J Korean Soc Transplant.  2016 Dec;30(4):178-183. 10.4285/jkstn.2016.30.4.178.

Hand-assisted Laparoscopic Donor Surgery for Living Donor Pancreas and Kidney Transplantation: A Single Center Experience

• Kim JS
• Jung CW
• Jun H
• Park KT

• KMID: 2364938
• DOI: http://doi.org/10.4285/jkstn.2016.30.4.178

Abstract

BACKGROUND
In this era of donor shortage, use of organs from living donors has increased significantly. Nonetheless, less than 1% of pancreas transplantations involve living donors, despite the immunological benefits, reduced cold ischemic time, and decreased waiting time. One reason for the paucity of donors is the high morbidity after open surgery. Using hand-assisted laparoscopic donor surgery (HALDS) can be a favorable technique for living donors.
METHODS
Using HALDS, we performed three Simultaneous pancreas-kidney transplantations (SPKs) involving living donors. Two donors were women; one was a man.
RESULTS
Their mean age was 34.3±4.7 years, and their body mass index was 23.2±2.36 kg/m². The mean operation time was 241±19.0 minutes and the mean cold-ischemic time of the kidney was 42.7±9.8 minutes, while that of the pancreas was 64.3±5.2 minutes. One donor developed a pancreatic fistula, which was controlled using conservative management. The donors' pancreatic and renal functions were well preserved postoperatively.
CONCLUSIONS
HALDS for SPKs can be performed without significant complications if the surgeon has sufficient skill.

Keyword

Hand-assisted laparoscopy; Simultaneous pancreas-kidney transplantation; Living donors

MeSH Terms

Body Mass Index
Cold Ischemia
Female
Hand-Assisted Laparoscopy
Humans
Kidney Transplantation*
Kidney*
Living Donors*
Pancreas Transplantation
Pancreas*
Pancreatic Fistula
Tissue Donors*

Figure

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  Fig. 1. Patient position and port site.

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  Fig. 2. Exposed vessels during hand-assisted laparoscopic donor surgery. (A) Exposed renal artery and vein. (B) Splenic artery and vein were exposed when the pancreatic tail was lifted up using dissector and 2nd finger of operator.

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  Fig. 3. Benching of the pancreas graft. (A) Cold perfusion with preservation solution right after the pancreas brought out from the living donor. (B) Pancreas graft after completing benching.

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  Fig. 4. Abdominopelvic computer tomography. (A) Horizontal view. (B) Coronal view. Arrows indicate a cystic mass (pseudocyst) at the pancreatectomy site.

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