BACKGROUND: Laparoscopic living donor nephrectomy has been a standard procedure of donor nephrectomy. The transperitoneal hand-assisted laparoscopic living donor nephrectomy (HALDN) has been commonly reported by many centers with excellent outcome. Retoperitoneal access enables to approach to the kidney directly without interfering with any of abdominal organs. However, there are few studies reporting retroperitoneoscopic living donor nephrectomy (RPLDN). The aim of this study is to evaluate the safety and efficacy of RPLDN. To this end, we compare HALDN with RPLDN.
METHODS: Four hundred four consecutive kidney donors (124 men, 280 women) were enrolled in this study. Mean age of the donors was 55.0 ± 10.7 years. RPLDN was performed for 294 donors, and HALDN for 110 donors. The following end points were evaluated: operative time, blood loss, warm ischemia time, graft function, intraoperative adverse events and postoperative complication.
RESULTS: There was no difference in donor age, gender and operative time between the two groups. Intraoperative blood loss was significantly less in the RPLDN than in the HALDN (136 ± 203 versus 189 ± 250 ml; P<0.05). Although warm ischemic time was significantly longer in the RPLDN than in the HALDN (295 ± 107 versus 208 ± 100 sec; P<0.01), the incidence of delayed graft function was similar between the two groups (2.0% in RPLDN and 3.6% in HALDN). Furthermore, there was no difference in 1-year graft survival between the two groups. Conversion rate to open surgery was similar between the two groups (0.68% in RPLDN and 0.91% in HALDN). Intraoperative complication rate was 1.0% (2 vascular injury and 1 bowel injury) in RPLDN and 0.9% (1 vascular injury) in HALDN (P = NS). Postoperative complication rate was 3.4% (6 surgical site infection, 2 postoperative bleeding, 1 ileus and 1 rhabdomyolysis) in RPLDN and 1.8% (2 surgical site infection) in HALDN (P = NS).
CONCLUSION: Both RPLDN and HALDN procedure are well tolerated with minimal complication rates and have similar impact on recipients graft function. These results suggest that RPLDN could be a feasible option for living donor nephrectomy as well as HALDN.
To cite this abstract in AMA style:Hotta K, Morita K, Harada H, Fukuzawa N, Seki T, Tanabe T, Sasaki H, Hirose T, Iwami D, Nonomura K. Retroperitoneoscopic Living Donor Nephrectomy Safely Provides Excellent Graft Function [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/retroperitoneoscopic-living-donor-nephrectomy-safely-provides-excellent-graft-function/. Accessed May 6, 2021.
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