Dostalík J., Guňková P., Martínek L., Guňka I., Mazur M., Samlík J., Foltys A.: „Low volume“ Laparoscopic Nephrectomy for Relative-to-Relative Transplantation


Authors: J. Dostalík;  P. Guňková;  L. Martínek;  I. Guňka;  M. Mazur;  J. Samlík;  A. Foltýs
Authors‘ workplace: Chirurgická klinika FN Ostrava, přednosta: doc. MUDr. Jan Dostalík, CSc.
Published in: Rozhl. Chir., 2011, roč. 90, č. 5, s. 293-297.
Category: Monothematic special - Original

Overview

Aim:
Worldwide, the number of suitable cadaverous donors is limited. Therefore, as a solution for patients with chronic renal failure appears to extend the group of living donors of healthy individuals who voluntarily donate kidney to relatives or emotionally related recipients. Given the altruistic circumstances of these operations, the main monitored parameters are security for donors and excellent graft function for recipients. Currently published works show that minimally invasive technique can guarantee comparable results with open access in both monitored parameters. The aim of this study is to asses our results with laparoscopic assisted living donor nephrectomy for transplantation.

Patients and Methods:
In retrospective study we analyzed data of patients in whom laparoscopic donor nephrectomy was performed on the Surgical Clinic, University Hospital Ostrava in the period from May 13, 2002 to June 30, 2010. Group of 34 donors were analyzed according to demographic characteristics (sex, age, ASA classification and BMI). From the perioperative data were monitored length of operation and warm ischemia, blood loss, frequency of intraoperative complications and conversion rate. In the postoperative period were evaluated in donors length of postoperative hospitalization, frequency of early and late reoperations, causes of morbidity and mortality, dynamics of the levels of creatinine and in the recipients was monitored 1-year survival of the graft.

Results:
There were 14 men (41%) and 20 women (59%), median age was 48 years (25–77 years), BMI 26.9 (18.7–37.0), 53% of patients were ASA II, 44% ASA I, 1 patient (3%) ASA III. Median length of operation was 180 min (90–300 min), warm ischemia 120 s (58–240 s), blood loss 50 ml (30–1000ml). There was no conversion. Intraoperative complications occured in 3 donors (8.8%). The length of hospital stay was 7 days (3–26 days), morbidity rate was 14.7%, without mortality. Early reoperations were in 2 patients (5.9%), late reoperations were performed in 4 patients (11.8%). In donors an average increase of creatinine value was 35.5 μmol/l the first postoperative day. One-year graft survival in our cohort was 94.1%.

Conclusion:
For patients with terminal renal insufficiency the living donor kidney transplantation offers possibility to shorten time in waiting list and to ensure a better graft function with its longer survival. Minimally invasive laparoscopic technique (we prefer transperitoneal approach), represents a safe alternative to open operation.

Key words:
living donor – laparoscopic donor nephrectomy – kidney transplantation


Sources

1. Drognitz, O., Donauer, J., Kamgang, J., et al. Living- donor kidney transplantation: the Freiburg experience. Langenbecks Arch. Surg., 2007; 392: 23–33.

2. Pacovský, J., Navrátil, P., Baker, K., et al. Trasplantace ledvin od žijících dárců. Urologie pro praxi, 2004; 3: 101–104.

3. Masahiko, O., Akioka, K., Nobori, S., et al. Short- and long- term donor outcomes after kidney donation: analysis of 601 cases over a 35- year period at Japanese single center. Transplantation, 2009, 87: 419–423.

4. Paul, A., Treckmann, J., Gallinat, A., et al. Current concepts in transplant surgery: laparoscopic living donor of the kidney. Langenbecks Arch. Surg., 2007, 392: 501–509.

5. Chin, E. H., Hazzan, D., Herron, D. M., et al. Laparoscopic donor nephrectomy – intraoperative safety, immediate morbidity and delayed complications with 500 cases. Surg. Endosc., 2007; 21: 521–526.

6. Tooher, R. L., Rao, M. M., Scott, D. F., et al. A systematic review of laparoscopic live- donor nephrectomy. Transplantation, 2007; 78(3): 404–414.

7. Saad, S., Paul, A., Treckmann, J., et al. Laparoscopic live donor nephrectomy: Are ten cases per year enough to reach the quality standarts? A report from a single small-volume transplant center. Surg. Endosc., 2010; 24: 594–600.

8. Saad, S., Paul, A., Treckmann, J., et al. Laparoscopic live donor nephrectomy for right kidneys: Experience in a German community hospital. Surg. Endosc., 2008; 22: 674–678.

9. Ratner, L. E., Ciseck, L. J., Moore, R. G., et al. Laparoscopic live donor nephrectomy. Transplantation, 1995; 60: 1047–1049.

10. Wolf, J. S., Tchetgen, M. B., Merion, R. M. Hand-assisted laparoscopic live donor nephrectomy. Urology, 1998; 52(5): 885–887.

11. Bemelman, W. A., van Doorn, R. C., de Wit, L. T., et al. Hand-assisted laparoscopic donor nephrectomy. Ascending the learning curve. Surg. Endosc., 2001; 15: 442–444.

12. Buell, J. F., Hanaway, M. J., Potter, S. R., et al. Hand-assisted laparoscopic living- donor nephrectomy as an alternative to traditional laparoscopic living- donor nephrectomy. Am. J. Transplant., 2002; 2: 983–988.

13. Dolce, Ch. J., Keller, J. E., Walters, K. Ch., et al. Laparoscopic versus open live donor nephrectomy: outcomes analysis of 266 consecutive patients. Surg. Endosc., 2009; 23: 1564–1568.

14. Oyen, O., Andersen, M., Mathisen, L., et al. Laparoscopic versus open living- donor nephrectomy: experiences from a prospective, randomized, single- center study focusing on donor safety. Transplantation, 2005; 79: 1236–1240.

15. Dostalík, J., Samlík, J., Martínek, L., et al. Manuálně asistovaná laparoskopická nefrektomie od živého dárce. Rozhl. Chir., 2003; 82(3): 188–191.

16. Su, L. M., Ratner, L. E., Montgomery, R. A., et al. Laparoscopic live donor nephrectomy: trends in donor and recipient morbidity following 381 consecutive cases. Ann. Surg., 2004; 240: 358–363.

17. Berends, F. J., Den Hoed, P. T., Bonjer, H. J., et al. Technical considerations and pitfalls in laparoscopic live donor nephrectomy. Surg. Endosc., 2002; 16: 893–898.

18. Sawatzky, M., Altaf, A., Ellsmere, J., et al. Is right laparoscopic donor nephrectomy right? Surg. Endosc., 2009; 23: 1321–1325.

19. Nanidis, T. G., Antcliffe, D., Kokkinos, C. Laparoscpic versus open live donor nephrectomy in renal transplantation: a meta- analysis. Ann. Surg., 2008; 247: 58–70.

20. Duchene, D. A., Johnson, D. B., Li, S., et al. Laparoscopic donor nephrectomy at a low volume living donor transplant center: successful outcomes can be expected. J. Urol., 2003; 170: 731–733.

21. Dalla Valle, R., Mazzoni, M. P., Capocasale, E., et al. Laparoscopic donor nephrectomy: short learning curve. Transplant. Proc., 2006; 38: 1731–1733.

Labels
Surgery Orthopaedics Trauma surgery

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