Summary of Living Donor Retroperitoneoscopic Nephrectomy in Kidney Transplantation at a Single Institution

Naotake Akutsu, MD, Michihiro Maruyama, MD, Chikara Iwashita, MD, Kazunori Otsuki, MD, Taihei Ito, MD, Ikuko Matsumoto, MD, Takehide Asano, MD, Takashi Kenmochi, MD. Department of Surgery, Chiba-East National Hospital

 

[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 trans-abdominal approach. However, the procedure is seemed to be more difficult than trans-abdominal approach, so recently, we have tried some resources to make easier and safer with this technique. In this presentation, we report the summary of recent cases with of successfully completed living donor nephrectomy in our institution. It indicates that retroperitoneoscopic nephrectomy would be good procedure for donor benefits of living donor kidney transplantation.
[METHOD AND PROCEDURES] One hundred and ninety-six living donors were performed retroperitoneoscopic nephrectomy for kidney transplantation at Chiba-East National Hospital between April 2004 and August 2011. With last 30 cases (group 1), we performed 1) preoperative examinations (3D-CT and simulation by virtual laparoscopy reconstructed from 3D-CT for recognizing 3D images of vessels of renal pedicle, and intra-abdominal fat estimation with CT for preoperative evaluation of difficultness with the operation), 2) standardization of the operation procedure, and 3) standardization of postoperative care. Group 1 were compared operative time, blood loss, warm ischemic time, length of hospital stay, graft function, and complications to previous cases (group 2).
[RESULTS] Nephrectomy was performed successfully in all donors without any complications and all donors were discharged hospital at estimated day. Eight cases(4.1%) of them were converted to open approach with difficulties of kidney dissection from retroperitoneal tissue, however, there was no converted cases in group 1. Mean time for nephrectomy were 145.9±36.6 and 165.5±47.2 min, respectively (group1 vs. group , P=0.014). Mean hospital stay was 5.7±0.5 and 6.5±1.4 days (group 1 vs. group 2, P±0.01), respectively. Mean estimated blood loss (60.9±62.6mL), warm ischemic time (3.3±1.1min), postoperative graft function (serum creatinine level) and operative complications were indicated no significant differences.
[CONCLUSIONS] Retroperitoneoscopic nephrectomy would be good technique for living donor operation of kidney transplantation. We have carried out this operation more safely and less invasively with some resources. In this presentation, we demonstrated that retroperitoneoscopic nephrectomy would have advantages of safeness for donor, minimal invasion, and short stay in hospital in living donor kidney transplantation.


Session Number: SS07 – Solid Organ
Program Number: S040

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