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@#The aim of this report is to validate the effectiveness and safety of the retroperitoneoscopic donornephrectomy in kidney transplantation and to document the first Retroperitoneoscopic Left DonorNephrectomy in the Philippines done last July 5, 2018.This is a case of 35-year-old female with no comorbidities but with an infraumibilical scar from aprevious cesarean section underwent the first Retroperitoneoscopic Left Donor Nephrectomy in thePhilippines.The principle was pure retroperitoneoscopic donor nephrectomy, hand-assist using Gelport devicewas applied only during vascular transection and allograft retrieval. Access to the retroperitoneumwas established using a modified trocar placement.Retroperitoneal Donor Nephrectomy is a safe and technically-feasible surgery as more urologistsbecome proficient with this approach. The benefits of this approach are in line with the goals of livingkidney allograft retrieval, to minimize morbidity and to maximize safety of the patient. Literatureshows that it has comparable outcomes with Transperitoneal donor nephrectomy (TDN) and opentraditional allograft kidney retrieval.
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Objective To introduce the advantages,incision designing methods and surgical procedures of spigelius' line incision in retroperitoneal laparoscopic living donor nephrectomy.Methods Among the 114 donors,39 were obtained by spigeliu'line incision (13 males and 26 females),with an average age of 35 years,35 left kidneys and 4 right kidneys.Gibson incision was performed in 75 patients (28 males and 47 females),with an average age of 31 years,73 left kidneys and 2 right kidneys.The clinical data of 114 donors undergoing retroperitoneal laparoscopic living donor nephrectomy from September 2012 to July 2017 were analyzed retrospectively.The operation was performed by laparoscopic surgery to separate the ureter,renal vessels and perirenal fat.Finally,the renal vessels were removed and the kidneys were removed with hand-assistant.75 cases were taken out of the kidney through the inguinal parallel incision (Gibson incision),while the other 39 cases used the spigelius' line incision (Through the linea pararectalis,the anterior sheath is cut opened at the margin of the rectus sheath (spigelius' line) and the lateral peritoneum is pushed into the midline between the arcuate line and the inferior abdominal vessels to expose the retroperitoneal space).The intraoperative data were collected.Results All the operations were not converted to open surgery.The incision length of the spigelius' line incision group was (6.8 ± 0.6) cm,and the incision length of the Gibson incision group was (7.0 ± 0.4) cm,P =0.02.The blood loss of the operation of the spigelius' line incision group was (59.2 ± 33.4) ml,while the Gibson incision group was (80.7 ± 32.8) ml,P =0.002.The warm ischemia time of the spigelius'line incision group was (2.8 ± 1.1) min,while the Gibson incision group was (3.1 ± 1.7) min,P =0.31.The operation time of the spigelius' line incision group was (160.8 ± 30.7) min,while the Gibson incision group was (162.5 ± 28.1) min,P =0.77.There was no significant difference between the two groups in the warm ischemia time and the operation time.No incisional hernia was found in these two groups.Conclusions Compared with Gibson incision,the spigelius' line incision is safe.It can completely avoid to cut the abdominal muscles,and effectively avoid the abdominal nerves injury.Without damaging the integrity of the peritoneum,it can avoid abdominal organ injury.
