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Donor Nephrectomy:: A Comparison of Techniques and Results of Open, Hand Assisted and Full Laparoscopic Nephrectomy

2004; Lippincott Williams & Wilkins; Volume: 171; Issue: 1 Linguagem: Inglês

10.1097/01.ju.0000100149.76079.89

1527-3792

Rizk El-Galley, Nedra Hood, Carlton J. Young, Mark H. Deierhoi, Donald A. Urban,

Organ Transplantation Techniques and Outcomes

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Jan 2004Donor Nephrectomy:: A Comparison of Techniques and Results of Open, Hand Assisted and Full Laparoscopic Nephrectomyis corrected byDONOR NEPHRECTOMY: A COMPARISON OF TECHNIQUES AND RESULTS OF OPEN, HAND ASSISTED AND FULL LAPAROSCOPIC NEPHRECTOMYDONOR NEPHRECTOMY: A COMPARISON OF TECHNIQUES AND RESULTS OF OPEN, HAND ASSISTED AND FULL LAPAROSCOPIC NEPHRECTOMY RIZK EL-GALLEY, NEDRA HOOD, CARLTON J. YOUNG, MARK DEIERHOI, and DONALD A. URBAN RIZK EL-GALLEYRIZK EL-GALLEY , NEDRA HOODNEDRA HOOD , CARLTON J. YOUNGCARLTON J. YOUNG , MARK DEIERHOIMARK DEIERHOI , and DONALD A. URBANDONALD A. URBAN View All Author Informationhttps://doi.org/10.1097/01.ju.0000100149.76079.89AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Laparoscopic donor nephrectomy (LAP) has been gaining more popularity among kidney donors and transplant surgeons. There have been some concerns about the function of kidney grafts harvested by laparoscopic procedures. We report our results of LAP. Materials and Methods: Prospective data were collected for our donor nephrectomy operations. A telephone survey was done by an independent investigator on the impact of surgery on quality of life. Graft function was also evaluated by serial serum creatinine and mercaptoacetyltriglycine renal nuclear scans. Results: A total of 100 patients were included in the study; of whom 55 underwent open donor nephrectomy (OD), 28 underwent LAP and 17 underwent hand assisted donor nephrectomy (HAL). Mean patient age was 39 ± 12 years and it was similar in all groups. Mean operative time was 306 ± 40 minutes for LAP, 294 ± 42 minutes for HAL and 163 ± 24 minutes for OD (p = 0.001). Laparoscopic operative time was decreased to 180 ± 56 minutes for LAP and 155 ± 40 minutes for HAL in the last 10 patients. Mean estimated blood loss was 200 ± 107 cc for LAP, 167 ± 70 cc for HAL and 320 ± 99 cc for OD (p = 0.0001). Mean warm ischemia time was 3 ± 2 minutes for LAP, 2 ± 2 minutes for HAL and 2 ± 1 minutes for OD (p = 0.002). Postoperative hospitalization was 2 ± 2 days for LAP and 3 ± 2 days for OD (p = 0.01). LAP required 30% less narcotic medicine than OD postoperatively (p = 0.04). There were no major complications in LAP cases and no complete or partial graft loss was noted. Mean followup was 7 months. Recipient creatinine was not significantly different for kidneys harvested by LAP or OD (p = 0.5). Diuretic mercaptoacetyltriglycine renograms were performed in all recipients 1 to 3 days after surgery and mean effective renal plasma flow was similar for the 3 groups (p = 0.9). According to telephone survey results 85% of LAP, 71% of HAL and 43% of OD patients reported a return to normal physical activity within 4 weeks after surgery. Similarly 74% of LAP, 62% of HAL and 26% of OD patients were able to return to work within 4 weeks after surgery. Conclusions: Our data show no significant difference in graft function between LAP and OD. LAP and HAL were safe and complications were minimal. The main difference was that patients treated with LAP and HAL returned to normal physical activity and work significantly earlier than those who underwent OD. References 1 : Laparoscopic live donor nephrectomy. Transplantation1995; 60: 1047. Medline, Google