Hand-assisted retroperitoneoscopic live donor nephrectomy in comparison to open and laparoscopic procedures: a prospective study on donor morbidity and kidney function.
BACKGROUND
Living donor nephrectomy (LDN) is a unique surgical challenge where surgery is performed on a healthy individual. A new hand-assisted retroperitoneoscopic nephrectomy (HARS) technique was compared to transperitoneal laparoscopic nephrectomy (LAP) and open nephrectomy (OPEN). The aim was to examine the perioperative and postoperative morbidity, and the effects of the different surgical techniques with regard to renal function.


METHODS
Donors (n=36) were divided into three groups (HARS, LAP and OPEN) according to surgical technique. During the operations, renal function, hormone output, warm ischemia time (WIT) and operating time were recorded. Renal function, complications, convalescence and allograft outcome were followed postoperatively for one year.


RESULTS
OPEN and HARS groups showed similar operation times: 150 (95-218) minutes and 145 (124-225) minutes, respectively. LAP procedures took longer: 218 (163-280) minutes. OPEN had the shortest WIT at 91 (55-315) seconds; LAP had the longest WIT at 207 (100-319) seconds, with HARS at 180 (85-240) seconds. In all groups, glomerular filtration rate and urine production were decreased during surgery. Endoscopic techniques had a higher catecholamine release, and OPEN donors showed higher serum aldosterone. Endoscopic techniques showed shorter convalescence and less postoperative pain compared to OPEN. HARS had a smaller rise in creatinine than LAP, and HARS recipients a better creatinine clearance than the other groups in the early posttransplantation period.


CONCLUSIONS
Evaluation of HARS shows that the operation is quick, the donors experience little pain, and recovery time is short. The renal function for donors and recipients is somewhat favorable to open surgery and transperitoneal laparoscopic approaches.
Sundqvist
Pernilla
P
Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.
Feuk
Ulla
U
Häggman
Mikael
M
Persson
A Erik G
AE
Stridsberg
Mats
M
Wadström
Jonas
J
D000328:Adult; D000368:Aged; D000758:Anesthesia; D009320:Atrial Natriuretic Factor / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000502:physiology; D016030:Kidney Transplantation / Q000401:mortality*; D020706:Laparoscopes; D010535:Laparoscopy; D019520:Living Donors / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009392:Nephrectomy / Q000379:methods*; D010149:Postoperative Pain / Q000401:mortality; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D011997:Recovery Room / Q000706:statistics & numerical data; D012084:Renin-Angiotensin System / Q000502:physiology; D012187:Retroperitoneal Space / Q000601:surgery
C099254:N-terminal proatrial natriuretic peptide; D011498:Protein Precursors; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor