Initial experience with laparoscopic live donor nephrectomy in Taiwan☆
Article Outline
Not long after laparoscopic live donor nephrectomy (lap–LDN) was shown to be feasible in an animal study in 1994,1 Ratner et al performed the first successfull lap–LDN in humans in 1995.2 Results from large-scale studies in recent years have demonstrated that the risk of this operation is comparable to those with the conventional open surgery with high success rates for both the donors and the recipients.3, 4, 5, 6, 7, 8, 9 Herein, we report the first series of lap–LDN performed in Taiwan, and discuss our modifications of the techniques.
Patients and methods
From September 2000 to February 2002, we performed 11 lap–LDNs. Ten left kidneys and one right kidney were harvested for engrafting. The right kidney was retrieved because of an early branching of the left renal artery in one donor. The operation techniques were combinations of those reported by Ratner and Kavoussi,2, 3 Jacobs et al,4 Wolf et al,5 and Slakey et al,6 as slightly modified with our experience. We used a hand-assisted device to facilitate surgical dissection and final retrieval of the kidney. The device was placed at periumbilical midline level for a left lap–LDN, and at the right subcostal area for a right lap–LDN. Beside the wound for the hand-assisted device, initially three, but now only two/12-mm more ports, were needed to complete the operation. The dissection of the right renal artery was done mainly when the kidney was flipped medially to expose it on the posterior surface. The right renal vein was harvested with a cuff of adjacent inferior vena cava (IVC); the defect in the IVC was closed with continuous 4–0 prolene sutures performed with conventional instruments through the incisional window created for the hand-assisted device. The perioperative parameters of the donors and the recipients are recorded herein.
Results
The 11 lap–LDNs were successful without any major complications. The perioperative parameters of the donors were as follows: The mean warm ischemia time was 3.5 minutes. The mean operative time was 214 minutes for the left kidney and 287 minutes for the right one. The mean blood loss was 80 mL. All 11 donors recuperated well. They started to take liquid on postoperative day (POD) 1, and were advanced to a tolerable diet on POD 2. The mean parenteral narcotic dose used was 27.5 mg of morphine sulfate equivalent. And they were discharged on POD 5. All 11 recipients produced a lot of urine immediately after revascularization, and displayed a smooth recovery of renal function after transplantation with serum creatinine levels reaching a mean nodes nadir of 1.3 mg/dL at POD 2–3.
Discussions
LDN require harvesting a kidney that is functional, in the recipient with no unnecessary morbidity in the donor.10 The donors recuperate better if they have a smaller incision, less pain, earlier resumption of oral intake, and shorter hospitalization.2, 3, 4 Our initial series of lap–LDN, although only 11 in number, clearly demonstrates these benefits, and yielded results that are comparable to those in other larger series.3, 4, 5, 6, 7 The annual number of renal transplants in Taiwan is much restricted by the limited number of cadaveric donors. Our successful performance of lap–LDN, might encourage more live kidney donations.
Instead of a pure-laparoscopic approach,2, 3, 4 we chose the hand-assisted lap–LDN because it is easier, safer, and there is no need to compress the kidney when the adrenal gland, spleen, and Gerota’s fat are dissected off the upper pole of the left kidney. The location of the wound for the hand-assisted device was designed to be suitable for possible open conversion, so as not to jeopardize donor safety or the recipient graft function if there is difficulty to proceed laparoscopically. Gathering more experience, we can now accomplish the lap–LDN with only the intra-abdominal hand and one working instrument.
References
☆ This study was sponsored by a grant from National Science Council, ROC (NSC-89-2314-B-002-347), and in part by a nonprofit grant from the Chu’s Medical Foundation.
PII: S0041-1345(02)03974-X
doi:10.1016/S0041-1345(02)03974-X
© 2003 Elsevier Science Inc. All rights reserved.
