopy-assisted donor nephrectomy (N = 4) using the Pneumosleeve followed by conventional heterotopic autotransplantation. RESULTS: No significant differences were noted between the groups with regard to vessel length, ureteral length, or postoperative urine output. The operating room time was 108+/-12 minutes in the LAP group v 75.8+/-10.3 minutes in the LAP-A group (P = 0.0065). Although the difference was not statistically significant, warm ischemic time, tended to be lower in the LAP-A than the LAP group: 70+/-3.0 seconds v 135+/-57 seconds, respectively (P = 0.059). Graft survival was identical in the two groups. CONCLUSION: Laparoscopy-assisted (via Pneumosleeve) live donor nephrectomy shortens the operative time without affecting graft survival in the domestic swine model.