[The living kidney donor: laparoscopy versus open surgery].
BACKGROUND
Living renal donors are an important source of transplanted kidneys due to the number of patients on waiting list is progressively increasing. On the other side, they allow the pre-emptive kidney transplantation. With the aim of reducing donor obstacles such as pain, hospital stay or cosmetic results and in creasing the number of living donors, in 1995 Ratner performed the first laparoscopic nephrectomy (LLDN). By now, LLDN is a routine procedure in more than 200 centres worldwide.


METHODS
Literature databases are searched. We have reviewed the data from our experience after performing 50 laparoscopic nephrectomies.


RESULTS
Preoperative living donor assessment and contraindications to LLDN do not differ from the open approach. Results are very influenced by the surgeon's situation in the learnig curve. Operating times use to be longer in laparoscopic procedures. The overall complication rate and mortality of LLDN are the same for both of the approaches. Conversion to open-donor nephrectomy has been reported in 0-13% of cases (8% in our data). Postoperative pain and donor estimated blood loss are lower for LLDN, as well as the convalescence period. To avoid the possible negative effects of the laparoscopic technique on kidney graft function a lot of method's variations have been proposed for gaining access and harvesting the kidney, including the hand-assistance techniques, with the aim of minimizing operative time, pneumoperitoneus negative effect on graft function and warm ischemia time (WIT). The higher WIT is not related to delayed graft function or acute rejections when it is less than ten minutes. Delayed graft function does not differ in both approaches and creatinine values from the first month until the third year after transplantation show no differences in randomized studies.


CONCLUSIONS
The laparoscopic approach to harvest the allograft from the living donor is a save and effective technique and has the advantage of being less invasive and allowing the donor a shorter convalescence. It has no negative effects on allograft function in the short term follow-up. Further studies are required to evaluate long term donor complications and allograft function and survival.
Facundo
C
C
Unidad de Trasplante Renal, Servicio de Nefrología, Fundació Puigvert, Barcelona. cfacundo@fundacio-puigvert.es
Guirado
Ll
L
Díaz
J M
JM
Sainz
Z
Z
Alcaraz
A
A
Rosales
A
A
Solà
R
R
D000367:Age Factors; D005500:Follow-Up Studies; D006084:Graft Rejection; D006801:Humans; D016030:Kidney Transplantation; D010535:Laparoscopy; D019520:Living Donors; D008875:Middle Aged; D009392:Nephrectomy; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013997:Time Factors; D020858:Tissue and Organ Harvesting; D014850:Waiting Lists