Korean J Urol.  2006 Dec;47(12):1309-1314. 10.4111/kju.2006.47.12.1309.

Donor Nephrectomy : Comparison of Open, Hand-assisted and Laparoscopic Donor Nephrectomy

• Yoo KY
• Hong SH
• Hwang TK

• KMID: 2139776
• DOI: http://doi.org/10.4111/kju.2006.47.12.1309

Abstract

PURPOSE
Minimally invasive donor nephrectomy has become a favored procedure for kidney transplantation. To compare the outcomes of kidneys procured using open donor nephrectomy (ODN), laparoscopic donor nephrectomy (LDN) and hand-assisted laparoscopic donor nephrectomy (HALDN).
MATERIALS AND METHODS
A total of 243 patients were included in the study. 177 HALDN and 24 LDN patients were compared with 42 ODN patients. The operation times, warm ischemic times, transfusions, times to regular diet, post-operation hospital stays, analgesics use, post-operation serum creatinine, complications, graft functions and survivals were evaluated.
RESULTS
The mean operation times were 197+/-43, 213+/-32.7 and 189+/-28.2 minutes for HALDN, LDN and ODN, respectively. The warm ischemic times were 175+/-76.7, 174+/-67.5 and 135+/-25.4 seconds for HALDN, LDN and ODN, respectively. The mean post-operation hospital stays were shorter for the HALDN and LDN than for ODN. There were no significant differences between the three groups in terms of the times to regular diet. The graft survivals were 98, 96 and 97.6% in the HALDN, LDN and ODN, respectively. The postoperative serum creatinine levels of the recipients showed no differences between the three groups.
CONCLUSIONS
HALDN and LDN are technically feasible, and appear to be safe and effective for live-donor transplantation. Evaluation of the HALDN and LDN showed less pain, a more rapid recovery and minimal cosmetic disfigurement than the ODN. The recipient graft functions were also similar in the laparoscopic and open surgery groups. Therefore, HALDN and LDN may result in increased acceptance of the donor operation and expand the pool of potential kidney donors.

Keyword

Laparoscopy; Donor; Hand; Kidney transplantation

MeSH Terms

Analgesics
Creatinine
Diet
Graft Survival
Hand
Humans
Kidney
Kidney Transplantation
Laparoscopy
Length of Stay
Nephrectomy*
Tissue Donors*
Transplants
Warm Ischemia
Analgesics
Creatinine

Figure

• 

  Fig. 1 The LDN procedure. (A) After dissection of the renal pedicle, a supraumbilical midline incision is made and the left hand inserted without the use of a hand-port device. The kidney is placed into a Lapbag prior to the renal pedicle transection to facilitate kidney extraction. (B) A home-made sponge device, rather than a hand-port device, is applied to minimize gas leakage. LDN: laparoscopic donor nephrectomy.

Reference

1. Wolf JS Jr, Merion RM, Leichtman AB, Campbell DA Jr, Magee JC, Punch JD, et al. Randomized controlled trial of hand-assisted laparoscopic versus open surgical live donor nephrectomy. Transplantation. 2001. 72:284–290.

2. Ranter LE, Montgomery RA, Kavoussi LR. Laparoscopic live donor nephrectomy. A review of the first 5 years. Urol Clin North Am. 2001. 28:709–719.

3. Clayman RV, Kavoussi LR, Soper NJ, Dierks SM, Merety KS, Darsy MD, et al. Laparoscopic nephrectomy. N Engl J Med. 1991. 324:1370–1371.

4. Gill IS, Carbone JM, Clayman RV, Fadden PA, Stone MA, Lucas BA, et al. Laparoscopic live-donor nephrectomy. J Endourol. 1994. 8:143–148.

5. Ranter LE, Ciseck LJ, Moore RG, Cigarroa FG, Kaufman HS, Kavoussi LR. Laparoscopic live donor nephrectomy. Transplantation. 1995. 60:1047–1049.

6. Wolf JS Jr, Tchetgen MB, Merion RM. Hand-assisted laparoscopic live donor nephrectomy. Urology. 1998. 52:885–887.

7. Chung KU, Seo SI, Hwang TK. Hand-assisted laparoscopic live donor nephrectomy. Korean J Urol. 2001. 42:189–194.

8. Hwangbo K, Kim JC, Hwang TK. Hand-assisted laparoscopic donor nephrectomy: a comparison with open approach. Korean J Urol. 2002. 43:449–453.

9. Alston C, Spaliviero M, Gill IS. Laparoscopic donor nephrectomy. Urology. 2005. 65:833–839.

10. Ishida H, Furusawa M, Murakami T, Tokumoto T, Nakajima I, Tanabe K, et al. Outcome of an ABO-incompatible renal transplant without splenectomy. Transpl Int. 2002. 15:56–58.

11. Fritsche L, Budde K, Rogalla P, Turk I, Neumayer HH, Loening SA. Successful living related kidney transplantation despite renal angiomyolipoma in situ. J Urol. 1999. 162:480–481.

12. Wolf JS Jr, Moon TD, Nakada SY. Hand assisted laparoscopic nephrectomy: comparison to standard laparoscopic nephrectomy. J Urol. 1998. 160:22–27.

13. Kercher K, Dahl D, Harland R, Blute R, Gallagher K, Litwin D. Hand-assisted laparoscopic donor nephrectomy minimizes warm ischemia. Urology. 2001. 58:152–156.

14. Harman PK, Kron IL, McLachlan HD, Freedlender AE, Nolan SP. Elevated intra-abdominal pressure and renal function. Ann Surg. 1982. 196:594–597.

15. Flowers JL, Jacobs S, Cho E, Morton A, Rosenberger WF, Evans D, et al. Comparison of open and laparoscopic live donor nephrectomy. Ann Surg. 1997. 226:483–490.

16. Ruiz-Deya G, Cheng S, Palmer E, Thomas R, Slakey D. Open donor, laparoscopic donor and hand assisted laparoscopic donor nephrectomy: a comparison of outcomes. J Urol. 2001. 166:1270–1273.

17. El-Galley R, Hood N, Young CJ, Deierhoi M, Urban DA. Donor nephrectomy: a comparison of techniques and results of open, hand assisted and full laparoscopic nephrectomy. J Urol. 2004. 171:40–43.

18. Sasaki T, Finelli F, Barhyte D, Trollinger J, Light J. Is laparoscopic donor nephrectomy here to stay? Am J Surg. 1999. 177:368–370.

19. Baik S, Rho J, Kim CS. Comparison of hand-assisted laparoscopic donor nephrectomy with open donor nephrectomy. Korean J Urol. 2005. 46:1125–1129.

20. Tanabe K, Miyamoto N, Ishida H, Tokumoto T, Shirakawa H, Yamamoto H, et al. Retroperitoneoscopic live donor nephrectomy (RPLND): establishment and initial experience of RPLND at a single center. Am J Transplant. 2005. 5:739–745.

21. Yeo WG, Kim HH. Hand-assisted laparoscopic live donor nephrectomy; comparison to open donor nephrectomy. Korean J Urol. 2004. 45:141–148.