Department for Visceral, Vascular and Transplantation Surgery, Clinic Cologne-Merheim, Cologne, Germany.
Surg Endosc. 2010 Mar;24(3):594-600. doi: 10.1007/s00464-009-0642-9. Epub 2009 Jul 25.
Laparoscopic live donor nephrectomy is the preferred method of kidney donation in high-volume US transplant centers, but for small transplant programs the question of the minimal case load per year necessary to reach the quality standards is open.
From 1996 to 2007 we performed 130 live kidney donations including 93 laparoscopic donor nephrectomies followed by transplantation in a community hospital with an average case load of 10 laparoscopic cases per year. We compared the results after 37 open and 93 laparoscopic live donor operations with respect to operating time, conversion rate, complications, and recipients' outcome.
There were no significant differences in terms of safe outcome of donor patients after open or laparoscopic donor nephrectomy. The mean operating time was significantly shorter (p < 0.001) in the open group (125 min, OG) than in the laparoscopic group (150 min, LG). Mean hospital stay was significantly shorter (p < 0.001) in LG (6.8 days) versus OG (9.7 days). The conversion rate was 3.2% in the LG. Postoperative complication of donors consisted of temporary nerve irritation (two patients) and retroperitoneal hematoma (one patient) in the LG, and wound infection followed by hernia formation (one patient) and ileus 1 year after organ donation (one patient) in the OG. Safe outcome of the recipients after open (RaOD) or laparoscopic donation (RaLD) was similar. Uneventful transplantation occurred in 94.6% of the RaOD and in 92.5% of the RaLD. One kidney was lost due to renal vein thrombosis (RaLD). Mean postoperative creatinine after 4 weeks showed no difference between RaOD (1.6 mg/dl) and RaLD (1.7 mg/dl).
Approximately ten cases per year may be enough to ensure safety and quality of laparoscopic live donor nephrectomy.
腹腔镜活体供肾切除术是美国大容量移植中心首选的肾脏捐献方法，但对于小型移植项目，每年需要完成的最低例数以达到质量标准仍存在争议。
自 1996 年至 2007 年，我们在一家社区医院进行了 130 例活体肾移植，其中 93 例为腹腔镜供肾切除术，平均每年进行 10 例腹腔镜手术。我们比较了 37 例开放性和 93 例腹腔镜活体供肾手术的结果，包括手术时间、转化率、并发症和受者结局。
开放性和腹腔镜供肾切除术的供者患者的安全结局无显著差异。开放性组（OG）的平均手术时间明显短于腹腔镜组（LG）（p < 0.001），分别为 125 分钟和 150 分钟。LG 的平均住院时间明显短于 OG（6.8 天与 9.7 天，p < 0.001）。LG 的转化率为 3.2%。LG 术后供者并发症包括暂时性神经刺激（2 例）和腹膜后血肿（1 例），OG 术后并发症包括伤口感染和疝形成（1 例）以及器官捐献 1 年后肠梗阻（1 例）。开放性（RaOD）或腹腔镜供肾（RaLD）后受者的安全结局相似。OG 中 94.6%的受者无并发症，LG 中 92.5%的受者无并发症。LG 中有 1 例因肾静脉血栓形成而失去 1 个肾脏。4 周后术后肌酐值无差异，OG 为 1.6mg/dl，LG 为 1.7mg/dl。
每年大约进行 10 例手术可能足以确保腹腔镜活体供肾切除术的安全性和质量。
