Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences (SBMU) , Tehran, Islamic Republic of Iran .
J Endourol. 2014 Jan;28(1):34-9. doi: 10.1089/end.2013.0460. Epub 2013 Nov 19.
This study evaluated the outcomes of laparoscopic donor nephrectomy (LDN) and proposed modifications for kidney donation surgery. From February 1997 to February 2011, 1510 LDNs were performed.
Surgical modifications included a modified open access technique for entry into the abdominal cavity, using vascular clips for safe and cost-effective control of the renal pedicle, control of the lumbar veins, and adrenal vein using bipolar cautery instead of clips, and leaving the gonadal vein intact with the ureter. Kidneys were extracted by hand through a Pfannenstiel incision. Heparin was not used after the first 300 cases to prevent potential hemorrhagic complications.
Although three major vascular injuries occurred using the closed access method that were managed successfully, no access-related complications occurred using the modified open access technique. Clip failure did not happen in any cases. Patient and graft survival at 1 year post-transplantation were 96.5% and 95.5%, respectively, and at 5 years post-transplantation were 95.3% and 89.5%, respectively.
The proposed surgical modifications are based on 14 years of experience and 1510 cases, and make LDN simple, safe, and cost-effective. The excellent recipient and graft outcomes with minimal morbidity obtained further confirm that LDN can be considered as the gold standard for kidney donation surgery.
本研究评估了腹腔镜供肾切取术（LDN）的结果，并提出了肾脏供体手术的改良方案。自 1997 年 2 月至 2011 年 2 月，共实施了 1510 例 LDN。
手术改良包括改良的开放式进入腹腔技术，使用血管夹安全且经济有效地控制肾蒂，使用双极电凝而非夹钳控制腰静脉和肾上腺静脉，并保持输尿管与精索静脉的完整性。通过经耻骨联合上切口用手取出肾脏。在前 300 例中未使用肝素以预防潜在的出血并发症，之后也未再使用。
尽管使用封闭入路方法发生了 3 例严重血管损伤，但均成功处理，而改良的开放式入路技术未发生与入路相关的并发症。未发生夹钳失效的情况。术后 1 年患者和移植物的存活率分别为 96.5%和 95.5%，术后 5 年分别为 95.3%和 89.5%。
所提出的手术改良方案基于 14 年的经验和 1510 例病例，使 LDN 变得简单、安全且经济有效。最小的发病率获得了令人满意的受者和移植物结局，进一步证实 LDN 可被视为肾脏供体手术的金标准。
