A comparison of pre- and post-operative outcomes in living donors undergoing transperitoneal laparoscopic nephrectomy and open nephrectomy: a retrospective single-center study

ABSTRACT BACKGROUND: Kidney transplantation is often regarded as the preferred therapy for end-stage renal disease. Several surgical procedures have been developed to reduce postoperative donor complications, while maintaining kidney quality. OBJECTIVE: This study aimed to compare the preoperative and postoperative outcomes of living kidney donors who underwent either transperitoneal laparoscopic nephrectomy or open nephrectomy. DESIGN AND SETTING: Retrospective study conducted in Istanbul, Turkey. METHODS: Fifty-five living-related kidney donors underwent nephrectomy and were retrospectively divided into two groups: 21 donors who underwent open nephrectomy (Group 1) and 34 donors who underwent transperitoneal laparoscopic nephrectomy (Group 2). RESULTS: In comparison to the donors who underwent open nephrectomy, those who underwent transperitoneal laparoscopic nephrectomy had significantly shorter postoperative hospital stays (2.3 ± 0.2 versus 3.8 ± 0.8 days, P = 0.003), duration of urinary catheterization (1.2 ± 0.8 days versus 2.0 ± 0.7 days, P = 0.0001), operating times (210 ± 27 minutes versus 185 ± 24 minutes, P = 0.02), and less blood loss (86 ml versus 142 ml, P = 0.048). There was no statistically significant difference between the two groups with regard to the estimated blood transfusion and warm ischemia time. The preoperative week, first postoperative week, and 1-month postoperative serum creatinine levels were comparable between the groups. CONCLUSIONS: Laparoscopic donor nephrectomy can be safely performed at centers with expertise in laparoscopic surgery. Laparoscopic donor nephrectomy has better outcomes than open donor nephrectomy in terms of length of hospital stay, duration of urinary catheterization, operating time, and blood loss.

Clinical outcomes of removing the better functioning kidney during laparoscopic donor nephrectomy: A retrospective five-year single-center study

OBJECTIVE@#The primordial principle in living kidney donation is leaving the better functioning kidney (BFK) with the donor. However, when laparoscopic donor nephrectomy (LDN) is utilized, certain conditions may warrant removing the BFK. These include lesser complex vasculature, renal calculi, or left-sidedness. Reported here are the long-term outcomes of removing the BFK among living donors.@*METHODS@#Chart review was done on all donor nephrectomy patients over a five-year period. Patients whose BFK were removed via LDN were identified. Clinical indications, patient demographics, perioperative and postoperative outcomes were summarized. Creatinine and eGFR at one-day, one-month and one-year follow-up were used to determine renal functional outcomes.@*RESULTS@#Between January 2011 to December 2015, 810 donor nephrectomies were performed: 366 (45.2%) and 444 (54.8%) had open donor nephrectomy and LDN, respectively. BFK was removed in 26 (5.8%) in the LDN and none in the open group. Mean age was 28.9+7.5 (18-49), with a male to female ratio of 4:1. The clinical indications were less complex vasculature in 18 (69%), left-sided BFK in 7 (27%) and renal calculi in 1 (3.8%). The mean operative time was 173 +25 (130–272) minutes, with a mean blood loss of 111 +96 (50-200)cc. The mean length of stay was 3.0+0.2 (2.8-4) days. Grade 1 complications were seen in 5 (19%) patients. There was no mortality. The eGFR after 1 year is 79.4+14.1 (54-91) cc/min.@*CONCLUSION@#Removing the BFK during LDN does not impact negatively on the safety and renal functional outcomes of living kidney donors.

Recomendaciones de la analgesia perioperatoria del donador de trasplante renal / Recommendations for perioperative renal transplant donor analgesia

Resumen: Actualmente a nivel global se recomienda que la realización del tratamiento médico de los donadores en el trasplante renal sea estandarizado, ya que estas acciones incrementan la seguridad y disminuyen la morbimortalidad del donador y receptor renal. La evaluación preoperatoria incluye la elaboración de una historia clínica con exploración física, laboratorio, estudios de imagen, pruebas especiales y pruebas para enfermedades infecciosas. El manejo analgésico debe ser cuidadoso y debe orientarse a fármacos y maniobras que no modifiquen la fisiología del paciente (visita http://www.painoutmexico.com para obtener la versión completa del artículo y el diagrama de recomendaciones).

