Abstract
Background
Recent developments in laparoscopic solid organ surgery suggest a possible reduction in postoperative discomfort and disability for kidney donors. Technical aspects and the influence of surgical experience in laparoscopic donor nephrectomy were evaluated.
Methods
The clinical outcome of 57 laparoscopic donor nephrectomies (LapNx) was compared with that for a historic control group of 27 open donor nephrectomies (OpenNx).
Results
Three conversions to open nephrectomy (5.2%) were necessary. Postoperative complications were minor and comparable in both groups. Patients who under-went laparoscopic surgery demonstrated significantly less postoperative pain and a shorter hospital stay, but operative time and warm ischemia time were significantly longer. Graft survival after LapNx was 100% during a median follow-up period of 13 months. Operative time for LapNx decreased considerably with experience gained and seemed to be less for right nephrectomy. Stenotic ureter-bladder anastomoses occured after LapNx in four patients during the first half year (7.0%), but this problem seemed to be resolved after modification of the technique.
Conclusion
LapNx is associated with less postoperative discomfort and improved convalescence.
Similar content being viewed by others
References
Anderson CF, Velosa JA, Frohnert PP, Torres VE, Offord KP, Vogel JP, Donadia JV Jr, Wilson DM (1985) The risks of unilateral nephrectomy: status of kidney donors 10 to 20 years postoperatively. Mayo Clin Proc 60: 367–374
Annual report of the U.S. Scientific Registry for Transplant Recipients and the Organ Procurement and Transplantation Network (1994) Transplant data: 1988–1993 United Network for Organs Sharing, Richmond, VA, USA
Blohmé I, Fehnman I, Norden G (1992) Living donor nephrectomy: complication rates in 490 cases. Scand J Nephrol 26: 149–153
Bonjer HJ, Lange JF, Kazemier G, De Herder WW, Steyerberg EW, Bruining HA (1997) Comparison of three techniques for adrenalectomy. Br J Surg 84: 679–682
Delaitre B, Maignien, B, Icard P (1992) Laparoscopic splenectomy. Br J Surg 79: 1334
Dunn JF, Richie RE, MacDonell RC, et al (1986) Living related kidney donors: a 14-year experience. Ann Surg 26: 149–153
Eurotransplant annual report (1997)
Fahy BG, Barnas GM, Flowers JL, Jacobs SC, Plotkin JS, Delaney PA (1998) Effects of split torso positioning and laparoscopic surgery for donor nephrectomy on respiratory mechanics. J Clin Anesth 10: 103–108
Flowers JL, Jacobs S, Cho E, Morton A, Rosenberger WF, Evans D, et al (1997) Comparison of open and laparoscopic live donor nephrectomy. Ann Surg 4: 483–490
Gagner M, Pomp A, Heniford BT, Pharand D, Lacroix A (1997) Laparoscopic adrenalectomy: lessons learned from 100 consecutive procedures. Ann Surg 226: 238–247
Gill IS, Carbone JM, Clayman RV, et al (1994) Laparoscopic live donornephrectomy. J Endourol 43: 453
Guler C, Sade M, Kirkali Z (1998) Renal effects of carbon dioxide insufflation in a rabbit pneumoretroperitoneum model. J Endourol 12: 361–310
Hardy JD (1984) Cadaveric kidney transplants: approach of the future? Surgical capsule and comment 3: 11–12
Ishiwaka A, Suzuki K, Saisu K, Kageyama S, Ushiyama T, Fujita K (1998) Endoscopy-assisted live donor nephrectomy: comparison between laparoscopic and retroperitoneoscopic procedures. Transplant Proc 30: 165–167
Kasiske BL, Ma JZ, Louis TA, Swan SK (1995) Long-term effects of reduced renal mass in humans. Kidney Int 48: 814–819
Kerbl CK, Clayman RV, MCDougall EM, et al (1994) Transperitoneal nephrectomy for benign disease of the kidney: a comparison of laparoscopic and open surgical techniques. Urology 43: 607–613
Laskow, et al (1991) Analysis of 22 years experience in living related at the University of Alabama in Birmingam. In: Terasaki, Cecka (eds) Clin Trans pp 179–191
McDougall EM, Monk TG, Wolf JS Jr, et al. (1995) The effect of prolonged pneumoperitoneum on renal function in an animal model. J Am Coll Surg 181: 397–406
Najarian JS, Chavers BM, McHugh LE, Matas AJ (1992) 20 Years or more of follow-up of living kidney donors. Lancet 340: 807–810
Nicholson ML, Veith PS, Donelly PK, Bell PR (1991) Urological complications of renal transplantation: the impact of double J-ureteric stents. Ann R Coll Surg Engl 73: 316–321
Nogueira JM, Cangro CB, Fink JC, et al (1999) A comparison of recipient renal outcomes with laparoscopic versus open live donor nephrectomy. Transplantation 67: 722–728
Parra RO, Perez MG, Boullier JA, Cummings JM (1995) Comparison between standard flank versus laparoscopic nephrectomy for benign disease. J Urol 153: 1171–1174
Philosophe B, Kuo PC, Schweizer EJ, Farney AC, Lim JW, et al (1999) Laparoscopic versus open donor nephrectomy: comparing ureteral complications in the recipients and improving the laparoscopic technique. Transplantation 68: 497–502
Ratner LE, Ciseck LJ, Moore RG, Cigorra FG, Kaufman HS, Kavoussi LR (1995) Laparoscopic live donor nephrectomy. Transplantation 60: 1047–1049
Ratner LE, Kavoussi LR, Chavin KD, Montgomery R (1998) Laparoscopic live donor nephrectomy: technical considerations and allograft vascular length. Transplantation 65: 1657–1658 [Letter]
Ratner LE, Kavoussi LR, Schulam PG, Bender JS, Magnuson TH, Montgomery R (1997) Comparison of laparoscopic live donor nephrectomy versus the standard open approach. Transplant Proc 29: 138–139
Salomon L, Saporta F, Amsellem D, et al (1999) Results of pluoureterostomy after ureterovesical anastomosis complications in renal transplantation. Urology 53: 908–912
Shulam PG, Kavoussi LR, Cheriff AD, Averch TD, Montgommery R, Moore RG, Ratner LE (1996) Laparoscopic live donor nephrectomy: the initial three cases. J Urol 55: 1857–1859
Terasaki PI, Cecka JM, Gjertson DW, Takemoto S (1995) High survival rates of kidney transplants from spousal and living unrelated donors. N Engl J Med 333: 379–380
Tilney, Kirkinan, et al (1993) Surgical aspects of kidney transplantation. In: Garavoy, Gutterman (eds) Renal transplantation
Zucchelli P, Cagnoli L, Casanova S, et al (1983) Focal glomeru-losclerosis in patients with unilateral nephrectomy. Kidney Int 24: 649–655
Author information
Authors and Affiliations
Additional information
Online publication: 27 February 2002
Rights and permissions
About this article
Cite this article
Berends, F.J., den Hoed, P.T., Bonjer, H.J. et al. Technical considerations and pitfalls in laparoscopic live donornephrectomy. Surg Endosc 16, 893–898 (2002). https://doi.org/10.1007/s004640090078
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s004640090078