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Objective To discuss the optimal operation mode and operation path in minimally invasive technique for living donor nephrectomy.Methods From September 2013 to August 2015, 68 living donor nephrectomy was retrospectively reviewed. Thirty-one patients were performed with robotic-assisted laparoscopic living donor nephrectomy(robotic group), twenty-nine patients underwent totally retroperitoneal laparoscopic living donor nephrectomy(non hand assisted group),and eight patients were performed with hand assisted retroperitoneal laparoscopic living donor nephrectomy(hand assisted group). Operation time, warm ischemia time, intraoperative hemorrhage volume, hospitalization time, complications and preoperative and postoperative serum creatinine value of the recipients between the two groups were compared.Results The operations of three groups were all performed successfully. Intraoperative hemorrhage volume in the three groups were(39±15)ml,(62±37)ml and(53±19)ml, and there were significant differences between these groups(P<0.05). But hospitalization time ,operation time, warm ischemia time and complications occurred rate in the three groups had no significant difference(P>0.05). In robotic group,2 donors occurred with splenic injury during operation and 1 donor was detected with hemorrhage after operation. In non-hand assisted group, 1 donor occurred with urinary tract infection, 1 donor occurred with external iliac vein thrombosis. In hand assisted group 1 donor was detected with wound fat liquefaction after operation. All the donors were followed up for more than 9 months, no hypertension, proteinuria and renal dysfunction complications were detected. The blood creatinine in three groups of recipients after operation of 5th day and 28th day were(118±26)μmol/L, (130±33)μmol/L,(128±41)μmol/L and(114±17)μmol/L,(116±34)μmol/L,(115±29)μmol/L, respectively, and there was no statistical difference(P>0.05).Conclusions Minimally invasive technique for living donor nephrectomy is beneficial to patients' recovery. Surgery doctors should combine personal experience and the hospital's hardware conditions and other factors. The principle is to ensure the donor's safety and to balance the interests of the donor and the recipient, to choose their own most skilled way of surgery.
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Objective To summarize the experience in retroperitoneal living donor nephrectomy under 3D laparoscopy and to investigate its clinical effect and safety. Methods The clinical data of 19 cases who underwent retroperitoneal living donor nephrectomy under 3D laparoscopy were collected.Operation duration,intraoperative blood loss, renal warm ischemia time,length of renal artery,renal vein and ureter,incision size and operative complications were recorded.Postoperative renal function of donors and recipients was observed. Results Nineteen cases of living donor nephrectomy were successfully completed under the 3D laparoscopy,and there were no conversion into conventional laparoscopy and open surgery.The operation duration of living donor nephrectomy under 3D laparoscopy was 80.5﹣125.2 (with an average of 102.3)min;intraoperative blood loss was 40.6﹣90.4 (60.8)ml;renal warm ischemia time was 100﹣230 (161)s.Length of renal artery,renal vein and ureter was 2.6﹣3.2 (2.9)cm,2.2﹣3.0 (2.6)cm and 8﹣13 (10)cm, respectively.The incision size was about 5﹣6 cm,and the wound healed.Urine volume of the donors at 24 h after operation was 2 000﹣2 500 ml.Serum creatinine increased slightly in 1 case at 3 d after operation,and returned to normal through reexamination after 7 d and 1 month.The donors stayed in the hospital 5﹣7 (6)d after operation.All transplant operations were performed successfully,and delayed graft function did not occurred. Conclusions Accuracy of operation can be improved effectively by 3D laparoscopic surgery system.It is safe and feasible to perform retroperitoneal living donor nephrectomy under 3D laparoscopy.
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Objective To analyze the early renal function of donors after nephrectomy.Methods Clinical data of 467 cases of living kidney donors during the period from April,2010 and November,2014 in our center were retrospectively analyzed.Data on serum creatinine (Scr),glomerular filtration rate (GFR),serum uric acid (UA),and urine microproteins before operation and three days,seven days,one month and three months after operation were collected to evaluate the impact of nephrectomy on early renal function after operation for donators.Results Before operation and three days,seven days,one month,three months after operation,the average serum creatinine (Scr) level was (59.9±12.8),(85.8±21.0),(91.2±21.3),(92.8±21.6),(91.0±21.3) μmol/L,respectively; The GFR were (113.5±25.3),(75.1± 17.9),(70.3± 15.2),(68.5± 16.0),(69.5± 15.1) ml/min,respectively; The levels of uric acid were (292.60±79.58),(142.18±55.28),(228.41±66.39),(321.31± 83.72),(346.61±87.21) μmol/L,respectively; All these data above-mentioned after operation reached statistical significance compared with that before operation (P ＜ 0.05).Parameters including urine IgG,urine albumin,urine retinol-binding protein and urine β2-microglobulin post-operation time point were significantly different when compared with relative parameters pre-operation (P ＜ 0.05).Conclusions Nephrectomy has significant influence on GFR,uric acid,and urine microprotein for donors in the early stage after operation.It's worth to evaluate nephrectomy's long-term effect on the renal function of donors in clinical practice.