Abstract: Nowadays, it is globally recommended that the realization of medical treatment for renal transplant donor patients be standardized as it increases safety and decreases donor and renal recipient mortality and morbidity factors. The preoperative evaluation includes a clinical history elaborated with a physical examination, laboratory tests, imaging studies, specialized tests and infectious disease tests. The analgesic management must be carefully considered and must be focussed on drugs and manoeuvring them so that it doesn't modify the physiology of the patient (visit http://www.painoutmexico.com to see the full article and recommendations).

Intraperitoneal nebulization versus intraperitoneal instillation of ropivacaine for postoperative pain management following laparoscopic donor nephrectomy / 대한마취과학회지

BACKGROUND: Laparoscopic donor nephrectomy is considered less painful than open nephrectomy but is still associated with significant postoperative pain. Studies reported that intraperitoneal instillation of local anesthetics provides uncertain pain relief after laparoscopic surgery. This randomized, double-blind study evaluated the effect of intraperitoneal nebulization of ropivacaine on postoperative pain relief after laparoscopic donor nephrectomy. METHODS: Sixty patients undergoing elective laparoscopic donor nephrectomy were randomly assigned to receive either an instillation of 20 ml 0.5% ropivacaine after the induction of pneumoperitoneum or nebulization of 5 ml 1% ropivacaine before and after surgery. The primary outcome was the degree of pain relief (static and dynamic) after surgery. The secondary outcomes were postoperative fentanyl consumption, incidence of shoulder pain, unassisted walking and postoperative nausea and vomiting (PONV). Data were collected in the postanesthesia care unit (PACU) and at 6, 24, and 48 h after surgery. RESULTS: Compared to patients in the instillation group, those in the nebulization group showed significant reductions in postoperative pain and fentanyl consumption, and none complained of significant shoulder pain (visual analog scale score ≥ 30 mm). Within 20 h of surgery, 13.3% of patients in the instillation group and 93.3% in the nebulization group started unassisted walking (absolute risk reduction, 38%; P = 0.001). In the nebulization group, PONV was significantly reduced in the PACU and at 6 h. CONCLUSIONS: Intraperitoneal nebulization of ropivacaine reduced postoperative pain, fentanyl consumption, referred shoulder pain, and PONV while enabling earlier mobility without any difference in the length of hospital stay.

Spigelius'line incision as a successful route to extract the kidney during retroperitoneal laparoscopic live-donor nephrectomy / 中华泌尿外科杂志

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.

Back door style: A case report on retroperitoneoscopic donor nephrectomy - a first in the Philippines

@#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.

Option of minimally invasive technique for living donor nephrectomy / 中华泌尿外科杂志

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.

Clinical analysis of retroperitoneal living donor nephrectomy under 3D laparoscopy / 器官移植

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.

Robot﹣assisted laparoscopic living donor nephrectomy:report of 31 cases / 器官移植

Objective To evaluate the safety and efficacy of robot﹣assisted laparoscopic living donor nephrectomy. Methods Clinical data of 31 donors and recipients undergoing robot﹣assisted laparoscopic living donor nephrectomy in Xijing Hospital of the Fourth Military Medical University from November 2013 to August 2015 were retrospectively analyzed. Results Donor nephrectomy was successfully performed in 31 cases.The operation time ranged from 110 to 190 min.Intraoperative hemorrhage volume was measured as 20﹣100 ml.The warm ischemia time of the donor kidney was 100 to 160 s.The retained length of renal vein was between 1.8 and 3.0 cm and the length of renal artery was 1.4 to 2.3 cm.In 2 cases,spleen injury occurred during the kidney extraction and was treated with splenorrhaphy.One donor had postoperative hemorrhage,which was treated with hemostasis and anemia correction.Thirty one donors received postoperative follow﹣up for over 6 months.No long﹣term complications were observed.Among 31 recipients,one patient had delayed recovery of renal graft function and the serum creatinine level returned to normal range after treatment at postoperative 1 month.The survival rate of kidney grafts was up to 100%. Conclusions Robot﹣assisted laparoscopic living donor nephrectomy is a safe and efficacious surgical procedure for kidney resection,which possesses the advantages of small trauma,rapid recovery and no influence upon renal function.

Impact of living donor nephrectomy on the early kidney function for donors / 中华肾脏病杂志

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.

