Laparoscopic Live Donor Nephrectomy: The Recipient

Ratner, Lloyd E.; Montgomery, Robert A.; Cohen, Charles D.; Maley, Warren R.; Burdick, James F.; Chavin, K.; Kittur, Dilip S.; Klein, Alison P.; Kraus, Edward S.; Kavoussi, Louis R.

doi:10.1097/00007890-199806270-00447

Cited by 29 publications

(40 citation statements)

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“…6 It was hypothesized that these factors would lead to an increased rate of graft dysfunction and failure; however, the literature fails to corroborate this. [10][11][12] Hazebroek and colleagues showed that pneumoperitoneum during LDN does not adversely affect the renal function of donors or recipients. 7 London and colleagues reported that increased intraoperative fluid administration could overcome decreased renal blood flow during LDN and prevent renal ischemia.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 More recent studies have shown that the short-term outcomes of allograft performance following LDN are equivalent to the open flank procedure. [7][8][9] However, Nogueira and colleagues 10 and Ratners and colleagues 11 found lower mean serum creatinine levels at 1 year post-transplant after LDN compared to open flank renal procurement. In their series, LDN donor kidneys were slower to achieve a nadir serum creatinine, but this had no effect on long-term outcomes.…”

Section: Introductionmentioning

confidence: 98%

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Laparoscopy, dorsal lumbotomy and flank incision live donor nephrectomy: comparison of donor outcomes

Samarasekera

Kim

Wang

et al. 2013

CUAJ

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Background: Flank incision (FL), dorsal lumbotomy (DL) and laparoscopic surgery have been effective approaches to donor nephrectomy. While laparoscopic donor nephrectomy (LDN) has become increasingly popular, there has yet to be a direct comparison of the three modalities. Methods: We performed a retrospective chart review of FL, DL and LDN operations between 2002 and 2010 within a single institution. Donor and recipient characteristics, as well as surgical outcomes, were assessed. Results: There were 496 donor nephrectomy operations available for analyses. Patients in the LDN group had the lowest estimated blood loss, compared to the DL and FL groups (p < 0.001), lowest rate of complications (p < 0.01), and shortest hospital stay (p < 0.0001). Donors who underwent DL used an average of 60.12 ± 5.0 mg of morphine, which was significantly less than that used by patients in the LDN (93.2 mg, p < 0.0001) and FL (111.82 mg, p < 0.001) groups. Mean serum creatinine of recipients at day 1 post-op was the highest in the FL group (p < 0.0001 FL vs. LDN, p < 0.001 FL vs. DL), but there were no significant differences between the three groups at 2 weeks, 6, 12, 18, and 24 months post-operation (p > 0.45). Conclusions: Although a lower pain experience of LDN was not indicated, the use of LDN should be favoured over DL and FL as it is associated with fewer complications, and shorter length of stay. Of note, DL appears to be associated with higher complications and is likely not a preferred option for donor nephrectomy. RésuméContexte : L'incision du flanc, la lombotomie dorsale et la laparoscopie sont des techniques efficaces pour une néphrectomie chez un donneur vivant. Même si la laparoscopie a connu une montée en popularité, aucune comparaison directe entre les trois modalités n'a été effectuée. Méthodologie : Nous avons procédé à un examen rétrospectif des dossiers de patients ayant subi une néphrectomie par incision du flanc, par lombotomie dorsale et par laparoscopie entre 2002 et 2010 dans un même établissement. Les caractéristiques des donneurs et des receveurs ainsi que les résultats de la chirurgie ont été évalués. Résultats : Les analyses ont porté sur 496 néphrectomies. En comparaison avec les donneurs ayant subi une incision du flanc ou une lombotomie dorsale, les donneurs ayant subi une laparoscopie présentaient la perte sanguine estimée la plus faible (p < 0,001), le taux le plus bas de complications (p < 0,01) et la plus courte durée du séjour en hôpital (p < 0,0001). Les donneurs qui ont subi une lombotomie dorsale ont utilisé en moyenne 60,12 ± 5,0 mg de morphine, soit une valeur significativement plus faible que celle notée chez les patients ayant subi une laparoscopie (93,2 mg, p < 0,0001) et une incision du flanc (111,82 mg, p < 0,001). Le taux moyen de créatinine sérique le lendemain de l'intervention était le plus élevé chez les patients ayant subi une incision du flanc (p < 0,0001 incision du flanc vs laparoscopie, p < 0,001 incision du flanc vs lombotomie dorsale), mais les différences entre...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Laparoscopy, dorsal lumbotomy and flank incision live donor nephrectomy: comparison of donor outcomes

Samarasekera

Kim

Wang

et al. 2013

CUAJ

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“…Moreover, the number and severity of episodes of acute rejection requiring therapy was equal in both groups. Two recent communications deal with this issue of renal allograft function, one of them reporting similar function in both groups [15]. However, another team reports significantly poorer initial function in the laparoscopic group [12], illustrating the potential detrimental effects on the graft of the procedure.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic and open live donor nephrectomy: a cost/benefit study

et al. 2000

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Recently, laparoscopic live-donor nephrectomy has been developed in order to increase organ donation. In this study we compare and review the records of 10 donors operated by open extraperitoneal approach and of 10 donors operated by a laparoscopic transperitoneal approach (LSC). Results show less use of postoperative parenteral narcotics in the LSC group (109 mg vs 272 mg; P < 0.0005) than in the extraperitoneal group. Morbidity was similar in both groups. There was no difference in postoperative stay. Allograft kidney function was similar in both groups until 6 months after donation. The use of disposable laparoscopic material bears an extra cost of 900 US$. We can thus conclude that laparoscopic live-donor nephrectomy is a safe procedure

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“…Laparoscopic live donor nephrectomy has been demonstrated to have several advantages when compared with open donor nephrectomy. They include but are not limited to shorter hospitalization, decreased pain measured by reduced analgesic requirements, an increased willingness of potential donors to undergo the procedure, and an earlier return to employment and full activities (5)(6)(7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

“…An additional donor who was a physician was found to have a small incidental nonfunctional adrenal tumor but declined concomitant adrenalectomy, preferring to be followed with serial CT imaging. Laparoscopic donor nephrectomies were performed as previously described (7,14) with modifications made as needed in each individual case as described later. There were four women and one man, with a mean age of 43.4 years (range 36-51).…”

Section: Introductionmentioning

confidence: 99%

Concomitant Surgery With Laparoscopic Live Donor Nephrectomy

Molmenti

Pinto

Montgomery

et al. 2003

American Journal of Transplantation

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Routine live donor evaluations reveal unexpected silent pathologies. Herein, we describe our experience treating such pathologies at the time of laparoscopic donor nephrectomy. We have not encountered any previous reports of such an approach. We prospectively collected data on 321 donors. Concomitant surgeries at the time of procurement included two laparoscopic adrenalectomies, one colposuspension, one laparoscopic cholecystectomy, and one liver biopsy. Mean operative time was 321 min (range 230-380), with a mean blood loss of 280 mL (range 150-500). No blood transfusions were required. The left kidney was procured in four cases. The right kidney was obtained on one occasion. Mean hospital stay was 3 days (median 3, range 2-4). No short-or longterm complications have been identified. Mean follow-up time was 2.63 years (median 2.76, range 2.23-2.99). Four of the five kidney recipients were firsttime transplants who had not yet started dialysis. Simultaneous surgical interventions at the time of laparoscopic live kidney donation are safe and can be undertaken in selected cases. This practice is beneficial to both the donor and the recipient, and is likely to become more commonplace with changing practice patterns involving donor evaluation and management.

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Laparoscopic Live Donor Nephrectomy: The Recipient

Cited by 29 publications

References 0 publications

Laparoscopy, dorsal lumbotomy and flank incision live donor nephrectomy: comparison of donor outcomes

Laparoscopy, dorsal lumbotomy and flank incision live donor nephrectomy: comparison of donor outcomes

Laparoscopic and open live donor nephrectomy: a cost/benefit study

Concomitant Surgery With Laparoscopic Live Donor Nephrectomy

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