2011, Number 3
Donor laparoscopic nephrectomy at a tertiary care center
Razón-Gutiérrez JE, Villeda-Sandoval CI, Rodríguez-Covarrubias FT, Gabilondo-Pliego B
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Language: Spanish
References: 13
Page: 151-155
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ABSTRACT
Background: Donor laparoscopic nephrectomy is a surgical modality that has substituted open technique due to recognized advantages such as shorter hospital stay, less blood loss, better postoperative pain control, and better cosmetic results.Objective: To review the authors’ initial experience with this procedure.
Methods: A cross-sectional study was carried out. The kidney donor database corresponding to the time frame January 2005 to August 2010 was analyzed. The following variables were included: age, sex, body mass index, number of graft veins and arteries, surgery duration in minutes, quantity of intraoperative blood loss in milliliters, warm ischemia time, blood transfusion necessity, hospital stay in days, and perioperative complications. In addition preoperative and postoperative hemoglobin and hematocrit, preoperative serum creatinine, and postoperative serum creatinine at one month and at six months were also evaluated.
Results: A total of sixty patients underwent donor handassisted laparoscopic nephrectomy from July 2008 to September 2010. Twenty-seven patients were men and thirty-three were women with a mean age of 36.22 ± 10.36 years. All procedures were left nephrectomies. Forty-five cases presented with single renal artery and fifteen cases with double artery. Fifty-nine cases presented with single vein and one case with double vein. There were no graft losses. Conversion to open surgery was required in one case due to vascular injury. Mean body mass index was 24.41 ± 2.04 Kg/m2 and mean surgery duration was 242.4 ± 67.8 min. Mean warm ischemia time was 4.78 ± 3.72 min and mean blood loss was 218.3 ± 172.51 mL. No transfusions were required. Mean hospital stay was 3.81 ± 0.70 days. Mean preoperative creatinine was 0.77 ± 0.16mg/dL, mean postoperative creatinine at 24 hours was 1.26 ± 0.29mg/dL (p ‹0.001), at one month was 1.10 ± 0.3mg/dL (p ‹0.001), and at six months was 1.19 ± 0.29mg/dL ( ‹0.001). Mean preoperative hemoglobin was 15.12 ± 1.38g/L and mean postoperative hemoglobin at twenty-four hours was 12.95 ± 1.48g/L (p ‹0.001). Mean preoperative hematocrit was 44.7 ± 4.50% and mean postoperative hematocrit at twenty-four hours was 37.52 ± 4.64% (p ‹0.001). The following correlations were found: body mass index and surgery duration (p = 0.04), and warm ischemia and blood loss (p = 0.01).
Discussion: Perioperative variables of the present study were similar to those reported at other international centers and metabolic variables showed an expected reduction. Body mass index was related to longer surgery duration and blood loss and total surgery duration were related to greater warm ischemia time, probably due to the greater technical skill demanded.
Conclusions: The results of the present study were similar to those reported in the majority of published series up to now and they showed that donor laparoscopic nephrectomy is a safe method with blood loss rates that do not require transfusion.
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