title: Perioperative management for laparoscopic kidney donation.
abstract: OBJECTIVE
  To report a single centre's experience in the perioperative management of live kidney laparoscopic donations. METHODS.
  
  
  METHODS
  comparative analysis of all laparoscopic kidney donations performed between April 2000 and August 2002 and a corresponding number of "traditional surgery" donors from a historical series.
  
  
  METHODS
  kidney transplant centre of a teaching hospital.
  
  
  METHODS
  39 and 27 subjects undergoing respectively laparoscopic and traditional "open" kidney donation were studied. A standard balanced anesthesiological technique was used in both groups but, to counterbalance the reported abdominal insufflation-related kidney dysfunction, laparoscopic donors were administered an extra intravascular volume loading with colloids and crystalloids starting from the night before surgery.
  
  
  RESULTS
  Laparoscopic donors underwent a longer procedure with a lower estimated blood loss (p=0.0001) and were intraoperatively administered with a higher amount of intravenous fluids (p<0.01); they showed less postoperative analgesic requirement (p<0.0001), a shorter ICU stay and overall hospitalisation (p<0.001), a quicker resumption of solid oral intakes (p<0.01) and full return to work (p<0.001) with no difference in the rate of postoperative complications. Diuresis resumed intraoperatively in all recipients and early graft function did not differ in the 2 groups although serum creatinine declined earlier, but not significantly, in those receiving kidneys by the traditional method.
  
  
  CONCLUSIONS
  Kidney laparoscopic donation does not require a particularly complex or expensive anaesthetic management or approach; it is advisable to adopt strategies to counterbalance laparoscopy-associated abdominal hypertension.
authors.affiliation: Postsurgical and Transplant ICU, Department of Anaesthesia and Intensive Care Cisanello Hospital, Pisa, Italy. g.biancofiore@med.unipit.it
authors.forename: G
authors.initials: G
authors.lastname: Biancofiore
authors.forename: G
authors.initials: G
authors.lastname: Amorose
authors.forename: D
authors.initials: D
authors.lastname: Lugli
authors.forename: L
authors.initials: L
authors.lastname: Bindi
authors.forename: M
authors.initials: M
authors.lastname: Esposito
authors.forename: N
authors.initials: N
authors.lastname: Fossati
authors.forename: L
authors.initials: L
authors.lastname: Meacci
authors.forename: C
authors.initials: C
authors.lastname: Pasquini
authors.forename: M
authors.initials: M
authors.lastname: Pieri
authors.forename: U
authors.initials: U
authors.lastname: Boggi
authors.forename: A
authors.initials: A
authors.lastname: Pietrabissa
authors.forename: F
authors.initials: F
authors.lastname: Mosca
mesh_terms: D000328:Adult; D006801:Humans; D016030:Kidney Transplantation; D010535:Laparoscopy; D019520:Living Donors; D009392:Nephrectomy / Q000379:methods*; D019990:Perioperative Care