Alcaraz A, Rosales A, Palou J, Caffaratti J, Montlleó M, Segarra J, Ponce de León J, Huguet J, Errando C, Díaz J M, Guirado L, Villavicencio H
Servicio de Urología, Fundación Puigvert, Barcelona, España.
Arch Esp Urol. 2004 Dec;57(10):1091-8.
Laparoscopic surgery offers potential advantages in terms of diminishment of postoperative pain, shorter hospital stay, faster convalescence, and better cosmetic results. These advantages may increase kidney donation, making donation be accepted by more candidates. We report our first 2 years' experience with laparoscopic donor nephrectomy
Between March 2002 and February 2004 we performed 38 laparoscopic living donor nephrectomies for kidney transplantation. The technique of choice was the transperitoneal laparoscopic approach with four trocars, usually three of them from the start of the procedure--two 10-12 mm and one 5 mm--, and a 6.5 cm perumbilical midline incision for kidney retrieval at the end of the procedure.
Receptor and donor survivals were 100%. Graft survival was 97.6%. There was not any case of delayed graft function. Donor: Mean operative time was 161 minutes (115-260). Mean estimated blood loss was 270 ml (100-1200). Three patients required blood transfusions, 2 units of packed red blood cells each. Mean hospital stay was 5.1 days (3-11). Mean warm ischemia time was 3.2 min. (2-10). Conversion to open surgery was necessary in four cases. Receptor: there have been three significant complications requiring surgical repair: one case of low arterial flow, one vesico ureteral leak, and one midurethra stenosis. Initial renal function: mean serum creatinine at one month was 147mmol/l, with a trend to improve to 126 mmol/l at one year, which is considered optimum. First postoperative day mean serum creatinine was 192mmol/l and the nadir was on second postoperative day with a value of 152mmol/l.
We believe laparoscopic living donor nephrectomy is a real alternative to open surgery because it offers better recovery to the donor with the same capacity to preserve renal function in the receptor.
腹腔镜手术在减轻术后疼痛、缩短住院时间、加快康复以及获得更好的美容效果方面具有潜在优势。这些优势可能会增加肾捐献量，使更多候选者接受捐献。我们报告我们开展腹腔镜供肾切除术的头两年经验。
在2002年3月至2004年2月期间，我们为肾移植进行了38例腹腔镜活体供肾切除术。选择的技术是经腹腔腹腔镜入路，使用四个套管针，通常从手术开始时使用三个——两个10 - 12毫米和一个5毫米——，手术结束时通过脐部正中6.5厘米切口取出肾脏。
受体和供体存活率均为100%。移植肾存活率为97.6%。没有出现移植肾功能延迟的病例。供体：平均手术时间为161分钟（115 - 260分钟）。平均估计失血量为270毫升（100 - 1200毫升）。三名患者需要输血，每人输2单位浓缩红细胞。平均住院时间为5.1天（3 - 11天）。平均热缺血时间为3.2分钟（2 - 10分钟）。4例需要转为开放手术。受体：有3例严重并发症需要手术修复：1例低动脉血流、1例膀胱输尿管漏和1例尿道中段狭窄。初始肾功能：术后1个月平均血清肌酐为147mmol/L，1年时有改善至126mmol/L的趋势，这被认为是最佳的。术后第1天平均血清肌酐为192mmol/L，最低点在术后第2天，值为152mmol/L。
我们认为腹腔镜活体供肾切除术是开放手术的一种切实可行的替代方法，因为它能使供体恢复得更好，同时在受体中保留肾功能的能力相同。
