title: Hand-assisted laparoscopic splenectomy in ABO-incompatible kidney transplant recipients.
abstract: OBJECTIVE
  We perform living-related ABO-incompatible kidney transplantations to alleviate the organ shortage in our country. Splenectomy has been performed routinely in these recipients, although its clinical significance remains controversial. In this study, we have reported our experience with a hand-assisted laparoscopic splenectomy (HALS) technique.
  
  
  METHODS
  Between April 2000 and December 2006, 50 patients (23 males) underwent ABO-incompatible kidney transplantation with HALS. The mean age and weight of the recipients were 44 +/- 13 years and 56 +/- 12 kg, respectively. All patients underwent preoperative plasmapheresis to reduce isoagglutinin (A and/or B antibody). In 6/50 patients, a hand-assisted device was placed through a peritoneal window in the right lower abdominal skin incision for kidney engraftment. In the remaining 44 patients, a 6-cm upper midline or periumbilical midline incision was made for the hand-assisted device in the lateral position.
  
  
  RESULTS
  An ABO-incompatible procedure was completed successfully in all cases. The average HALS time was 118 +/- 42 minutes, with an average pneumoperitoneum time of 79 +/- 40 minutes and average blood loss of 48 +/- 81 g. There were two conversions to open splenectomy because of intraoperative bleeding and suspected pneumothorax. Two other cases required relaparotomy because of hematoma and perforation of the ileum. Successfully operations were achieved through the previous periumbilical incision.
  
  
  CONCLUSIONS
  Although meticulous, rigorous surgical technique is essential, HALS is safe and feasible for recipients of ABO-incompatible grafts with tissue weakness and a bleeding tendency because of renal failure and preoperative plasmapheresis.
authors.affiliation: Department of Surgery, Tokyo Women's Medical University, Tokyo, Japan. tojimbara@iuhw.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Tojimbara
authors.forename: I
authors.initials: I
authors.lastname: Nakajima
authors.forename: K
authors.initials: K
authors.lastname: Nanmoku
authors.forename: Y
authors.initials: Y
authors.lastname: Ishii
authors.forename: M
authors.initials: M
authors.lastname: Tonsho
authors.forename: J
authors.initials: J
authors.lastname: Yashima
authors.forename: S
authors.initials: S
authors.lastname: Kudo
authors.forename: Y
authors.initials: Y
authors.lastname: Kato
authors.forename: K
authors.initials: K
authors.lastname: Kai
authors.forename: A
authors.initials: A
authors.lastname: Sannomiya
authors.forename: I
authors.initials: I
authors.lastname: Koyama
authors.forename: S
authors.initials: S
authors.lastname: Fuchinoue
authors.forename: S
authors.initials: S
authors.lastname: Teraoka
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D001787:Blood Group Incompatibility; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D016030:Kidney Transplantation / Q000276:immunology* / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D011187:Posture; D012189:Retrospective Studies; D013156:Splenectomy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System