Rampersad Christie, Patel Premal, Koulack Joshua, McGregor Thomas
College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
Section of Urology, University of Manitoba, Winnipeg, MB, Canada.
Can Urol Assoc J. 2016 Aug;10(7-8):253-257. doi: 10.5489/cuaj.3725.
Laparoscopic living donor nephrectomy is the standard of care at high-volume renal transplant centres, with benefits over the open approach well-documented in the literature. Herein, we present a retrospective analysis of our single-institution donor nephrectomy series comparing the mini-open donor nephrectomy (mini-ODN) to the laparoscopic donor nephrectomy (LDN) with regards to operative, donor, and recipient outcomes.
From 2007-2011, there were 89 cases of mini-ODN, at which point our centre transitioned to LDN; 94 cases were performed from 2011-2014. In total, 366 patients were reviewed, including donor and recipient pairs. Donor and recipient demographics, intraoperative data, postoperative donor recovery, recipient graft outcomes, and financial cost were assessed comparing the surgical approaches.
We demonstrate a reduced estimated blood loss (347.83 vs. 90.3 cc), lower intraoperative complication rate (4 vs. 11) and shorter length of hospital stay (2.4 vs. 3.3 days) for patients in the LDN group. Operative time was significantly longer for the LDN group (108.4 vs. 165.9 minutes), although this did not translate to a longer warm ischemia time (mean 2.0 minutes for each group). The rate of delayed graft function and recipient 12-month creatinine were comparable for ODN and LND. Overall cost of LDN was $684 higher for an uncomplicated admission.
Despite a longer surgical time and higher upfront cost, our study supports that LDN yields several advantages over the mini-ODN, with a lower estimated blood loss, fewer intraoperative complications, and shorter length of hospital stay, all while maintaining excellent renal allograft outcomes.
腹腔镜活体供肾切除术是大型肾脏移植中心的标准治疗方法，文献中已充分证明其相较于开放手术的优势。在此，我们对本单机构供肾切除术系列进行回顾性分析，比较了小切口开放供肾切除术（mini-ODN）与腹腔镜供肾切除术（LDN）在手术、供体和受体结局方面的差异。
2007年至2011年，共进行了89例mini-ODN手术，之后我们中心转为采用LDN；2011年至2014年进行了94例LDN手术。总共对366例患者进行了评估，包括供体和受体配对。比较两种手术方式下供体和受体的人口统计学特征、术中数据、供体术后恢复情况、受体移植结局以及费用。
我们发现LDN组患者的估计失血量减少（347.83对90.3毫升）、术中并发症发生率较低（4对11）且住院时间较短（2.4对3.3天）。LDN组的手术时间明显更长（108.4对165.9分钟），不过这并未转化为更长的热缺血时间（每组平均2.0分钟）。ODN和LND的移植肾功能延迟发生率和受体12个月时的肌酐水平相当。对于无并发症的住院患者，LDN的总体费用高出684美元。
尽管手术时间更长且前期费用更高，但我们的研究支持LDN相较于mini-ODN具有多项优势，包括估计失血量更低、术中并发症更少、住院时间更短，同时能保持出色的肾移植结局。