Retroperitoneal laparoscopic living donor nephrectomy:a report of 22 cases / 器官移植

Objective To summarize the experience of retroperitoneal laparoscopic living donor nephrectomy.Methods Clinical data of 22 donors undergoing retroperitoneal laparoscopic living donor nephrectomy in the First Affiliated Hospital of Sun Yat-sen University from January 201 2 to May 201 4 were analyzed retrospectively.The ureter,renal vessel and perirenal fat were dissected by laparoscopic approach.Then the renal vessels were cut off and the kidney was extracted by hand through superomedial inguinal parallel incision.The surgical process and the postoperative follow-up of the donors were recorded.Results One right kidney and 21 left kidneys were extracted.The operations in 22 cases were performed successfully without conversion to laparotomy.The operation time was (1 23 ±31 )min.The length of kidney extracting incision was (7.2 ±0.5)cm.The intraoperative blood loss was 1 5-80 ml and the warm ischemia time was 60-1 50 s.The length of donor renal arteries was 2.0-3.2 cm.The length of renal veins was 1 .0-3.5 cm.The donors were followed up for 1 -21 months.The serum creatinine (Scr)levels at 1 d,1 week and 1 month after operation were (1 20 ±57),(95 ±25),(90 ±21 )μmol/L respectively.Two cases suffered from renal fossa hematoma and poor wound healing after operation respectively.The pain score of the donors was 0-5 at 1 week after operation and 0-1 at 1 month after operation.No donor had the perception that donating kidney had obvious impacts on the general health,but 1 donor felt it had some influence on physical strength.Conclusions It is safe to perform retroperitoneal laparoscopic living donor nephrectomy on the basis of strict donor selection.It has little impacts on the donor's quality of life with small surgical incision and mild postoperative pain.

Comparative and prospective analysis of three different approaches for live-donor nephrectomy

PURPOSE: Living donor nephrectomy is usually performed by a retroperitoneal flank incision. Due to the significant morbidity and long recovery time for a flank incision, anterior extra peritoneal sub-costal and transperitoneal video-laparoscopic methods have been described for donor nephrectomy. We prospectively compare the long-term results of donors as well as functional recipients submitted to these three approaches. MATERIALS AND METHODS: A total of 107 live donor renal transplantations were prospectively evaluated from May 2001 to January 2004. Donors were compared with regard to operative and warm ischemia time, postoperative pain, analgesic requirements, and complications. Recipients were compared with regard to graft function, acute cellular rejection, surgical complications, and graft and recipient survival. RESULTS: The mean operative and warm ischemia times were longer in the video-laparoscopic group (p<0.001), whereas patients of the flank incision group presented more postoperative pain (p=0.035), required more analgesics (p<0.001), had longer hospital stays (p<0.001), and suffered more pain on the 90th day after surgery (p=0.006). In the sub-costal and flank incision groups, there was a larger number of paraesthesias and abdominal wall asymmetries (p<0.001). Recipient groups were demographically comparable and presented similar acute tubular necrosis incidence and delayed graft function. The incidence of acute cellular rejection was higher in the video-laparoscopic and flank incision groups (p=0.013). There was no difference in serum creatinine levels, surgical complications, or recipient or graft survival between groups. CONCLUSIONS: The video-laparoscopic and sub-costal approaches proved to be safe, and to provide donor advantages relative to the flank incision approach. Among recipients, the complication rate, graft survival, and recipient survival were similar in all groups.

Severe Hypercarbia by Subcutaneous Emphysema Occurring during Hand Assisted Laparoscopic Donor Nephrectomy: A case report / 대한마취과학회지

Hand assisted laparoscopic donor nephrectomy (HALDN) has recently emerged as a very attractive modality in standard donor nephrectomy because of its many advantages. However, it also has disadvantages, which include gas emboli, subcutaneous emphysema, hypercarbia, pneumothorax and pneumomediastinum. This case involves a male patient who had suffered from temporary hypercarbia due to increased carbon dioxide absorption due to massive subcutaneous emphysema about 1 hour after pneumoperitoneum during HALDN. Following multiple skin punctures with an 18 G disposable needle, chest compliance and blood gas findings improved. Three hours later the operation ended successfully and he was transferred to the recovery room, and show no further problems. We report upon this clinical experience and include a brief review of the literature.

