Hand-assisted Retroperitoneoscopic Live Donor Nephretomy: Reduced Perioperative Risk and Excellent Outcome – Experience from the first 110 Consecutive Cases
Titel:
Hand-assisted Retroperitoneoscopic Live Donor Nephretomy: Reduced Perioperative Risk and Excellent Outcome – Experience from the first 110 Consecutive Cases
Auteur:
J. Wadström
Verschenen in:
Transplantationsmedizin
Paginering:
Jaargang 18 (2006) nr. 1 pagina's 15-20
Jaar:
2006
Inhoud:
Aim/Background: Laparoscopic live donor nephrectomy is associated with two major life-threatening complications, sudden severe bleeding and intestinal injury. Hand-assisted and retroperitoneoscopic techniques reduces the risk of these life-threatening complications. In this study, we report on our experience from the first 110 consecutive live donor nephrectomies operated with a combined hand-assisted and retroperitoneoscopic technique (HARS). Material/Methods: The first consecutive 110 donors operated with the HARS technique are included in the study. The data has been collected prospectively according to intention to treat. Body Mass Index (BMI), warm ischemia time (WIT), operating time and blood loss were recorded. Complications, and allograft outcome in the recipient were followed postoperatively with a mean follow-up of 870 (1868-40) days. Results: The mean operating time was 142 (80-305) min and the mean WIT 172 (85-510) seconds. The operative time was significantly longer in male donors, 167 (110-305) min vs 126 (80-215) min, (p<0.001). BMI did not influence the operating time but kidneys with multiple arteries prolonged the operating time significantly, 137 (80-305) min vs. 182 (115-265) min (p<0.001). The mean bleeding was 185 (50-700) ml. Major complications were one non-lethal pulmonary embolus and two donors required blood transfusion. One donor was reoperated due to suspicion of trocar hernia. Fourteen patients had minor complications (fever, n=4; urinary tract infection, n=6; chylous ascites, n=1; orchialgia, n=2; subcostal pain, n=1). Two kidneys did not have immediate onset of function. Neither of these were attributed to the donor operation. Two recipients experienced urinary leakage and one a stenosis. Overall recipient- and graft survival were 97% and 95%, respectively. Conclusions: HARS enables short operating times and reduces the risks associated with endoscopic live donor nephrectomy.
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