RT Journal Article
SR Electronic
T1 Hand-assisted laparoscopic versus open nephrectomies in living donors
JF Canadian Journal of Surgery
JO CAN J SURG
FD Canadian Medical Association
SP 123
OP 130
VO 48
IS 2
A1 Amer Rajab
A1 John E. Mahoney
A1 Mitchell L. Henry
A1 Elmahdi A. Elkhammas
A1 Ginny L. Bumgardner
A1 Ronald M. Ferguson
A1 Ronald P. Pelletier
YR 2005
UL http://canjsurg.ca/content/48/2/123.abstract
AB Shortages of cadaveric kidneys for transplant into rising numbers of patients with end-stage renal failure have increased the demand for kidneys from live donors. The morbidity associated with traditional open donor nephrectomies (ODN) may discourage many candidates. The newer laparoscopic technique has been promoted as having less morbidity.Objectives: To evaluate outcomes of hand-assisted laparoscopic nephrectomies (HALN) and prospectively compare HALN and ODN.Methods: After retrospectively reviewing donor and recipient outcomes in 33 HALN (December through August, 2000), we prospectively compared another 47 with 30 ODN performed from September 2000 through April 2001.Results: All 80 HALN were successful, with no requirement to convert to an open procedure. Four donors experienced surgery-related complications: wound infection, retroperitoneal hematoma, prolonged ileus and early small-bowel obstruction, respectively. Two recipients had ureteral complications (1 stricture, 1 leak); 5 experienced delayed graft function, 2 requiring dialysis; and 2 kidneys were lost from infarction. The prospective comparison showed the operative time for HALN (mean 184 min, standard deviation [SD] 39 min) was significantly longer (143 [SD 27] min, p < 0.01), but resulted in less blood loss (p < 0.05). Lengths of time to warm ischemia/early graft function, resumption of oral intake/first bowel movement, and hospital discharge were similar. The abdominal-wall laxity and loss of cutaneous sensation from the flank incision experienced by many ODN patients after was uncommon in the HALN group. Three months after nephrectomy, donor complaints of incisional pain were less common after HALN (p < 0.01).Conclusions: HALN had good outcomes for donors and recipients, with quicker, more complete recoveries 3 months afterward.Les pénuries de reins de cadavre à greffer à des patients de plus en plus nombreux atteints d’insuffisance rénale au stade ultime ont augmenté la demande de reins de donneurs vivants. La morbidité associée aux néphrectomies traditionnelles «ouvertes» peut décourager beaucoup de candidats. On préconise une nouvelle technique laparoscopique qui réduirait la morbidité.