Hand-assisted Laparoscopic Donor Nephrectomy: A Comparison with Open Approach / 대한비뇨기과학회지

PURPOSE: We report our initial experience with hand-assisted laparoscopic donor nephrectomy (HALDN) and compare it to our results with open donor nephrectomy (ODN). MATERIALS AND METHODS: Using the medical records of consecutive, renal, living donor-recipient pairs, 60 HALDN patients were compared with 19 ODN patients. In addition, the HALDN group was divided into two groups, initial HALDNs (n=20) and late HALDNs (n=40), for consideration of the surgeons' learning curve. RESULTS: Except 1 case of open conversion, 59 patients underwent HALDN successfully. Mean operation times were 202, 255, and 201 minutes for ODNs, initial HALDNs, and late HALDNs respectively. Mean warm ischemic time decreased from 4.5 minutes in the initial HALDNs to 3.1 minutes in the late HALDNs. Major intraoperative complications included 1 transfusion in the ODNs, 1 open conversion and 1 transfusion in the initial HALDNs, but none in the late HALDNs. Mean hospital stay decreased from 6.4 days in the ODNs to 4.6 and 3.8 days in the initial and late HALDNs, respectively. Mean analgesic use decreased from 403mg and 323mg in ODNs and initial HALDNs, respectively, to 219mg in late HALDNs. Serum creatinine levels of the recipients on post operation days 7 and 30 showed no differences among the three groups. CONCLUSIONS: All but one, HALDNs resulted in a safe donor operation with a kidney of excellent quality. The length of hospital stay and postoperative analgesic use were decreased. The cosmetic result was enhanced. Additionally, the number of living donors can be potentially increased.

Experience of Consecutive 485 Cases of Living Donor Nephrectomy: Operative Technique and Safety / 대한이식학회지

PURPOSE: Living donors are more frequently used to treat end stage renal disease in Korea. We investigated postoperative complications and recent trends of the living donor nephrectomy. METHODS: From November 1982 to December 2001, we performed consecutive 485 cases of living donor nephrectomy. Among them, 445 cases were performed through extra-retroperitoneal flank incision without rib resection and 40 cases through thoracoabdominal or supracostal incision with 11 th or 12 th rib resection. All cases were analyzed by reviewing medical records. RESULTS: Total 50 (10.3%) patients had complications after donor nephrectomy. Complication rate was significantly higher in rib resected group. In 40 cases of rib resected group, there were 4 cases of pneumothorax, 1 case of intraoperative transfusion, 2 cases of retroperitoneal hematoma, 3 cases of wound infection, 2 cases of paralytic ileus, 1 case of atelectasis and 1 case of UTI. In 445 cases without rib resection, there were 2 cases of intraoperative transfusion, 3 cases of retroperitoneal hematoma, 15 cases of wound infection, 2 cases of incisional hernia, 1 case of paralytic ileus, 1 case of atelectasis and 5 cases of UTI. Total 5 cases were readmitted with wound infection. But no one had expired due to intraoperative or immediate postoperative complications. Average hospital stay was 9.4 days, and it was 8.2 days in recent 7 years. Mean operative time was 160 minutes. Mean time to regular diet was 2.6 days. CONCLUSION: Kidney donors had a few complications and low operative risk, so living donor nephrectomy can be safely recommended to kidney donors. The patients, who had been nephrectomised by extra-retroperitoneal flank approach without rib resection, had no major complications, recovered much faster and hospitalized much shorter than those of thoracoabdominal or supracostal incision with rib resection. We recommend extra-retroperitoneal flank incision without rib resection in living donor nephrectomy.

Retroperitoneoscopy-Assisted Living Donor Nephrectomy: Recipient's Outcome / 대한이식학회지

PURPOSE: Laparoscopic living donor nephrectomy has recently been emerged as a very attractive measure to the standard open surgical procedure for kidney transplantation (KTx) because of many advantages. But it also has some disadvantages such as technical difficulty, impaired early graft function and expensiveness. To overcome this shortcomings, we developed a new surgical method of retroperitoneoscopy assisted live donor nephrectomy. The method has been reported as an attractive surgical methods with many advantages to donor. But, recipient`s outcome is also equally important in living donor kidney transplantation. METHODS: We retrospectively studied recipient`s outcome between patients who received living donor kidneys from conventional open nephrectomies (Group I, n=247) and retroperitoneoscopy assisted nephrectomies (Group II, n=82) at our institution from March 1, 1997 and July 30, 2000. We compared postoperative complication, patient and graft survival and graft function between two groups for 12 months retrospectively. RESULTS: Demographic data such as age, sex, kidney weight/body weight ratio; ABO compatibility; degree of HLA matching and method of immunosuppression were not different between two groups (p>0.05). Complications, such as delayed graft function, acute rejection, ureter complication, graft failure, patients motality were not different. For the evaluation of graft function, we measured serum creatinine level for 12 months after trasplantation. There also was no difference of graft function between two groups. CONCLUSION: Recipient's outcome in patient received kidney by retroperitoneoscopy assisted live donor nephrectomy was similar to those of patient received kidney by conventional operation.

