Hand-assisted right laparoscopic nephrectomy in living donor

Abstract

Objective: To assess results obtained with the authors' technique of right hand-assisted laparoscopic nephrectomy in living kidney donors.Materials and Methods: We retrospectively analyzed 16 kidney donors who underwent handassisted right laparoscopic nephrectomy from February 2001 to July 2004. Among these patients, 7 were male and 9 were female, with mean age ranging between 22 and 58 years (mean 35.75).Results: Surgical time ranged from 55 to 210 minutes (mean 127.81 min) and warm ischemia time from 2 to 6 minutes (mean 3.78 min) with mean intra-operative blood loss estimated at 90.62 mL. There was no need for conversion in any case. Discharge from hospital occurred between the 3rd and 6th days (mean 3.81). On the graft assessment, immediate diuresis was seen in 15 cases (93.75%) and serum creatinine on the 7th post-operative day was 1.60 mg/dL on average. Renal vein thrombosis occurred in 1 patient (6.25%) who required graft removal, and lymphocele was seen in 1 recipient (6.25%).Conclusion: Hand-assisted right laparoscopic nephrectomy in living donors is a safe and effective alternative to open nephrectomy. Despite a greater technical difficulty, the procedure presented low postoperative morbidity providing good morphological and functional quality of the graft on the recipient.

Laparoscopic live donor nephrectomy for right kidneys: Experience in a German community hospital

“…However, with increasing experience and progress of technology like Ultracision Ò and Ligasure Ò devices large series from highvolume transplant centres have overcome these difficulties and demonstrated ecellent outcomes for donors and recipients after laparoscopic right donor nephrectomy [16,17,20]. The prediction has been made that laparoscopic live donor nephrectomy will be the new gold standard in the near future [10].…”

Hand-Assisted Laparoscopic Right Donor Nephrectomy: Safety and Feasibility

“…In addition, although there have been debates about this issue, some authors have emphasized the left-side preference by arguing that left-sided HALDNs are successful even in cases with multiple left renal arteries [1,3-5]. Obviously, several indications, including significantly lower function in the right kidney than in the left one [6-10] or a woman of child-bearing age [7,11], should prompt consideration of the right rather than the left kidney. However, fewer reports have been made on right laparoscopic donor nephrectomy because most right donor nephrectomies have been performed in open surgery owing to a lack of experience and the technical difficulties in performing laparoscopic procedures.…”

Avaliação do comprimento das veias renais em cadáver e perda da sua extensão com três diferentes tipos de ligadura e secção

“…Nos últimos anos, a NLDV representou o maior avanço na cirurgia do TR, entretanto observou-se uma redução na utilização do rim direito (RD) (9,10,14,15) , isto devido ao fato de ser a veia renal direita (VRD) anatomicamente mais curta que a veia renal esquerda (VRE), o que pode estar diretamente relacionado com dificuldades técnicas no implante do órgão, além da possibilidade de complicações no pós-operatório, particularmente a trombose venosa (TV) (2,17,27,28,29,30) . Na nefrectomia para transplante, aberta ou de cadáver, quando o RD é o escolhido, pode-se retirar, adicionalmente à VRD, uma faixa circunferencial da veia cava inferior (VCI).…”

“…Em NLDV, prefere-se o rim esquerdo, uma vez que a VRE é mais longa (15,27,30,32,35) , apesar da necessidade de mobilização de todo o cólon esquerdo, liberação do ligamento frenoperitoneal, ligaduras das veias gonadal, adrenal e lombar quando presentes.…”

“…Apesar de muitos autores realizarem a nefrectomia laparoscópica direita (NLD) para TR, a mesma continua sendo pouco utilizada e considerada um desafio na maioria dos serviços, pelos riscos impostos pela menor extensão da VRD, como acima mencionados (2,17,19,30) , além de alguns aspectos não consensuais, como, por exemplo, sobre qual dos clampeamentos utilizados proporciona menor perda de extensão da VRD. …”