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

Abstract

We tried to establish the technique of retroperitoneoscopic live donor nephrectomy (RPLDN).Between July 2001 and March 2004, 135 renal transplant donors underwent RPLDN. Low (average: 7 mmHg) CO 2 gas pressure was employed during the procedure. All procedures were performed through a three-port retroperitoneal approach without opening the peritoneal cavity. The hand-assisted technique was not used. One hundred and twenty-seven cases were of left and eight cases were of right nephrectomy. Donor nephrectomy was carried out successfully in all patients. In one donor, the procedure was changed to open donor nephrectomy because of severe adhesion around the renal vein due to previous surgery. No serious complications, such as massive bleeding or bowel injury were encountered. Return of bowel function took 0.7 days on average. Post-operative hospital stay was 4.9 days on average, and return to work was 12 days on average. Ureteral complications occurred in 2 patients and were treated with temporally retrograde ureteral stenting. Average serum creatinine levels were 1.5 mg/dL, 1.3 mg/dL and 1.3 mg/dL at 3, 7 and 14 days after transplantation, respectively. No patients required hemodialysis after transplantation due to acute tubular necrosis. RPLDN could be an option for laparoscopic live donor nephrectomy.

Complications of retroperitoneoscopic living donor nephrectomy: single center experience after 164 cases

“…Today, most surgeons use the transperitoneal approach, except few clinics who established primarily the retroperitoneoscopic approach [19][20][21][22]. Although the limited working space makes the retroperitoneoscopic approach more demanding compared to the transperitoneal approach, it oVers two major advantages: Wrst, it is possible to operate without interfering with intraperitoneal organs or adhesions in case of prior abdominal surgery.…”

Retroperitoneoscopic live donor nephrectomy: Review of the first 50 cases at Tygerberg Hospital, Cape Town, South Africa

“…The fact that the same surgeon performs the donor and recipient operation may remove some stress, as the length of the renal graft vessels becomes less of a potential issue. In our series, as in the report by Tanabe et al, [10] the surgical time was defined as the time from the first port insertion until removal of the kidney. The mean surgical time in our series was shorter than in the study of Tanabe et al, [10] similar to that reported by Bachmann et al [8] and slightly longer than that reported by Ma et al [9] (Table 3).…”

“…In our series, as in the report by Tanabe et al, [10] the surgical time was defined as the time from the first port insertion until removal of the kidney. The mean surgical time in our series was shorter than in the study of Tanabe et al, [10] similar to that reported by Bachmann et al [8] and slightly longer than that reported by Ma et al [9] (Table 3). In our series the proportion of rightsided nephrectomies was considerably higher than in the compared series (Table 3).…”

The Detrimental Effect of Poor Early Graft Function After Laparoscopic Live Donor Nephrectomy on Graft Outcomes

“…The procedure's history has been dominated by reports of the benefits of this less invasive procedure for the donor (3)(4)(5)(6)(7) and on organ supply (8)(9)(10)(11)(12) and of excellent recipient renal outcomes (36), and some other groups have also found worse early allograft function in laparoscopically procured allografts (13,(37)(38)(39)(40)(41)(42)(43)(44) (45). Additionally, animal and human studies have shown that the pneumoperitoneum used during the lapNx procedure impairs renal cortical blood flow (45)(46)(47)(48)(49)(50) (52)(53)(54)(55)(56) or slow graft function (SGF) (53) (57)(58)(59)(60) (53)(54)(55)(56) Ratner (12) and by Derweesh (69) and national data from the era prior to the laparoscopic nephrectomy (70) …”