Current concepts in transplant surgery: laparoscopic living donor nephrectomy
Keywords:
Laparoscopy, Live donor nephrectomy, safetyAbstract
Objective: The basic idea of introducing laparoscopy in living donor nephrectomy was to obtain a potential reduction in incision-related morbidity while providing at least the same level of operative security. This study is focusing on technical aspects, outcome, results and possible current concerns of laparoscopic donor nephrectomy.
Material and Methods: From January 2001 to December 2006, 115 consecutive patients (56 open and 59 laparoscopy) underwent living donor nephrectomy at Siriraj hospital. The open and laparoscopic procedures were compared in the following categories: patientûs characteristics, surgical outcomes, warm ischemic time and graft function. Here we review the current evidence for laparoscopic donor nephrec- tomy available in the literature.
Results: Laparoscopic donor nephrectomy was successfully done in 56 (94.9%) cases. The mean operative times (329+51 vs 220+50 minutes, p<0.001) and warm ischemic time (180+74 vs 114+112 seconds, p<0.001) were longer in the laparoscopic than in the open group. However, the mean length of hospital stay was significantly shorter in the laparoscopic than the open group (p=0.018). For the graft outcome, there were 6 (10%) vs 5(9%) instances of slow or delayed graft function among the recipients in laparoscopic vs the open group. One year graft survival rates were comparable between the two groups (94.3% vs 98.2% p=0.80).
Conclusion: According to our results and the results available in the literature, laparoscopic living donor nephrectomy is safe when performed with sufficient experience. However large-scale, prospective comparative studies with adequate follow-up will help to define the exact role of this procedure in renal transplantation.
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