Duchene David A, Johnson D Brooke, Li Shujun, Roden Jay S, Sagalowsky Arthur I, Cadeddu Jeffrey A
Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9110, USA.
J Urol. 2003 Sep;170(3):731-3. doi: 10.1097/01.ju.0000081648.65198.2d.
Concern has been raised about possible increased morbidity associated with laparoscopic donor nephrectomy (LDN) during the learning curve of the procedure and at centers with a low volume of living donors. We evaluated the safety and success of LDN at a low volume living donor transplant center with a skilled laparoscopic urologist and experienced renal transplant team.
We reviewed the records of all patients who underwent LDN at our institution. A single surgeon skilled in laparoscopy (JAC) performed all LDNs. Patient demographics, operative reports, complications and recipient outcomes were evaluated.
A total of 17 LDNs were performed between January 2000 and September 2002. There was 1 elective conversion to an open procedure for kidney harvest due to complex hilar anatomy. Only 1 minor complication occurred (wound seroma) and 1 donor had creatinine persistently elevated to 1.9 mg/dl (normal 0.6 to 1.2). Mean operating room time, estimated blood loss and hospital stay were 250 minutes, 188 ml and 2.5 days, respectively. Recipient creatinine had a nadir mean of 1.2 mg/dl and a 90-day postoperative mean of 1.6 mg/dl. One recipient eventually lost the graft due to recurrent disease.
LDN can be performed safely and efficiently at low volume transplant centers with a skilled laparoscopist and experienced renal transplant team. Laparoscopic skills developed during similar procedures, such as laparoscopic radical and partial nephrectomy, minimize the learning curve and morbidity of LDN to produce results consistent with those in the published literature.
人们对腹腔镜供肾切除术（LDN）在手术学习曲线期间以及活体供者数量较少的中心可能增加的发病率表示关注。我们评估了在一个活体供者数量较少的移植中心，由一位技术熟练的腹腔镜泌尿外科医生和经验丰富的肾移植团队进行LDN的安全性和成功率。
我们回顾了在本机构接受LDN的所有患者的记录。所有LDN均由一位精通腹腔镜技术的外科医生（JAC）完成。评估了患者的人口统计学资料、手术报告、并发症及受者结局。
2000年1月至2002年9月期间共进行了17例LDN。由于肾门解剖结构复杂，有1例择期转为开放取肾手术。仅发生1例轻微并发症（伤口血清肿），1例供者肌酐持续升高至1.9mg/dl（正常为0.6至1.2）。平均手术时间、估计失血量和住院时间分别为250分钟、188ml和2.5天。受者肌酐最低点平均为1.2mg/dl，术后90天平均为1.6mg/dl。1例受者最终因疾病复发失去了移植肾。
在活体供者数量较少的移植中心，由技术熟练的腹腔镜医生和经验丰富的肾移植团队可以安全、有效地进行LDN。在类似手术（如腹腔镜根治性和部分肾切除术）中培养的腹腔镜技术可将LDN的学习曲线和发病率降至最低，从而产生与已发表文献一致的数据。
