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Die laparoskopische transperitoneale Donornephrektomie

Technik und Ergebnisse

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Zusammenfassung

Die Lebendnierenspende stellt für chronisch niereninsuffiziente Patienten eine Möglichkeit dar, der wachsenden Diskrepanz von Organbedarf und Organangebot und der daraus resultierenden langen Wartezeit auf eine Verstorbenenniere zu begegnen. 1995 erfolgte in den USA die 1. laparoskopische Spendernierenentnahme (LDN). Weltweit wird sie aktuell an über 100 Zentren praktiziert und hat die an sie gestellten Erwartungen einer erhöhten Bereitschaft zur Lebendnierenspende als Folge dieses weniger traumatisierenden Eingriffs erfüllt. Mittlerweile existieren unterschiedliche strikt laparoskopische und handassistierte, trans- und retroperitoneale Techniken der LDN.

Von Februar 1999 bis September 2002 wurden an der Klinik für Urologie der Charité Berlin 63 strikt laparoskopische transperitoneale LDN durchgeführt. Die genaue Technik wird beschrieben. Die warme Ischämiezeit lag bei 148 (105–360) s, die Operationszeit bei 203 (110–305) min. Intraoperative Komplikationen traten bei 4 Patienten in Zusammenhang mit einem insuffizienten Gefäßverschluss der Spenderniere auf; 5,7 (3–9) Tage postoperativ konnten die Donoren das Krankenhaus verlassen. Nierenfunktion und Kreatinin bei den Empfängern 1 Jahr nach LDN zeigten keinen Unterschied zur vorher praktizierten offenen Nierenentnahme an unserer Klinik.

Die rein laparoskopische, transperitoneale Donornephrektomie ist eine für den Spender sichere Art der Nierenentnahme und gewährleistet eine exzellente Transplantatfunktion.

Abstract

Living donor kidney transplantation is one possibility to meet the growing demand for organs in patients with chronic renal failure. In 1995 the first laparoscopic living donor nephrectomy (LDN) was performed in the United States. More than 100 transplant centers worldwide perform LDN. The expectations of a larger number of willing organ donors were fulfilled due to the less traumatic operation. Meanwhile, several techniques exist to retrieve a kidney laparoscopically, including the trans- or retroperitoneal, strictly laparoscopic, or hand-assisted approach.

From February 1999 to September 2002, 63 strictly laparoscopic, transperitoneal LDNs were performed at the Department of Urology of the Charité University Hospital, Berlin. Warm ischemic time was 148 s (105–360) and operating time was 203 min (110–305). Intraoperative complications were due to insufficient closure of the vessels in four patients. Mean postoperative hospital stay was 5.7 days (3–9). One year after LDN, renal function as well as creatinine levels of the recipient showed no difference compared to the organs harvested via the approach at our department prior to implementation of LDN.

Strictly laparoscopic transperitoneal donor nephrectomy is a safe method for kidney retrieval and ensures excellent graft function.

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Authors and Affiliations

  1. Universitätsklinik für Urologie, Charité, Berlin

    M. Giessing, S. Deger, V. Ebeling, J. Roigas, I. Türk & S. A. Loening

  2. Universitätsklinik für Urologie, Charité, Schumannstraße 20/21, 10098, Berlin

    M. Giessing

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  1. M. Giessing
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  2. S. Deger
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  3. V. Ebeling
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  4. J. Roigas
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  5. I. Türk
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  6. S. A. Loening
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Correspondence to M. Giessing.

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Giessing, M., Deger, S., Ebeling, V. et al. Die laparoskopische transperitoneale Donornephrektomie. Urologe [A] 42, 218–224 (2003). https://doi.org/10.1007/s00120-002-0281-4

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