Transperitoneal laparoendoscopic single-site (LESS) live donor nephrectomy: The first clinical case in China / 第二军医大学学报

ABSTRACT

Objective To summarize out experience in the first case of transperitoneal laparoendoscopic single-site live donor nephrectomy (LESS-DN) in mainland China and to assess its safety and feasibility. Methods The female donor was aged 59-year-old, with a body mass indexCBMI) of 21. 6 kg/m2 and a preoperative serum creatinine level of 45 μmol/L. Tc 99m-DTPA was used to determine the glomerular filtration rate (GFR). The preoperative unilateral renal function was 50 ml/min for the left side and 56 ml/min for the right side. Recipient was a 41-year-old male, with a BMI of 19. 5 kg/m2 and a preoperative serum creatinine level of 1,446 μmol/L, and who was to receive transplantation due to chronic renal dysfunction (renal failure stage). On Nov. 9th, 2011, the LESS-DN was performed via a multi-channel TriPort™ (Advanced Surgical Concepts, Wicklow, Ireland) through a 5 cm skin incision at our institute. The dissection of the kidney was facilitated with the standard laparoscopic instruments at all the steps. The renal artery and the renal vein were skeletonized after the adrenal vein and the lumber vein, if any, were clipped. The ureterogonadal packet was left en bloc and transected at the level when crossing the common iliac vessels. The kidney was entrapped, and the mouth of the bag loosely cinched around the intact renal artery and vein. The renal artery and the vein were separated. The pre-entrapped kidney was extracted through the original incision after generous cranial and caudal extension of the rectus fascia incision. Results The procedure was smoothly completed without any extra skin incision. The operating time was 210 min, with an estimated blood loss of 50 ml, and a warm ischemia time of 3. 8 min. The lengths of harvested renal artery, vein and ureter were 3. 6 cm, 4. 5 cm and 13 cm, respectively. The length of skin incision at closure was 5 cm. Allograft functioned immediately on transplantation. Donor Visual Analog Pain Scores at postoperative day 1, 2 and 3 were 2. 5/10, 1/10, and 0/10, respectively. The recovery of the donor was uneventful and she was discharged on the 4th postoperative day. Postoperative serum creatinine levels of the recipient at 12 h, 24 h, 2 d, 3 d, 4 d, 5 d, 6 d, 7 d, discharge day, and 1 month postoperatively were 475, 282, 148, 145, 117, 100, 103, 98, 80, and 84 μmol/L, respectively. He was discharged on the 10 day after transplantation. Conclusion Our initial experience shows that the laparoendoscopic single-site live donor nephrectomy is a safe, feasible and effective procedure. It has the clinical benefits of less pain, rapid recovery and good cosmesis, with an encouraging future. But more clinical experience needs to be accumulated.