Favorable outcomes among recipients of living-donor nephrectomy using video-assisted minilaparotomy.
BACKGROUND
Minimally invasive, living-donor nephrectomy (LDN) is an attractive procedure for the donor in kidney transplantation (KTx). Its advantages include better cosmesis, shorter hospital stay, and rapid recovery. The most commonly performed, minimally invasive nephrectomy is done laparoscopically. However, the technical challenges, a steep learning curve for the surgeon, the risk of impaired early graft function, and the high cost of the procedure, have prevented minimally invasive LDN from gaining wide acceptance. To overcome these problems, we have developed a new surgical procedure named video-assisted minilaparotomy (VAM) for LDN. VAM-LDN is performed entirely with a small retrieval incision. Moreover, it does not require the induction of pneumoperitoneum, thereby avoiding potential vascular and renal complications.


METHODS
We evaluated the outcome of transplant recipients receiving kidneys with the VAM-LDN procedure by retrospectively comparing the surgical outcomes of patients who underwent KTx with the conventional open nephrectomy (group I, n=82) and VAM-LDN (group II, n=70) procedures from March 1, 1997, to June 30, 2002, at our institution. We compared postoperative complications, patient and graft survival, and graft functions between these two groups during a 12-month follow-up period.


RESULTS
There were no differences in demographic data, ABO compatibility, degree of human leukocyte antigen matching, or method of immunosuppression between the two groups (P >0.05). No significant difference was observed in complications such as delayed graft function, acute rejection, ureter complication, graft failure, or patient's mortality. There was no difference in graft function between the two groups, as determined by serum creatinine level measured during the 12-month follow-up.


CONCLUSIONS
The short-term recipient outcome was favorable in patients who underwent KTx with the VAM-LDN procedure.
Kim
Soon I
SI
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. soonkim@yumc.yonsei.ac.kr
Rha
Koon H
KH
Lee
Jong H
JH
Kim
Hyun J
HJ
Kwon
K I H
KI
Kim
Yu Seun
YS
Yang
Seung C
SC
Hong
Sung J
SJ
Park
Kiil
K
D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000401:mortality; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods*; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted; D013690:Television; D016896:Treatment Outcome