Division of Transplantation, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Ann Surg. 2013 Mar;257(3):527-33. doi: 10.1097/SLA.0b013e318262ddd6.
Minimally invasive techniques have expanded the donor pool for living kidney donation. We changed our approach to single-port donor nephrectomy in 2009 and have compared outcomes with traditional multiple-port laparoscopic donor nephrectomy.
The development of minimally invasive surgical techniques to procure kidneys from living donors has allowed expansion of living donor renal transplantation to account for one third of all renal transplants. Recent technical advancement allows for the entire surgical procedure to be done through a single incision contained within the umbilicus.
We compared outcomes from 135 single-port donor nephrectomies with an immediately preceding cohort of 100 multiple-port laparoscopic donor nephrectomies. Survey data were collected from both groups to compare outcomes. Additional comparisons were made to total center experience with 1300 laparoscopic donor nephrectomies.
A total of 135 patients completed successful single-port donor nephrectomy without major complication or open conversion. Another 16 patients required additional port placement because of excessive intra-abdominal fat or limited abdominal domain. Compared with multiple-port donor nephrectomy, single-port patients had similar operative times to cross clamp (2.8 vs 2.6 hours; P = 0.11) that normalized after a learning curve of approximately 50 cases. Recipient creatinine levels were similar at 1 week and 1 month posttransplant. Although 36-Item Short Form Health Surveys demonstrated no significant differences, additional survey data revealed that single-port patients were more satisfied with cosmetic outcomes (P < 0.01) and the overall donation process (P = 0.01). Single-port approach had similar outcomes compared with all previous laparoscopic donor nephrectomies.
Single-port donor nephrectomy can be integrated as a standardized approach for renal donation without additional donor risk, and with benefits of improved patient satisfaction with cosmetic and overall outcomes. Although the primary benefit is cosmetic, (a single incision predominantly contained within the umbilicus) outcomes justify application for kidney donors in experienced centers and may motivate additional living kidney donation.
微创技术扩大了活体肾脏供体的来源。我们于 2009 年改变了单端口供体肾切除术的方法，并将其结果与传统的多端口腹腔镜供体肾切除术进行了比较。
微创外科技术的发展使活体供体肾脏移植得以扩展，占所有肾脏移植的三分之一。最近的技术进步使整个手术过程都可以通过一个位于脐内的单一切口完成。
我们将 135 例单端口供体肾切除术的结果与之前的 100 例多端口腹腔镜供体肾切除术的结果进行了比较。两组都收集了调查数据来比较结果。此外，我们还与中心 1300 例腹腔镜供体肾切除术的总经验进行了比较。
共有 135 例患者成功完成了单端口供体肾切除术，没有出现重大并发症或开放性转化。另有 16 例患者由于腹部脂肪过多或腹部区域有限而需要额外放置端口。与多端口供体肾切除术相比，单端口患者的夹闭时间相似（2.8 小时对 2.6 小时；P = 0.11），在大约 50 例病例的学习曲线后正常化。移植后 1 周和 1 个月，受体的肌酐水平相似。尽管 36 项简明健康调查问卷没有显示出显著差异，但其他调查数据显示，单端口患者对美容结果（P < 0.01）和整体捐赠过程（P = 0.01）更满意。单端口方法与所有以前的腹腔镜供体肾切除术的结果相似。
单端口供体肾切除术可以作为一种标准化的肾脏捐赠方法，无需增加供体风险，并且可以提高患者对美容和整体结果的满意度。虽然主要的好处是美容（一个主要位于脐内的单一切口），但结果证明在有经验的中心对肾脏供体适用，并且可能会激发更多的活体肾脏捐赠。
