Nakamura Y, Konno O, Matsuno N, Yokoyama T, Kuzuoka K, Kihara Y, Taira S, Jojima Y, Akashi I, Iwamoto H, Hama K, Iwahori T, Ashizawa T, Kubota K, Tojimbara T, Nakajima I, Nagao T
Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan.
Transplant Proc. 2008 Sep;40(7):2104-7. doi: 10.1016/j.transproceed.2008.07.081.
In Japan, living donor renal transplantation has gained momentum due to an increased number of patients with end-stage renal disease. Living donation not only provides better outcomes, but also the recipients usually need less medications, thereby increasing the quality of life and reducing the potential side effects of immunosuppression.
For the past 25 years, our center had performed 140 open donor nephrectomy (OPNx) renal transplantations. Since July 2003, we changed our procurement operation to living hand-assisted laparoscopic donor nephrectomy (HALNx) in 49 cases. Our operative technique consisted of two 12-mm ports placed in the midaxillary line at the superior and inferior levels of the umbilicus. Next, a 5-cm incision was made in the midline periumbilicus and the hand port system fitted through a midline abdominal incision.
In 49 cases, HALNx was completed successfully; no patient required conversion to laparotomy. The estimated blood loss was 33.0 +/- 43.4 g and no patient required blood transfusion. In comparison, in OPNx the blood loss was 426.5 +/- 247.6 g (P < .001). The mean operative times were 167.4 +/- 39.7 minutes for HALNx and 228.4 +/- 35.7 minutes for OPNx (P < .001). The postoperative hospital stays were 9.1 +/- 3.8 days for HALNx and 13.0 +/- 1.9 days for OPNx (P < .001). For 3 years prior to introduction of HALNx, we had performed only 10 living donor renal transplantations. Since the introduction of HALNx in 2003, the number of living donors has tripled during the following 3 years.
Herein we have reported that HALNx was superior in terms of less operative time and blood loss, postoperative pain and recovery, and shorter hospital stay. Overall donor patient satisfaction was also better in the HALNx group. HALNx is a safe procedure that makes kidney donation more appealing to potential live donors and has increased the living donor pool at our center.
在日本，由于终末期肾病患者数量增加，活体供肾移植发展迅速。活体供肾不仅能带来更好的治疗效果，而且受者通常所需药物较少，从而提高了生活质量并减少了免疫抑制的潜在副作用。
在过去25年里，我们中心进行了140例开放性供肾肾切除术（OPNx）肾移植。自2003年7月起，我们对49例患者采用了活体手辅助腹腔镜供肾切除术（HALNx）。我们的手术技术包括在脐部上下的腋中线处放置两个12毫米的端口。接下来，在脐周中线做一个5厘米的切口，并通过腹部中线切口安装手辅助端口系统。
49例患者成功完成HALNx手术；无患者需要转为开腹手术。估计失血量为33.0±43.4克，无患者需要输血。相比之下，OPNx的失血量为426.5±247.6克（P<.001）。HALNx的平均手术时间为167.4±39.7分钟，OPNx为228.4±35.7分钟（P<.001）。HALNx术后住院时间为9.1±3.8天，OPNx为13.0±1.9天（P<.001）。在引入HALNx之前的3年里，我们仅进行了10例活体供肾肾移植。自2003年引入HALNx以来，在随后的3年里活体供者数量增加了两倍。
我们在此报告，HALNx在手术时间、失血量、术后疼痛与恢复以及住院时间方面更具优势。总体而言，HALNx组供者与受者的满意度也更高。HALNx是一种安全的手术方式，使肾脏捐赠对潜在的活体供者更具吸引力，并增加了我们中心的活体供者库。
