Ahearn Aaron J, Posselt Andrew M, Kang Sang-Mo, Roberts John P, Freise Chris E
Division of Transplantation, Department of Surgery, University of California, San Francisco, San Francisco, CA 94143-0780, USA.
Arch Surg. 2011 Jul;146(7):859-64. doi: 10.1001/archsurg.2011.156.
Despite the overall acceptance of laparoscopic donor nephrectomy (LDNX), concern remains about the application of this technique in certain complex situations, such as right-sided nephrectomies and in donors with complex kidney anatomy and obese donors. This study was designed to determine if complication rates have remained stable as we have offered LDNX to all medically acceptable donors and to analyze the results of cases in each of the complex categories. We hypothesized that complication rates in the 3 complex categories would be equivalent to those among more straightforward cases.
Retrospective medical record review.
Academic medical center.
A total of 1045 patients who underwent LDNX between November 3, 1999, and August 28, 2009.
Operative times, lengths of hospital stay, overall complications, major complications, conversions to open surgery, blood transfusions, readmissions, and reoperations.
The outcomes of the first 250 patients (when LDNX was selectively offered) were compared with the outcomes of the last 795 patients (when LDNX was offered to all medically acceptable donors). Overall operative times significantly improved (212 vs 176 minutes), overall complication rates did not change (6.4% vs 5.5%), and major complication rates significantly declined (4.0% vs 1.4%). Among the last 795 patients, 1 conversion to open surgery and 1 blood transfusion occurred. There were no deaths in the series. Moreover, no differences in overall or major complication rates were seen when cases involving 200 right-sided nephrectomies, 204 donors with complex kidney anatomy, and 148 obese donors were analyzed independently.
Low complication rates persist for LDNX, even when applied to more technically challenging cases. This procedure is offered to all medically acceptable donors, with an excellent safety profile, and should be considered the standard of care for kidney donation.
尽管腹腔镜供肾切除术（LDNX）已被广泛接受，但对于该技术在某些复杂情况下的应用仍存在担忧，例如右侧肾切除术以及肾脏解剖结构复杂的供体和肥胖供体。本研究旨在确定随着我们将LDNX应用于所有医学上可接受的供体，并发症发生率是否保持稳定，并分析每个复杂类别中的病例结果。我们假设这3个复杂类别的并发症发生率将与更简单病例中的发生率相当。
回顾性病历审查。
学术医疗中心。
1999年11月3日至2009年8月28日期间接受LDNX的1045例患者。
手术时间、住院时间、总体并发症、主要并发症、转为开放手术、输血、再次入院和再次手术。
将前250例患者（选择性提供LDNX时）的结果与后795例患者（向所有医学上可接受的供体提供LDNX时）的结果进行比较。总体手术时间显著改善（212分钟对176分钟），总体并发症发生率未改变（6.4%对5.5%），主要并发症发生率显著下降（4.0%对1.4%）。在后795例患者中，发生了1例转为开放手术和1例输血。该系列中无死亡病例。此外，对200例右侧肾切除术、204例肾脏解剖结构复杂的供体和148例肥胖供体的病例进行独立分析时，总体或主要并发症发生率未见差异。
即使应用于技术上更具挑战性的病例，LDNX的并发症发生率仍然很低。该手术适用于所有医学上可接受的供体，具有出色的安全性，应被视为肾脏捐赠的护理标准。