Scholar 2 : Hand-assisted laparoscopy: con. Urology2001; 58: 313. Google Scholar 3 : Open donor, laparoscopic donor and hand assisted laparoscopic donor nephrectomy: a comparison of outcomes. J Urol2001; 166: 1270. Link, Google Scholar 4 : Hand assisted laparoscopic donor nephrectomy: a comparison with the open approach. J Urol2001; 166: 444. Abstract, Google Scholar 5 Grady D.: The new organ donors are living strangers. N Y Times: September 20, p. 1, 1999 Google Scholar 6 : Comparison of laparoscopic live donor nephrectomy versus the standard open approach. Transplant Proc1997; 29: 138. Google Scholar 7 : Quality of life, pain and return to normal activities following laparoscopic donor nephrectomy versus open mini-incision donor nephrectomy. J Urol2003; 169: 2018. Link, Google Scholar 8 : Laparoscopic versus open donor nephrectomy. Surg Endosc2003; 17: 134. Google Scholar 9 : Clinical perspectives. Laparoscopic living donor nephrectomy for kidney transplantation: the University of Maryland experience. Dialysis Transplant1999; 20: 321. Google Scholar 10 : Randomized controlled trial of hand-assisted laparoscopic versus open surgical live donor nephrectomy. Transplantation2001; 72: 284. Crossref, Medline, Google Scholar 11 : A comparison of recipient renal outcomes with laparoscopic versus open live donor nephrectomy. Transplantation1999; 67: 722. Google Scholar 12 : Laparoscopic donor nephrectomy with a 23-hour stay: a new standard for transplantation surgery. Ann Surg2000; 231: 772. Google Scholar From the University of Alabama at Birmingham, Birmingham, Alabama© 2004 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byRamasamy R, Afaneh C, Katz M, Chen X, Aull M, Leeser D, Kapur S and Del Pizzo J (2011) Comparison of Complications of Laparoscopic Versus Laparoendoscopic Single Site Donor Nephrectomy Using the Modified Clavien Grading SystemJournal of Urology, VOL. 186, NO. 4, (1386-1390), Online publication date: 1-Oct-2011.Gimenez E, Leeser D, Wysock J, Charlton M, Kapur S and Del Pizzo J (2010) Laparoendoscopic Single Site Live Donor Nephrectomy: Initial ExperienceJournal of Urology, VOL. 184, NO. 5, (2049-2053), Online publication date: 1-Nov-2010.Shokeir A (2007) Open Versus Laparoscopic Live Donor Nephrectomy: A Focus on the Safety of Donors and the Need for a Donor RegistryJournal of Urology, VOL. 178, NO. 5, (1860-1866), Online publication date: 1-Nov-2007.Fisher P, Montgomery J, Johnston W and Wolf J (2018) 200 Consecutive Hand Assisted Laparoscopic Donor Nephrectomies: Evolution of Operative Technique and OutcomesJournal of Urology, VOL. 175, NO. 4, (1439-1443), Online publication date: 1-Apr-2006.PREMINGER G, ASSIMOS D, LINGEMAN J, NAKADA S, PEARLE M and WOLF J (2018) CHAPTER 1: AUA GUIDELINE ON MANAGEMENT OF STAGHORN CALCULI: DIAGNOSIS AND TREATMENT RECOMMENDATIONSJournal of Urology, VOL. 173, NO. 6, (1991-2000), Online publication date: 1-Jun-2005.Related articlesJournal of Urology9 Nov 2018DONOR NEPHRECTOMY: A COMPARISON OF TECHNIQUES AND RESULTS OF OPEN, HAND ASSISTED AND FULL LAPAROSCOPIC NEPHRECTOMYJournal of Urology9 Nov 2018DONOR NEPHRECTOMY: A COMPARISON OF TECHNIQUES AND RESULTS OF OPEN, HAND ASSISTED AND FULL LAPAROSCOPIC NEPHRECTOMY Volume 171Issue 1January 2004Page: 40-43 Advertisement Copyright & Permissions© 2004 by American Urological Association, Inc.Keywordskidneykidney transplantationliving donorsnephrectomylaparoscopyMetrics Author Information RIZK EL-GALLEY More articles by this author NEDRA HOOD More articles by this author CARLTON J. YOUNG More articles by this author MARK DEIERHOI More articles by this author DONALD A. URBAN More articles by this author Expand All Advertisement PDF downloadLoading ...