Kim Soon I, Rha Koon H, Lee Jong H, Kim Hyun J, Kwon K I H, Kim Yu Seun, Yang Seung C, Hong Sung J, Park Kiil
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Transplantation. 2004 Jun 15;77(11):1725-8. doi: 10.1097/01.tp.0000129411.49661.1c.
Minimally invasive, living-donor nephrectomy (LDN) is an attractive procedure for the donor in kidney transplantation (KTx). Its advantages include better cosmesis, shorter hospital stay, and rapid recovery. The most commonly performed, minimally invasive nephrectomy is done laparoscopically. However, the technical challenges, a steep learning curve for the surgeon, the risk of impaired early graft function, and the high cost of the procedure, have prevented minimally invasive LDN from gaining wide acceptance. To overcome these problems, we have developed a new surgical procedure named video-assisted minilaparotomy (VAM) for LDN. VAM-LDN is performed entirely with a small retrieval incision. Moreover, it does not require the induction of pneumoperitoneum, thereby avoiding potential vascular and renal complications.
We evaluated the outcome of transplant recipients receiving kidneys with the VAM-LDN procedure by retrospectively comparing the surgical outcomes of patients who underwent KTx with the conventional open nephrectomy (group I, n=82) and VAM-LDN (group II, n=70) procedures from March 1, 1997, to June 30, 2002, at our institution. We compared postoperative complications, patient and graft survival, and graft functions between these two groups during a 12-month follow-up period.
There were no differences in demographic data, ABO compatibility, degree of human leukocyte antigen matching, or method of immunosuppression between the two groups (P >0.05). No significant difference was observed in complications such as delayed graft function, acute rejection, ureter complication, graft failure, or patient's mortality. There was no difference in graft function between the two groups, as determined by serum creatinine level measured during the 12-month follow-up.
The short-term recipient outcome was favorable in patients who underwent KTx with the VAM-LDN procedure.
微创活体供肾肾切除术（LDN）对肾脏移植（KTx）的供体来说是一种有吸引力的手术方式。其优点包括更好的美观效果、更短的住院时间和快速康复。最常用的微创肾切除术是通过腹腔镜进行的。然而，技术挑战、外科医生陡峭的学习曲线、早期移植肾功能受损的风险以及该手术的高成本，阻碍了微创LDN被广泛接受。为克服这些问题，我们开发了一种名为视频辅助小切口剖腹术（VAM）的LDN新手术方法。VAM-LDN完全通过一个小的取出切口进行。此外，它不需要气腹的诱导，从而避免了潜在的血管和肾脏并发症。
我们通过回顾性比较1997年3月1日至2002年6月30日在我们机构接受传统开放性肾切除术（I组，n = 82）和VAM-LDN（II组，n = 70）手术的KTx患者的手术结果，评估接受VAM-LDN手术供肾的移植受者的结局。我们比较了这两组在12个月随访期内的术后并发症、患者和移植物存活率以及移植物功能。
两组在人口统计学数据、ABO血型相容性、人类白细胞抗原匹配程度或免疫抑制方法方面无差异（P>0.05）。在移植肾功能延迟、急性排斥反应、输尿管并发症、移植物失败或患者死亡率等并发症方面未观察到显著差异。根据12个月随访期间测量的血清肌酐水平，两组的移植物功能无差异。
接受VAM-LDN手术的KTx患者短期受者结局良好。
