Hand-assisted versus total laparoscopic live donor nephrectomy
Journal
Journal of the Formosan Medical Association
Journal Volume
103
Journal Issue
10
Pages
749-753
Date Issued
2004
Author(s)
Abstract
Background and Purpose: The optimal minimally invasive procedure to procure live donor kidneys for renal transplantation has not been established. This study compared the donor outcome of hand-assisted laparoscopic live donor nephrectomy (H-LLDN) with total laparoscopic live donor nephrectomy (T-LLDN). Methods: The outcomes of 12 donors undergoing H-LLDN were compared to that of a subsequent series of 12 donors undergoing T-LLDN. Body mass index, operation time, warm ischemia time, hospital stay, surgical complications, and short-term graft function were compared between the 2 groups. Results: LLDN was successfully performed in all 24 donors. Both approaches resulted in excellent early graft function. The mean operation time in T-LLDN (215 minutes) was slightly shorter than that in H-LLDN (258 minutes), suggesting that the skills developed as surgeons learned the H-LLDN procedure had transferred to their performance of T-LLDN. The mean warm ischemia time of the T-LLDN group (4.5 minutes) was longer than that of the H-LLDN group (3.8 minutes), although this difference was not significant. One minor tear of the lumbar vein occurred in the H-LLDN group and the resultant bleeding necessitated blood transfusion. One mechanical failure occurred when the renal vein was divided by endoscopic gastrointestinal anastomosis in the T-LLDN group. The length of hospital stay, resumption of diet, and the use of narcotic analgesics were not different between the 2 groups. Conclusions: Both H-LLDN and T-LLDN are safe and effective approaches for the procurement of live donor kidneys. The benefits of the H-LLDN technique include direct manual control of the operative field and increased safety margin. The development of a hospital LLDN program by starting with a hand-assisted approach may reduce the potential bleeding complications and facilitate the safe transition to the cosmetically preferable total laparoscopic approach.
SDGs
Other Subjects
narcotic analgesic agent; pethidine; adult; anastomosis; article; bleeding; blood transfusion; body mass; clinical article; clinical trial; controlled clinical trial; controlled study; diet; drug use; endoscopic surgery; esthetics; feasibility study; female; gastrointestinal surgery; health program; hospitalization; human; intermethod comparison; ischemia; kidney donor; kidney function; kidney vein; laparoscopic surgery; learning; living donor; lumbar spine; male; nephrectomy; operation duration; outcomes research; postoperative complication; prospective study; safety; skill; surgical approach; surgical equipment; surgical technique; treatment outcome; vein injury; Adult; Female; Humans; Kidney Transplantation; Laparoscopy; Living Donors; Male; Middle Aged; Nephrectomy; Outcome Assessment (Health Care)
Type
journal article