Trans-abdominal HALS conversion from retroperitoneoscopic donor nephrectomy in living donor kidney transplantation

Naotake Akutsu, MD, Michihiro Maruyama, MD, Kenichi Saigo, MD, Masayuki Hasegawa, MD, Kazunori Otsuki, MD, Hiromichi Aoyama, MD, Ikuko Matsumoto, MD, Takehide Asano, MD. Chiba-East Hsopital

[INTRODUCTION] It is seriously important for living donations to make safer and to reduce operating stress. Endoscopic surgery is thought to be a useful operating procedure for solving these problems. For living donor of kidney transplantation, we have performed retroperitoneoscopic nephrectomy, because of its less operation stress and less intra-abdominal complications such as bleeding and intestinal injury than open approach. When it was too difficult to complete this procedure, we had converted to open approach. However, we recently converted to trans-abdominal HALS nephrectomy in last conversion cases. With this technique, the donors had less stress than with open conversion. In this presentation, we report the summary of recent 4 cases with of successfully completed trans-abdominal HALS conversion in our institution.

[METHOD AND PROCEDURES] Two hundred and seventy-eight living donors were performed retroperitoneoscopic nephrectomy for kidney transplantation at Chiba-East National Hospital between April 2004 and August 2014. Two hundreds and sixty-five donors (95.3%) were completely achieved nephrectomy with retroperitoneoscopic approach. However, 13 cases were converted to different approach because of some complications such as peritoneum injuries and difficulty of kidney dissection from retroperitoneal tissue. Out of 13 convert cases, last 4 cases were converted to trans-abdominal HALS approach, which was thought to be less invasive than open approach. In this technique, the patient was replaced in the supine position rotated 30 degrees to the right. Placements of working ports were newly made as follows (one hand port (7cm); around umbilicus, two 12mm ports; (left lateral abdomen and left subcostal abdomen)). We used Gel-sealed hand-assist access device (GelPort) with this approach and performed living donor nephrectomy.

[RESULTS] Nephrectomy was performed successfully in all donors converted to trans-abdominal HALS approach without any complications and all donors were discharged hospital at estimated day. Mean time for nephrectomy of 4 cases were 259.5±76.5 min (230.7±55.9 min in complete cases). Mean postoperative hospital stay was 6±0 days (6.3±1.3 days). Mean estimated blood loss was 88.7±102.1mL (64.6±77.5mL), and warm ischemic time was 3.1±1.4min (3.7±1.4min). Postoperative graft function (serum creatinine level and delayed graft function for recipients) and operative complications were indicated no significant differences.

[CONCLUSIONS] Trans-abdominal HALS conversion from retroperitoneoscopic nephrectomy would be good recovery technique for living donor endoscopic operation. We have carried out this conversion more safely and less invasively. In this presentation, we will demonstrate that this conversion would have more advantages of safeness, minimal invasion, and short stay in hospital than open conversion for donors.

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