Laparoscopic Live Donor Nephrectomy

Ratner, Lloyd E.; Montgomery, Robert A.; Maley, Warren R.; Cohen, Charles D.; Burdick, James F.; Chavin, Kenneth D.; Kittur, Dilip S.; Colombani, Paul M.; Klein, Andrew S.; Kraus, Edward S.; Kavoussi, Louis R.

doi:10.1097/00007890-200006150-00016

Cited by 187 publications

(107 citation statements)

References 21 publications

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“…[4][5][6][12][13][14] Morphine equivalents used in our LDN group were actually higher than that of our DL group and not different from that of the FL group. However, 62% (n = 85) of our FL patients used adjuvant epidural analgesia, which was not included in our morphine equivalent measure of pain management.…”

Section: Discussioncontrasting

confidence: 54%

“…Since LDN entered the realm of transplantation in 1995, 4 it has been scrutinized because of its technically challenging nature, longer operating time, and associated longer warm ischemia time. 6 It was hypothesized that these factors would lead to an increased rate of graft dysfunction and failure; however, the literature fails to corroborate this.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopy, dorsal lumbotomy and flank incision live donor nephrectomy: comparison of donor outcomes

Samarasekera

Kim

Wang

et al. 2013

CUAJ

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Background: Flank incision (FL), dorsal lumbotomy (DL) and laparoscopic surgery have been effective approaches to donor nephrectomy. While laparoscopic donor nephrectomy (LDN) has become increasingly popular, there has yet to be a direct comparison of the three modalities. Methods: We performed a retrospective chart review of FL, DL and LDN operations between 2002 and 2010 within a single institution. Donor and recipient characteristics, as well as surgical outcomes, were assessed. Results: There were 496 donor nephrectomy operations available for analyses. Patients in the LDN group had the lowest estimated blood loss, compared to the DL and FL groups (p < 0.001), lowest rate of complications (p < 0.01), and shortest hospital stay (p < 0.0001). Donors who underwent DL used an average of 60.12 ± 5.0 mg of morphine, which was significantly less than that used by patients in the LDN (93.2 mg, p < 0.0001) and FL (111.82 mg, p < 0.001) groups. Mean serum creatinine of recipients at day 1 post-op was the highest in the FL group (p < 0.0001 FL vs. LDN, p < 0.001 FL vs. DL), but there were no significant differences between the three groups at 2 weeks, 6, 12, 18, and 24 months post-operation (p > 0.45). Conclusions: Although a lower pain experience of LDN was not indicated, the use of LDN should be favoured over DL and FL as it is associated with fewer complications, and shorter length of stay. Of note, DL appears to be associated with higher complications and is likely not a preferred option for donor nephrectomy. RésuméContexte : L'incision du flanc, la lombotomie dorsale et la laparoscopie sont des techniques efficaces pour une néphrectomie chez un donneur vivant. Même si la laparoscopie a connu une montée en popularité, aucune comparaison directe entre les trois modalités n'a été effectuée. Méthodologie : Nous avons procédé à un examen rétrospectif des dossiers de patients ayant subi une néphrectomie par incision du flanc, par lombotomie dorsale et par laparoscopie entre 2002 et 2010 dans un même établissement. Les caractéristiques des donneurs et des receveurs ainsi que les résultats de la chirurgie ont été évalués. Résultats : Les analyses ont porté sur 496 néphrectomies. En comparaison avec les donneurs ayant subi une incision du flanc ou une lombotomie dorsale, les donneurs ayant subi une laparoscopie présentaient la perte sanguine estimée la plus faible (p < 0,001), le taux le plus bas de complications (p < 0,01) et la plus courte durée du séjour en hôpital (p < 0,0001). Les donneurs qui ont subi une lombotomie dorsale ont utilisé en moyenne 60,12 ± 5,0 mg de morphine, soit une valeur significativement plus faible que celle notée chez les patients ayant subi une laparoscopie (93,2 mg, p < 0,0001) et une incision du flanc (111,82 mg, p < 0,001). Le taux moyen de créatinine sérique le lendemain de l'intervention était le plus élevé chez les patients ayant subi une incision du flanc (p < 0,0001 incision du flanc vs laparoscopie, p < 0,001 incision du flanc vs lombotomie dorsale), mais les différences entre...

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Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Laparoscopy, dorsal lumbotomy and flank incision live donor nephrectomy: comparison of donor outcomes

Samarasekera

Kim

Wang

et al. 2013

CUAJ

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“…Unfortunately, donor organ shortage has become a problem preventing the wider application of this treatment (1). Since the first laparoscopic donor nephrectomy (LDN) performed by Ratner et al in 1995, the procedure has gained worldwide acceptance and popularity (2). The use of LDN may remove some of the disincentives of living donor transplantation, increasing the pool of kidneys available for transplantation with an increase of voluntary kidney donors (3).…”

Section: Introductionmentioning

confidence: 99%

Early outcomes of laparoscopic donor nephrectomy with multiple renal arteries

et al. 2012

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ARTIcLE INFO _________________________________________________________ ___________________Purpose: We evaluated our experience with laparoscopic donor nephrectomy in patients with multiple renal arteries, comparing operative outcomes and early graft function with patients with a single renal artery. Materials and Methods:From January 2003 to February 2009, 130 patients underwent laparoscopic donor nephrectomy at our institution, 108 (83%) with a single renal artery and 22 (17%) with multiple arteries. Donor and recipient outcomes for single artery and multiple arteries allografts were compared. Results: The LDN operative time was similar between the single artery and multiple arteries groups (162 vs 163 min, respectively, p = 0.87). Allografts with multiple arteries had significantly longer warm ischemia time (3.9 vs 4.9 min, p = 0.05) and cold ischemia time (72 vs 94 min, p < 0.001) than those with single artery. The conversion rate was similar between single and multiple arteries groups (6% vs 4.5%, respectively, p = 0.7). Multiple arteries grafts had a non statistically significant higher rate of poor graft function when compared to single artery grafts (23% vs 12%, respectively, p = 0.18). Five patients in the single artery group (4.6%) and one patient in the multiple arteries group (4.5%) needed dialysis during the first postoperative week. Overall, recipient complication rates were similar between single and multiple arteries groups (12.9% vs 18.1%, respectively, p = 0.51). Conclusion: Laparoscopic donor nephrectomy with multiple arteries was associated with a non statistically significant higher rate of poor early graft function. The procedure appears to be safe in patients with multiple arteries, with similar complications rates. Multiple arteries should not be a contraindication for laparoscopic donor nephrectomy.

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“…In 1995, Ratner et al [1] performed the Wrst laparoscopic living donor nephrectomy. Since then, minimally invasive techniques have become more and more favored procedures.…”

Section: Introductionmentioning

confidence: 99%