[Comparison of the surgical approaches for nephrectomy in living related donors].
OBJECTIVE
To compare the clinical effects and graft outcomes of 4 surgical approaches for nephrectomy in living related kidney donors.


METHODS
Between June, 2004 and June, 2007, 119 living related kidney donors underwent nephrectomy via different surgical approaches, and their clinical data were retrospectively analyzed. Of these donors, 22 received retroperitoneal open nephrectomy, 21 had retroperitoneoscopic nephrectomy, 13 had hand-assisted laparoscopic nephrectomy, and 63 underwent transperitoneal open nephrectomy. The operating time, warm ischemia time of the graft, renal graft artery and vein lengths, reduction rate of recipient serum creatinine in the first 3 days after renal transplantation, mean hospital stay and complications of the donors were compared between the 4 surgical approaches.


RESULTS
Open surgeries were associated with significantly shorter operating time (P=0.0033) and warm ischemia time of the graft (P=0.0001), longer hospital stay (P=0.0000), higher hospital expenses (P=0.0000), faster postoperative reduction of recipient serum creatinine (P=0.0001), and longer renal artery and vein lengths (P=0.0000 on the left and P=0.0001 on the right) than laparoscopic surgeries. In the laparoscopic surgery group, subcutaneous emphysema occurred in 1 case, DGF in 2 cases, and lumbar vein hemorrhage in 2 cases for which open surgery was performed. In the open surgery group, only one case required reoperation due to adrenal gland hemorrhage. All the kidney grafts were successfully harvested without other complications observed in the donors.


CONCLUSIONS
Both open and laparoscopic surgeries are safe for nephrectomy in living related kidney donors, and the selection of the surgical approaches depends on the kidney and donor conditions and the surgical proficiency of the surgeons.
Nie
Hai-Bo
HB
Department of Organ Transplantation, Nangfang Hospital, Southern Medical University, Guangzhou, China. niehaibo@medmail.com.cn
Yu
Li-Xin
LX
Hu
Wei-Lie
WL
Gao
Xin
X
Lü
Jun
J
Zhang
Xiao-Ming
XM
Zhang
Li-Chao
LC
Wang
Wei
W
Qiu
Xiao-Fu
XF
Xiao
Yuan-Song
YS
Zhu
Yun-Song
YS
D000328:Adult; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D010535:Laparoscopy / Q000379:methods; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting