title: Retroperitoneoscopic living-donor nephrectomy and laparoscopic kidney transplantation:  experience of initial 72 cases.
abstract: BACKGROUND
  To evaluate the feasibility, safety, and outcome of laparoscopic kidney transplantation (LKT) after retroperitoneoscopic living-donor nephrectomy.
  
  
  METHODS
  Between February 2010 and January 2012, a total of 217 renal transplantations were performed from living donors by a single surgical unit. All living-donor nephrectomies were performed by retroperitoneoscopic approach. Recipient surgery was performed either laparoscopically (n=72) or by conventional open approach (n=145). In the LKT group, a 5 to 6 cm Pfannenstiel incision was placed and the kidney was dropped into abdomen. Renal vessels were anastomosed by freehand suturing technique. Calcineurin inhibitor-based immunosuppressants were given.
  
  
  RESULTS
  The mean operative time was 223.8 and 175.7 min (P=0.07) and the rewarming time was 60.3 and 30.3 min (P=0.03) in the LKT and open kidney transplantation (OKT) groups, respectively. The estimated glomerular filtration rate value on days 7 and 30 was significantly less in the LKT group, but no difference was found at 3, 6, 12, and 18 months. The mean wound length was 5.5 and 17.8 cm (P=0.0001) and the analgesic requirement was 1.4 and 3.2 mg morphine equivalent in first 24 hr (P=0.005) in the LKT and OKT groups, respectively. In the LKT group, four cases required conversion to open surgery due to vascular complications and one for urinary leak. Kaplan-Meier curve shows 86.5% and 94.6% (P=0.086) and patient survival is 94.1% and 94.7% (P=0.745) at 22.3 months of follow-up.
  
  
  CONCLUSIONS
  LKT after living-donor nephrectomy is feasible, but it has steep learning curve. Graft fixation with peritoneal fold is necessary to avoid torsion and related graft loss. Pain after LKT is significantly less compared with conventional OKT.
authors.affiliation: Institute of Kidney Diseases and Research Centre, Institute of Transplantation Sciences, Ahmedabad, Gujarat, India. dr_pranjal@yahoo.com
authors.forename: Pranjal
authors.initials: P
authors.lastname: Modi
authors.forename: Bipinchandra
authors.initials: B
authors.lastname: Pal
authors.forename: Jayesh
authors.initials: J
authors.lastname: Modi
authors.forename: Suresh
authors.initials: S
authors.lastname: Singla
authors.forename: Chirag
authors.initials: C
authors.lastname: Patel
authors.forename: Ram
authors.initials: R
authors.lastname: Patel
authors.forename: Sukant
authors.initials: S
authors.lastname: Padhy
authors.forename: Krishnaprasad
authors.initials: K
authors.lastname: T
authors.forename: Keval
authors.initials: K
authors.lastname: Patel
authors.forename: Jamal
authors.initials: J
authors.lastname: Rizvi
authors.forename: Sumit
authors.initials: S
authors.lastname: Sharma
authors.forename: Varun
authors.initials: V
authors.lastname: Sharma
authors.forename: Manisha
authors.initials: M
authors.lastname: Modi
authors.forename: Veena R
authors.initials: VR
authors.lastname: Shah
authors.forename: Hargovind L
authors.initials: HL
authors.lastname: Trivedi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012187:Retroperitoneal Space