Learning Laparoscopic Donor Nephrectomy Safely

Abstract

There is concern that learning laparoscopic live donor nephrectomy (LLDN) is associated with increased morbidity. We propose that with a team approach LLDN can be learned safely, without increased donor morbidity or graft failure, even during the early portion of a learning curve. Design: Case series with cohort comparison. Setting: Tertiary referral center. Patients: The laparoscopic group consisted of 100 donors and 100 recipients; the open group, 50 donors and 50 recipients. Interventions: A team approach that combines laparoscopic and urologic expertise was used to perform 100 cases of LLDN. Main Outcome Measures: Donor morbidity and graft function in the laparoscopic group were compared with those in the open group. Results: Laparoscopic live donor nephrectomy was completed in 99 patients. One patient required conversion to open donor nephrectomy because of intraoperative hemorrhage. Minor complications occurred in 6 laparoscopic group donors (6%) and 3 open group donors (6%). Laparoscopic and open group donors were of similar age. Operative times were longer for laparoscopic group donors (231 vs 209 minutes). Mean hospital stay was shorter for laparoscopic group donors (3.3 vs 4.7 days). Graft function was comparable between the laparoscopic and open groups, with equivalent postoperative creatinine levels. Graft survival was comparable. Recipient ureteral complications occurred with less frequency (2% vs 6%) in the laparoscopic group. Conclusions: By forming an operative team that combines expertise in laparoscopy with expertise in live donor nephrectomy, surgeons can learn LLDN safely. Adoption of the techniques developed by those who pioneered the procedure can further minimize the morbidity associated with a learning curve.

Retroperitoneoscopic Live Donor Nephrectomy (RPLDN): Establishment and Initial Experience of RPLDN at a Single Center

“…Most of the renal arteries were very small and almost always we did not see any significant infarction after clipping these arteries. Renal arteries were reconstructed on the back table in 20% of all cases, which is very close to the number of multiple renal arteries reported in the literature (9). Therefore, I believe that the magnifying effect of the endoscope makes it easy to identify the small renal arteries that are probably missed during open surgery.…”

“…In fact, our donor group was relatively older compared to other studies (6,9,12,13,23). On the other hand, female donors with a high BMI usually showed less adhesion of the kidney and less fat around the kidney compared to male donors.…”

“…Many authors have shown that compared with conventional open nephrectomy, laparoscopic nephrectomy results in less post-operative pain, a shorter length of hospital stay, a faster return to work and higher donation rates (3)(4)(5)(6)(7)(8)(9). Although in the initial experience of this procedure, some investigators observed higher vascular and ureteral complication rates and poorer early graft function (10)(11)(12)(13)(14)(15)(16)(17), recent experience of laparoscopic donor nephrectomy has shown an excellent outcome without surgical complications and delayed graft function (18,19).…”

Current concepts in transplant surgery: laparoscopic living donor of the kidney

“…Descriptions vary from 20% major complications during the first 50 cases and 6% during cases 200-250 [39] to 30% major complications during the first 30 laparoscopic cases with no complications during the next 50 LDN [40], but there are also reports of series without an apparent learning curve effect [41].…”

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

“…A idéia de NLDV foi originalmente descrita por Gill et al (17,18) em modelos porcinos e, em 1995, Ratner et al (14,46,47,48,50,54,55) realizaram a primeira NLDV.…”