Initial experience with laparoscopic live donor nephrectomy

Odland, Mark D.; Ney, Arthur L.; Jacobs, Donald M.; Larkin, Joan A.; Steffens, Eugenia K; Kraatz, James; Rodriguez, Jorge Luis

doi:10.1067/msy.2099.100720

Cited by 30 publications

(46 citation statements)

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“…dian acceptable values for length of scar and length of stay were lower than average values reported for open nephrectomy in the literature. To date, promising data suggest that the laparoscopic procedure may address these concerns (17,(27)(28)(29).…”

Section: Discussionmentioning

confidence: 99%

The General Public's Concerns about Clinical Risk in Live Kidney Donation

Boulware

Ratner²,

Sosa³

et al. 2002

American Journal of Transplantation

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Difficulty in attracting live kidney donors may be related to fears regarding both the surgical procedure for kidney harvesting and future failure of the remaining kidney. We conducted a cross-sectional study of households in Maryland to identify public disincentives to living related kidney donation. In multivariate analyses, we assessed the independent effects of several factors on willingness to donate a kidney to a sibling. We also assessed thresholds for factors above which persons would not donate a kidney. Of 385 participants, 66% were extremely willing to donate to a sibling. After adjustment, those who considered the length of a hospital stay, out-of-pocket expenses, size and appearance of a scar, the time it takes to get to the transplant center, and the donor risk of developing kidney failure very important had 50-60% less odds of being extremely willing to donate. Median acceptable levels for risk of complications, hospital stay, compensated and uncompensated time from work, time requiring pain medications, and out-of-pocket expenses were greater than levels from clinical evidence regarding both laparoscopic and open nephrectomy. Unrealistic concerns among the general public regarding live donation may serve as potential disincentives to donation. Efforts to educate the public regarding live donation might help assuage fears and attract those who may not otherwise donate.

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Section: Discussionmentioning

confidence: 99%

The General Public's Concerns about Clinical Risk in Live Kidney Donation

Boulware

Ratner²,

Sosa³

et al. 2002

American Journal of Transplantation

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“…A review of previously published series (8)(9)(10)(16)(17)(18) showed that operative times ranged from 183 to 230 min for laparoscopic donor nephrectomies, and from 183 to 213 for open donor nephrectomies. Estimated blood loss ranged from 122 to 266 mL for laparoscopic procurements, and from 192 to 408 mL for open approaches.…”

Section: Patient #5mentioning

confidence: 99%

“…Laparoscopic live donor nephrectomy has been demonstrated to have several advantages when compared with open donor nephrectomy. They include but are not limited to shorter hospitalization, decreased pain measured by reduced analgesic requirements, an increased willingness of potential donors to undergo the procedure, and an earlier return to employment and full activities (5)(6)(7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Concomitant Surgery With Laparoscopic Live Donor Nephrectomy

Molmenti

Pinto

Montgomery

et al. 2003

American Journal of Transplantation

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Routine live donor evaluations reveal unexpected silent pathologies. Herein, we describe our experience treating such pathologies at the time of laparoscopic donor nephrectomy. We have not encountered any previous reports of such an approach. We prospectively collected data on 321 donors. Concomitant surgeries at the time of procurement included two laparoscopic adrenalectomies, one colposuspension, one laparoscopic cholecystectomy, and one liver biopsy. Mean operative time was 321 min (range 230-380), with a mean blood loss of 280 mL (range 150-500). No blood transfusions were required. The left kidney was procured in four cases. The right kidney was obtained on one occasion. Mean hospital stay was 3 days (median 3, range 2-4). No short-or longterm complications have been identified. Mean follow-up time was 2.63 years (median 2.76, range 2.23-2.99). Four of the five kidney recipients were firsttime transplants who had not yet started dialysis. Simultaneous surgical interventions at the time of laparoscopic live kidney donation are safe and can be undertaken in selected cases. This practice is beneficial to both the donor and the recipient, and is likely to become more commonplace with changing practice patterns involving donor evaluation and management.

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“…But subsequent studies have demonstrated that with increasing surgical experience, low technical complication rates can also be achieved with laparoscopic kidneys, regardless whether left or right kidneys (8), or kidneys with anatomical variations, such as multiple renal arteries, are used (9). Second, several investigators have shown slower early post-transplant function for laparoscopic (vs. open) grafts, as measured by delayed function rates (10)(11)(12) and by the recipients' early post-transplant serum creatinine levels (10,13,14). These findings are a priori not surprising, because warm ischemia times in laparoscopic donors are longer (11), and the pneumoperitoneum created during the laparoscopic operation negatively affects renal hemodynamics (15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

“…Second, several investigators have shown slower early post-transplant function for laparoscopic (vs. open) grafts, as measured by delayed function rates (10)(11)(12) and by the recipients' early post-transplant serum creatinine levels (10,13,14). These findings are a priori not surprising, because warm ischemia times in laparoscopic donors are longer (11), and the pneumoperitoneum created during the laparoscopic operation negatively affects renal hemodynamics (15)(16)(17)(18). Slower early function in laparoscopic grafts, however, was not observed on all post-transplant days, did not persist beyond the first month, and did not achieve statistical significance at all time points in all studies (10,11,13,14,19,20).…”

Section: Introductionmentioning

confidence: 99%