Retroperitoneoscopic live donor nephrectomy: Review of the first 50 cases at Tygerberg Hospital, Cape Town, South Africa

Abstract

Background.Changing from an open to a laparoscopic live renal donor programme poses challenges and may affect donor and graft outcomes. Objectives. To evaluate donor safety and graft outcomes for the first 50 retroperitoneoscopic live donor nephrectomies performed at Tygerberg Hospital, Cape Town, South Africa. Methods. The procedures were performed by a single surgeon from 8 April 2008 to 3 April 2012. Operative and anatomical data were prospectively collected. A flank approach with lateral and posterior placements was used. Vascular control was achieved with Hemolok clips in the majority of cases. Results. The mean age of the donors was 31.5 years (range 18 50), 28 (56.0%) were male, and the left kidney was harvested in 28 (56.0%) of cases. The mean operating time was 149.8 minutes (range 75 250), mean warm ischaemic time (WIT) 181.3 seconds (107 630), mean blood loss 139.7 ml (5 700) and mean hospital stay 3.2 days (2 5). Mean WIT was significantly longer for rightsided than leftsided nephrectomy (213 v. 162 seconds). In two rightsided cases the renal vein was too short and vena profunda femoris was used to create length. No donor received a blood transfusion. Comparing the last 25 with the first 25 cases showed a significant decrease in mean WIT (158 v. 204 seconds, respectively) and operating time (128 v. 172 minutes, respectively). No major complications occurred. Conclusion. Our initial 50 retroperitoneoscopic live donor nephrectomies were performed without major complications. Donor safety was maintained during the early learning curve of the transition to minimalaccess donor nephrectomy.S Afr J Surg 2013;52(2):5356.

Vascular Control of the Renal Pedicle Using Non-Absorbable Polymer Ligating Clips in Hand-Assisted Living Donor Laparoscopic Nephrectomies

“…Although the use of VS is the standard technique in most centers of the United States, the safety of NPL clips for laparoscopic nephrectomy has been assessed in several publications. Its safety is supported by 12 publications and 5369 cases along with this report, including any kind of nephrectomy and no deaths or major complications occurred (14,15,22,23,(25)(26)(27)(28)(29)(30)(31)(32). Out of those 5369 nephrectomies, 3840 were LDN and the summary of these papers is shown in Table 3.…”

“…Six reports of deaths after the usage of NPL clips in 2006, forced the FDA to emit a warning that NPL clips are contraindicated for vascular control during nephrectomy (11). However, its discontinuation as part of the procedure in LDN is still controversial because as reported by Deng et al (12) and Chan et al (13) the usage of VS have been associated with death in two cases, and because the cost of a VS compared to NPL clips is considerably higher and it impacts directly over health systems in countries with limited resources (14).…”

Laparoscopic kidney donation – giving in the best way possible

“…It allows for earlier discharge from hospital and earlier return to work, and increases donation rates. As shown by Van der Merwe and Heyns, [7] high standards can be maintained with the minimally invasive approach and these patients can be returned smoothly back to normal living, having safely and effectively passed on their gift of a kidney to a grateful recipient.…”

“…The use of the Hem-o-lok clips for control of the renal vessels as reported in this article [7] is contentious. Although there are multiple studies demonstrating the safety and decreased cost of Hem-o-lok clips, for example Simforoosh et al's [8] study with 1 834 consecutive patients, significant reservations about this practice remain.…”

“…The retroperitoneal approach offers the advantage of avoiding contact with the bowel and spleen, but at the cost of decreased visibility and working space. In this edition of SAJS, Van der Merwe and Heyns [7] publish the results of their first 50 retroperitoneoscopic donor nephrectomies, encompassing the learning curve of a difficult procedure, and highlight some of the issues relating to the procedure.…”