Laparoscopic live donor nephrectomy

Laparoscopic donor nephrectomy offers numerous advantages when compared with the traditional open approach. For the donor, it has resulted in a shorter hospital stay, fewer postoperative analgesic requirements, earlier return to activities of daily living and employment, and decreased financial loss owing to absence from the workforce. For the recipient, the procedure does not adversely impact on allograft function, graft survival, or patient survival.     

腹腔镜活体供肾摘除术

腹腔镜活体供肾摘除术是近几年才在我国许多肾移植中心起步开展的微创取肾手术,该术式有效地增加了活体供肾来源,促进了现阶段我国活体供肾肾脏移植的开展.本文就腹腔镜活体供肾摘除术在国内外的发展现状进行综述.     

Laparoscopic live donor nephrectomy

BACKGROUND: The demand for renal transplants is greater than the available kidneys. Live donation is one way of increasing the supply. Laparoscopic removal of the donor kidney appears to reduce morbidity for the donors. Some who are hesitant because of the morbidity associated with open nephrectomy are willing to consider the laparoscopic donor nephrectomy. METHODS: Laparoscopic donor nephrectomy was offered to all but three donors since the commencement of the programme in 1997. Data were collected both prospectively and retrospectively for the first 120 donors. Venous and arterial anatomy was assessed preoperatively by computed tomographic angiography. RESULTS: All but four donor procedures were completed laparoscopically. Three of these were for bleeding that could not be safely controlled laparoscopically and the fourth was a planned conversion to deal with the renal vessels, in the first right nephrectomy. Two kidneys were lost due to arterial thrombosis and two underwent segmental infarction after the loss of one of two or three separately anastomosed vessels. Three recipients had delayed function and two of them required dialysis postoperatively. Other minor complications occurred but were uncommon. CONCLUSIONS: Laparoscopic live donor nephrectomy is safe for the donor and the transplant kidney. It offers the advantage of decreased morbidity for the donor, with a shorter hospital stay, earlier return to normal activity and, for some, early return to work.     

Laparoscopic live donor nephrectomy

Live donor renal transplantation has many advantages including greater graft and patient survival, shorter waiting periods, improved human leukocyte antigen matching, and less cold ischemia. Until recently, disincentives from the operation, such as prolonged hospitalization, postoperative pain, and significant convalescence, have deterred live donor renal transplantation. This article describes the technique of laparoscopic live donor nephrectomy and briefly reports the results. The procedure has resulted in improved postoperative recovery and shorter convalescence, with no effect on recipient renal function.     

Laparoscopic live donor nephrectomy: trends in donor and recipient morbidity following 381 consecutive cases

OBJECTIVE: To review a single-institution 6-year experience with laparoscopic live donor nephrectomy detailing the technical modifications, clinical results, as well as the trends in donor and recipient morbidity. SUMMARY BACKGROUND DATA: Since 1995, laparoscopic donor nephrectomy has had a significant impact on the field of renal transplantation, resulting in decreased donor morbidity, without jeopardizing procurement of a high-quality renal allograft. This technique has become the preferred method of allograft procurement for many transplantation centers worldwide but still remains technically challenging with a steep learning curve. METHODS: Records from 381 consecutive laparoscopic donor nephrectomies were reviewed with evaluation of both donor and recipient outcomes. Trends in donor and recipient complications were assessed over time by comparing the outcomes between four equally divided groups. RESULTS: All 381 kidneys were procured and transplanted successfully with only 8 (2.1%) open conversions. Mean operative time was 252.9 +/- 55.7 minutes, estimated blood loss 344.2 +/- 690.3 mL, warm ischemia time 4.9 +/- 3.4 minutes, and donor length of stay was 3.3 +/- 4.5 days. There was a significant decline in total donor complications, allograft loss, and rate of vascular thrombosis with experience. The rate of ureteral complications declined significantly when comparing our early (Group A) versus later (Groups B-D) experience. CONCLUSION: Laparoscopic donor nephrectomy has remained a safe, less invasive, and effective technique for renal allograft procurement. Over our 6-year experience and with specific refinements in surgical technique, we have observed a decline in both donor and recipient morbidity following laparoscopic live donor nephrectomy.     

