Division of Vascular- and Transplant Surgery, Department of Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
Clin Transplant. 2013 Jul-Aug;27(4):E478-83. doi: 10.1111/ctr.12143. Epub 2013 Jun 24.
Nowadays, laparoscopic donor nephrectomy (LDN) has become the gold standard to procure live donor kidneys. As the relationship between donor and recipient loosens, it becomes of even greater importance to optimize safety and comfort of the surgical procedure. Low-pressure pneumoperitoneum has been shown to reduce pain scores after laparoscopic cholecystectomy. Live kidney donors may also benefit from the use of low pressure during LDN. To evaluate feasibility and efficacy to reduce post-operative pain, we performed a randomized blinded study. Twenty donors were randomly assigned to standard (14 mmHg) or low (7 mmHg) pressure during LDN. One conversion from low to standard pressure was indicated by protocol due to lack of progression. Intention-to-treat analysis showed that low pressure resulted in a significantly longer skin-to-skin time (149 ± 86 vs. 111 ± 19 min), higher urine output during pneumoperitoneum (23 ± 35 vs. 11 ± 20 mL/h), lower cumulative overall pain score after 72 h (9.4 ± 3.2 vs. 13.5 ± 4.5), lower deep intra-abdominal pain score (11 ± 3.3 vs. 7.5 ± 3.1), and a lower cumulative overall referred pain score (1.8 ± 1.9 vs. 4.2 ± 3). Donor serum creatinine levels, complications, and quality of life dimensions were not significantly different. Our data show that low-pressure pneumoperitoneum during LDN is feasible and may contribute to increase live donors' comfort during the early post-operative phase.
如今，腹腔镜供肾切取术（LDN）已成为获取活体供肾的金标准。随着供受者关系的放松，优化手术的安全性和舒适度变得更为重要。研究表明，低压气腹可降低腹腔镜胆囊切除术患者术后疼痛评分，LDN 中使用低压也可能使活体供者受益。为评估其减少术后疼痛的可行性和效果，我们进行了一项随机、双盲研究。20 名供者随机分为标准（14mmHg）或低压（7mmHg）气腹组。根据方案，由于进展不佳，1 例从低压转为标准压。意向治疗分析显示，低压组皮肤至皮肤时间显著延长（149±86 分钟比 111±19 分钟），气腹期间尿量增加（23±35 毫升/小时比 11±20 毫升/小时），72 小时后累积总疼痛评分较低（9.4±3.2 分比 13.5±4.5 分），深部腹腔内疼痛评分较低（11±3.3 分比 7.5±3.1 分），累积总牵涉痛评分较低（1.8±1.9 分比 4.2±3 分）。供者血清肌酐水平、并发症和生活质量维度无显著差异。我们的数据表明，LDN 中低压气腹是可行的，可能有助于增加活体供者术后早期的舒适度。
