Van der Merwe Andre, Heyns C F
Department of Urology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Tygerberg, Cape Town, South Africa.
S Afr J Surg. 2014 Jun 6;52(2):53-6. doi: 10.7196/sajs.2080.
Changing from an open to a laparoscopic live renal donor programme poses challenges and may affect donor and graft outcomes.
To evaluate donor safety and graft outcomes for the first 50 retroperitoneoscopic live donor nephrectomies performed at Tygerberg Hospital, Cape Town, South Africa.
The procedures were performed by a single surgeon from 8 April 2008 to 3 April 2012. Operative and anatomical data were prospectively collected. A flank approach with lateral and posterior placements was used. Vascular control was achieved with Hem-o-lok clips in the majority of cases.
The mean age of the donors was 31.5 years (range 18 - 50), 28 (56.0%) were male, and the left kidney was harvested in 28 (56.0%) of cases. The mean operating time was 149.8 minutes (range 75 - 250), mean warm ischaemic time (WIT) 181.3 seconds (107 - 630), mean blood loss 139.7 ml (5 - 700) and mean hospital stay 3.2 days (2 - 5). Mean WIT was significantly longer for right-sided than left-sided nephrectomy (213 v. 162 seconds). In two right-sided cases the renal vein was too short and vena profunda femoris was used to create length. No donor received a blood transfusion. Comparing the last 25 with the first 25 cases showed a significant decrease in mean WIT (158 v. 204 seconds) and operating time (128 v. 172 minutes). No major complications occurred.
Our initial 50 retroperitoneoscopic live donor nephrectomies were performed without major complications. Donor safety was maintained during the early learning curve of the transition to minimal-access donor nephrectomy.
从开放式活体肾供体手术方案转变为腹腔镜手术方案会带来挑战，且可能影响供体和移植肾的结局。
评估在南非开普敦泰格堡医院进行的前50例后腹腔镜活体供肾切除术的供体安全性和移植肾结局。
手术由一名外科医生于2008年4月8日至2012年4月3日完成。前瞻性收集手术和解剖学数据。采用经侧方和后方放置的侧腹入路。大多数病例使用Hem-o-lok夹进行血管控制。
供体的平均年龄为31.5岁（范围18 - 50岁），28例（56.0%）为男性，28例（56.0%）切除的是左肾。平均手术时间为149.8分钟（范围75 - 250分钟），平均热缺血时间（WIT）为181.3秒（107 - 630秒），平均失血量为139.7毫升（5 - 700毫升），平均住院时间为3.2天（2 - 5天）。右侧肾切除术的平均WIT明显长于左侧（213秒对162秒）。在两例右侧病例中，肾静脉过短，使用股深静脉来延长长度。没有供体接受输血。将最后25例与前25例进行比较，平均WIT（158秒对204秒）和手术时间（128分钟对172分钟）显著缩短。未发生重大并发症。
我们最初的50例后腹腔镜活体供肾切除术未发生重大并发症。在向微创供肾切除术过渡的早期学习曲线期间，供体安全性得到了维持。
