title: From Open to Laparoscopic Living-donor Nephrectomy: Changing the Paradigm in a High-volume Transplant Center.
abstract: In 1995, Ratner et al reported the first laparoscopic living-donor nephrectomy, and since then this approach is gradually replacing traditional open surgery. The learning curve of the procedure is still unclear and lessons taken from initial experience series are of utmost importance. We retrospectively analyzed our initial 50 living-donor laparoscopic nephrectomies, of which 90% were performed on the left side. Renal vascular variation occurred in 28% of donors. The median age and body mass index of the donors were 50 years (IQR 39-55) and 24.65 kg/m(2) (IQR 22.5-27.3), respectively. The median operative time and warm ischemia time were 160 minutes (IQR 141-178) and 240 seconds (IQR 210-280), respectively. Estimated blood loss was 60 mL (IQR 60-127.5). The serum creatinine of the receptors was 97.6 μmol/L (IQR 87.5-139.6) 1 month after transplant. Overall, there were 5 complications, including 2 (4%) open conversions, 1 (2%) incisional hernia, 1 (2%) graft loss, and 1 (2%) reintervention. The body mass index and the multiple arteries did not influence the operative time and warm ischemia time or the recipient's serum creatinine level. Along the series, there was a significant reduction in the operative time (Spearman ρ = -5.2; P < .001), but no significant differences were found for warm ischemia time, blood loss, or serum creatinine of the recipients (P > .05). Laparoscopic donor nephrectomy is a safe procedure in centers experienced in laparoscopic surgery; however, the learning curve plateau was not reached after the initial 50 cases.
authors.affiliation: Department of Urology, Hospital de Santo António, C.H.P., Portugal. Electronic address: joaoferreiracabral@gmail.com.
authors.forename: J F
authors.initials: JF
authors.lastname: Cabral
authors.affiliation: Department of Urology, Hospital de Santo António, C.H.P., Portugal.
authors.forename: I
authors.initials: I
authors.lastname: Braga
authors.affiliation: Department of Urology, Hospital de Santo António, C.H.P., Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Fraga
authors.affiliation: Department of Nephrology, Hospital de Santo António, C.H.P., Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Castro-Henriques
authors.affiliation: Department of Urology, Hospital de Santo António, C.H.P., Portugal.
authors.forename: P
authors.initials: P
authors.lastname: Príncipe
authors.affiliation: Department of Urology, Hospital de Santo António, C.H.P., Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Silva-Ramos
mesh_terms: D000328:Adult; D005260:Female; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D012189:Retrospective Studies; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000379:methods*