Hung Chung-Jye, Lin Yih-Jyh, Chang Shen-Shin, Chou Tsung-Ching, Lee Po-Chang
Division of Transplant Surgery, Department of Surgery, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan.
J Formos Med Assoc. 2009 Feb;108(2):135-45. doi: 10.1016/S0929-6646(09)60044-9.
BACKGROUND/PURPOSE: Laparoscopic donor nephrectomy (LDN) has emerged as the preferred technique worldwide, and has contributed to a dramatic increase in living kidney donation during the past decade. We adopted LDN in 2002 with the intention of increasing living kidney donation incentive and maintaining equivalent donor/recipient outcome.
Forty-five LDNs were performed between September 2002 and November 2007. Donor demographics, operative characteristics, perioperative complications and donor/recipient outcome were reviewed retrospectively. The LDN series was divided into earlier and later groups for comparison. To confirm the safety and efficacy of LDN, we compared the results with those of previous series and our open donor nephrectomy (ODN) series.
All 45 LDN kidneys were procured and transplanted successfully. Mean donor operation time was 327.7+/-10.2 minutes, blood loss was 286.0+/-48.3 mL, and warm ischemia time was 233.9+/-19.6 seconds. Two (4.4%) open conversions happened in the earlier group. There was a significant decrease in warm ischemia time and donor intraoperative complications in the later group. There was no donor mortality and there were no repeat surgical procedures. Delayed graft function occurred in 8.9% of cases and three (6.7%) recipients developed ureteral complications. All but one recipient was discharged with adequate renal function. Graft function continued in 41 of the 43 harvested kidneys (95.3%). Compared with ODN, there was a significant decrease in donor postoperative stay in the LDN series (p=0.00). There was no difference between the series with regard to donor safety, donor outcome, and immediate and long-term recipient outcome.
The number of living kidney donations increased significantly after adopting LDN in our series. The equivalent donor/recipient outcome of the LDN series compared with that of previous and ODN series was achieved with increasing experience.
背景/目的：腹腔镜供肾切除术（LDN）已成为全球首选技术，并在过去十年中促使活体肾捐献显著增加。我们于2002年采用LDN，旨在提高活体肾捐献积极性并维持供体/受体等效结局。
2002年9月至2007年11月期间进行了45例LDN。回顾性分析供体人口统计学、手术特征、围手术期并发症及供体/受体结局。将LDN系列分为早期和晚期组进行比较。为证实LDN的安全性和有效性，我们将结果与先前系列及我们的开放性供肾切除术（ODN）系列进行了比较。
45例LDN肾均成功获取并移植。供体平均手术时间为327.7±10.2分钟，失血量为286.0±48.3毫升，热缺血时间为233.9±19.6秒。早期组发生2例（4.4%）转为开放手术。晚期组热缺血时间和供体术中并发症显著减少。无供体死亡，也无再次手术。8.9%的病例发生移植肾功能延迟恢复，3例（6.7%）受体出现输尿管并发症。除1例受体外，所有受体均肾功能正常出院。43例获取肾脏中的41例（95.3%）移植肾功能持续良好。与ODN相比，LDN系列供体术后住院时间显著缩短（p = 0.00）。在供体安全性、供体结局以及受体近期和远期结局方面，各系列之间无差异。
在我们的系列中采用LDN后，活体肾捐献数量显著增加。随着经验增加，LDN系列与先前及ODN系列相比实现了等效的供体/受体结局。