Laparoscopic donor nephrectomy for pediatric recipient

INTRODUCTION: To present our outcome of laparoscopic donor nephrectomy for pediatric recipients, who may pose special challenges. MATERIALS AND METHODS: Since March 2003, we performed more than 400 laparoscopic donor nephrectomies for 39 pediatric recipients (age less than 17 years of age). The preoperative, intraoperative, and postoperative data were reviewed to analyze the outcomes of these cases. We used the left kidney in 26 and the right kidney in 13 cases. Seven cases had double renal arteries, which were reconstructed on the bench. RESULTS: The mean donor and recipient ages were 31 +/- 5 years and 13 +/- 4 years, respectively. The mean donor operative time was 2.1 hours (range 1.2 to 3.2). The warm ischemia time averaged 3 +/- 0.6 minutes. In 27 cases, we used the common iliac artery and common iliac vein for vascular anastomosis. In 12 cases, the anastomosis was performed to the aorta and vena cava. Seven patients had prior augmentation cystoplasty, and the ureter was anastomosed to the pouch directly. All grafts functioned immediately, with a mean creatinine at 24 hours of 1.5 +/- 0.3 mg/dL. At last follow-up (mean 13.6 months), the mean creatinine was 0.9 mg/dL. One patient lost the graft due to severe rejection that was resistant to antithymocyte globulin. CONCLUSIONS: Laparoscopic donor nephrectomy for pediatric recipients is safe and provides quality organs with excellent function. Outcome is comparable to those after open donor nephrectomy.     

Laparoscopic live donor nephrectomy: single center experience

AIMS: The aim of this study was a retrospective assessment of the safety of laparoscopic live donor nephrectomy (LLDN) and the outcome of these renal transplantations. METHODS: From November 2001 to October 2006, we performed 30 LLDN (all left nephrectomies) after excluding any renal vascular anomalies in the donor. All laparoscopic procedures were performed by a team consisting of an expert laparoscopic surgeon and a transplant surgeon. The donor mean age was 48.9 +/- 7.6 years (range 22 to 69), 33% of the donors were men and their mean Body Mass Index was 24.7 +/- 3.8 kg/m(2). The recipients were a 32 +/- 14 years old (range 6 to 64), with 66% of them men, and their mean time on dialysis, 33 +/- 49 months (range 0 to 120). RESULTS: After a mean follow-up of 39 +/- 14 months, all donors and recipients are alive. The mean operative time was 272 +/- 41 min (range 225-360) and the mean warm ischemia time, 161 +/- 35 seconds (range 107 to 240). Surgical complications in the donors were one incisional hernia and two cases of pneumonia. The donor's mean hospital stay was 5.3 +/- 1.7 days (range 3 to 12) and their mean serum creatinine at discharge was 111 +/- 21 micromol/L. There was one surgical complication-a hematoma-among the recipients, and all transplants functioned immediately except for one case. CONCLUSIONS: LLDN was confirmed to be safe and effective, with no negative impact on transplants success. Expertise in laparoscopic surgery is needed to minimize the side effects for the transplant donor and for the recipient.     

Laparoscopic live donor nephrectomy: the preliminary experience.

BACKGROUND: Recent improvements in video technology and surgical instrumentation have resulted in the application of minimally invasive techniques to many surgical procedures including splenectomy and adrenalectomy. Nephrectomy requires a long flank incision with division of abdominal musculature and possible subcostal nerve damage. Severe postoperative pain and a prolonged recuperative period may result, and the cosmetic outcome may not be satisfactory. A new surgical approach utilizing laparoscopic dissection and delivery of the kidney through a small incision was performed to circumvent these problems. The aim of this paper is to describe the technique of laparoscopic live donor nephrectomy (LLDN) and present the preliminary outcome. METHODS: Over the 12-month period between May 1997 and April 1998, 16 donors underwent donor nephrectomy by a laparoscopic approach. The procedure was assessed with regard to its safety, feasibility and advantages over the open method. RESULTS: All the nephrectomies were completed without conversion to an open procedure. The average postoperative pain score on a visual analogue scale of 1-10 was 2 in LLDN. The donors required 36 mg morphine on average over 36 h postoperatively. Postoperative stay averaged 3 days. One donor developed an infective complication along the wound drain tract which settled with adequate drainage and antibiotics. All the removed donor kidneys were transplanted with immediate good function. There were no surgical complications or graft losses. The recipients' serum creatinine was in the range of 96-181 mmol/L 3 months after transplantation. CONCLUSIONS: Significant potential advantages of LLDN include less postoperative pain, shorter hospitalization and decreased recuperative time. This preliminary experience indicates LLDN to be effective in terms of safety and feasibility.