Living donor renal transplantation : Hand-assisted laparoscopic donor nephrectomy is superior to laparoscopic donor nephrectomy / 中国微创外科杂志

Objective The aim of this case-control study was to compare hand-assisted laparoscopic donor nephrectomy (HALDN) and laparoscopic donor nephrectomy (LDN) evaluating donor and recipient outcomes. Methods A review of data from all LDNs and HALDNs conducted at the Mount Sinai Medical Center from October 1996 to February 2001 was undertaken. In October 1996, LDN was started. In June 1999, the technique changed from LDN to HALDN. Results HALDN was associated with significant shorter operating times((211?7)min vs (257?5) min, P

Are prophylactic antibiotics really necessary in donor nephrectomy patients?

OBJECTIVE: To determine whether prophylactic antibiotics are necessary in preventing possible postoperative infectious complications in healthy living kidney donorsMATERIALS AND METHODS: Twenty-five living kidney donors were divided into two groups: Group A - received intravenous normal saline solution (placebo) and Group B - received prophylactic broad-spectrum antibiotics. Both of these were administered one hour prior to donor nephrectomy and in two doses within 24 hours postoperatively. Signs of postoperative infection were evaluated with fever, pyuria, wound changes and bacteriologic studies as clinical parameters. Data were analyzed using the chi-square testRESULTS: Five patients (30.7 percent) in the placebo group and two patients (16 percent) in the prophylaxis group developed postoperative fever. The differences in these two groups were however not statistically significant. "Significant pyuria" was noted in two patients belonging to group A while none was seen in group B. The presence of urinary tract infection was documented in both cases by culture studies. No patient in Group B developed urinary tract infection. This difference however, was not statistically significant. No documented wound infection occurred in both placebo and prophylaxis groups. However, one patient in the placebo group developed serous wound discharge, which healed with intake of antibiotics, and daily wound careCONCLUSIONS: No statistically significant differences were observed in donor nephrectomies who received either placebo or broad-spectrum prophylaxis in terms of postoperative fever, significant pyuria and wound infection. The use of prophylactic antibiotics in these otherwise healthy individuals may not really be necessary in preventing postoperative infectious complications. (Author)

Short-term Follow-up of Renal Function after Donor Nephrectomy / 대한비뇨기과학회지

PURPOSE: Eventhough cadaveric renal grafts are increasing, kidneys from living donors remain as the major mode of renal transplantations and there is a need to establish theoretical bases for securing the safety of the donors. Follow-up of donors was done for a year using several indices of renal function to evaluate the function of the remaining kidneys after donor nephrectomies. MATERIALS AND METHODS: Two hundred and sixty one living donors were included in this study. Blood urea nitrogen(BUN), serum creatinine, 24 hour creatinine clearance, 24 hour urine protein, and blood pressure were checked preoperatively. The same indices were checked at one, six, and twelve months after the operation. These indices were compared with those before the operation. RESULTS: Although some increase was observed in serum BUN, creatinine, and 24hr urine protein, and decrease in creatinine clearance after donor nephrectomies, all were within normal limits, which did not show clinically significant differences. All indices did not deviate from the normal limits through-out one year. CONCLUSIONS: Renal indices varied within normal limits and donor nephrectomies seemed to cause no significant harmful effect on the donors. Prospective and long term follow-up of the donors after donor nephrectomies are needed to ensure a high quality life of living donors.

Living donor nephrectomies-right side : intraoperative assessment of the right renal vascular pedicle in 112 cases

Generally, the left kidney from a living donor is more commonly preferred but the right kidney is occasionally donated because of multiple left renal arteries or repeated transplantation. The right donor nephrectomy is usually more difficult compared to the left because the right renal vein is often multiple and short, which complicates dissection of the vascular pedicle. From Jan. 1989 to Sep. 1992, 112 consecutive cases of right donor nephrectomies out of a total of 771 cases were retrospectively reviewed with the preoperative renal angiography and the intraoperative assessment of the right renal vascular pedicle. The indications for right donor nephrectomy include 1) multiple or proximal bifurcating renal arteries of the left kidney (89.3%), 2) repeated transplantation in the recipient (9%). In 26.8% of the cases, there were more than two right renal veins. In the right donor nephrectomy, it is often necessary to perform vena cava cuff resection because of short and frequently occurring multiple right renal veins. For the dissection of the inferior vena cava (IVC), the aberrantly occurring right gonadal vein, the adrenal vein draining above the junction of the renal vein and IVC, and the lumbar vein below the junction should always be looked for and must be ligated if any are found.