Open Donor, Laparoscopic Donor and Hand Assisted Laparoscopic Donor Nephrectomy: A Comparison of Outcomes

Abstract

Classic laparoscopic donor and hand assisted laparoscopic donor nephrectomies appear to be safe procedures for harvesting kidneys. The recipient graft function is similar in the laparoscopic and open surgery groups.

Laparoscopic (vs. Open) Live Donor Nephrectomy: A UNOS Database Analysis of Early Graft Function and Survival

“…A previously published report suggests that hand-assisted laparoscopic nephrectomy is associated with a shorter warm ischemia time than traditional laparoscopic nephrectomy, mainly because kidney extraction is faster (31). Moreover, hand-assisted nephrectomy was also found to result in shorter operating times (31). This technique may therefore reduce the overall intraoperative hemodynamic stress on the donor kidney.…”

“…Finally, we were not able to control for the potential impact of different laparoscopic procurement techniques. A previously published report suggests that hand-assisted laparoscopic nephrectomy is associated with a shorter warm ischemia time than traditional laparoscopic nephrectomy, mainly because kidney extraction is faster (31). Moreover, hand-assisted nephrectomy was also found to result in shorter operating times (31).…”

Laparoscopic donor nephrectomy, complications and management: a single center experience

“…[17] In one study the authors concluded that with increasing experience shorter warm ischemia time could be achieved. [18] Ruiz-Dey et al [19] found the mean warm ischemia time in LDN operations as 3.9±0.3 minutes. We think that warm ischemia time should be as short as possible in order to minimize ischemic damage, and increase graft survival.…”

Controle dos vasos renais usando clips vasculares e fio cirúrgico em nefrectomias vídeo-assistidas de doadores vivos

“…Todos esses benefícios são obtidos com o acesso laparoscópico, com resultados equivalentes à cirurgia aberta com relação ao enxerto renal 7,12,24 . Há uma série de vantagens comparando a cirurgia vídeo-assistida à técnica laparoscópica convencional, resultante de facilidades técnicas como maior sensibilidade tátil e habilidade para o controle e exposição do rim, notadamente do hilo renal 18 . O pólo renal superior é dissecado mais facilmente 5 , o cólon é mobilizado com facilidade, os sangramentos inesperados são controlados mais rapidamente, a exposição dos vasos é otimizada na hora do grampeamento com staplers ou clips de titânio, a torção dos vasos renais é evitada e a chance de lesão esplênica é menor 18 .…”

“…Esta técnica facilita a dissecção do pólo renal superior e do ureter 16 , reduz a curva de aprendizado, diminui o tempo de cirurgia e de isquemia quente 5,17,18 , com resultados semelhantes à técnica laparoscópica convencional 19 .…”