title: The minimal-access kidney transplantation technique in living-donor transplantation: results from a retrospective analysis.
abstract: OBJECTIVE
  During the last 15 years, there was tremendous progress in minimally invasive surgery and minimal-access surgery. Many conventional surgical procedures were replaced by these techniques, resulting in a wide range of benefits for the patients. In kidney transplantation, many centers choose an approach to the iliac fossa through an oblique or J-shaped incision. This might have possible disadvantages due to the extent of tissue trauma. Thus, we introduced a minimal-access kidney transplantation technique (MAKT) as a transplantation method in our center. We retrospectively analyzed this technique used for 11 living-donor kidney transplants and report here our experience.
  
  
  METHODS
  From April 2008 to July 2011, 11 living-donor kidney recipients were subjected to the MAKT and were matched (age, sex) with a historical group from our center from 2000 to 2007. To analyze the assumption of noninferiority of the MAKT in comparison to the standard approach, a matched case-control study design was chosen, with creatinine level at 1 year after transplantation as the primary outcome variable. We used a Wilcoxon signed rank test; 1-sided significance level was 2.5%.
  
  
  RESULTS
  Eleven recipients were included. Both groups were almost similar regarding age and body mass index. Characteristics of the procedure were significantly different only for cold ischemic time (114 minutes MAKT vs 77 minutes historical group). In the MAKT group, there were no reinterventions necessary, no wound infections, no incisional hernia, no acute rejection episodes, no graft losses, and 2 lymphoceles occurred. Further, no urinary leakage or ureteral stenosis and no vascular complications were observed. The statistical analysis of the primary endpoint revealed a noninferiority of the MAKT technique (P = .0005).
  
  
  CONCLUSIONS
  Considering the fact that this is an initial series and a retrospective analysis, the applied MAKT technique seems to be safe in terms of both graft function after 1 year and surgical complications.
authors.affiliation: Department of General and Visceral Surgery, University of Ulm, Ulm, Germany. Electronic address: claas.brockschmidt@uniklinik-ulm.de.
authors.forename: C
authors.initials: C
authors.lastname: Brockschmidt
authors.forename: C
authors.initials: C
authors.lastname: Kaltenmeier
authors.affiliation: Department of General and Visceral Surgery, University of Ulm, Ulm, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Köksal
authors.affiliation: Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Mayer
authors.affiliation: Department of General and Visceral Surgery, University of Ulm, Ulm, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Henne-Bruns
authors.affiliation: Department of General and Visceral Surgery, University of Ulm, Ulm, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Wittau
mesh_terms: D000328:Adult; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008875:Middle Aged; D012189:Retrospective Studies