Tsoulfas Georgios, Agorastou Polyxeni, Ko Dicken S C, Hertl Martin, Elias Nahel, Cosimi A B, Kawai Tatsuo
Georgios Tsoulfas, Polyxeni Agorastou, Department of Surgery, Aristotle University of Thessaloniki, 54622 Thessaloniki, Greece.
World J Nephrol. 2017 Jan 6;6(1):45-52. doi: 10.5527/wjn.v6.i1.45.
To compare laparoscopic and open living donor nephrectomy, based on the results from a single center during a decade.
This is a retrospective review of all living donor nephrectomies performed at the Massachusetts General Hospital, Harvard Medical School, Boston, between 1/1998 - 12/2009. Overall there were 490 living donors, with 279 undergoing laparoscopic living donor nephrectomy (LLDN) and 211 undergoing open donor nephrectomy (OLDN). Demographic data, operating room time, the effect of the learning curve, the number of conversions from laparoscopic to open surgery, donor preoperative glomerular filtration rate and creatinine (Cr), donor and recipient postoperative Cr, delayed graft function and donor complications were analyzed. Statistical analysis was performed.
Overall there was no statistically significant difference between the LLDN and the OLDN groups regarding operating time, donor preoperative renal function, donor and recipient postoperative kidney function, delayed graft function or the incidence of major complications. When the last 100 laparoscopic cases were analyzed, there was a statistically significant difference regarding operating time in favor of the LLDN, pointing out the importance of the learning curve. Furthermore, another significant difference between the two groups was the decreased length of stay for the LLDN (2.87 d for LLDN 3.6 d for OLDN).
Recognizing the importance of the learning curve, this paper provides evidence that LLDN has a safety profile comparable to OLDN and decreased length of stay for the donor.
基于一个单一中心十年间的结果，比较腹腔镜活体供肾切除术和开放性活体供肾切除术。
这是一项对1998年1月至2009年12月在波士顿哈佛医学院麻省总医院进行的所有活体供肾切除术的回顾性研究。总共有490名活体供者，其中279例行腹腔镜活体供肾切除术（LLDN），211例行开放性供肾切除术（OLDN）。分析了人口统计学数据、手术时间、学习曲线的影响、腹腔镜手术转为开放手术的次数、供者术前肾小球滤过率和肌酐（Cr）、供者和受者术后Cr、移植肾功能延迟和供者并发症。进行了统计分析。
总体而言，LLDN组和OLDN组在手术时间、供者术前肾功能、供者和受者术后肾功能、移植肾功能延迟或主要并发症发生率方面无统计学显著差异。当分析最后100例腹腔镜手术病例时，手术时间在LLDN组更具优势，具有统计学显著差异，这指出了学习曲线的重要性。此外，两组之间的另一个显著差异是LLDN组住院时间缩短（LLDN组为2.87天，OLDN组为3.6天）。
认识到学习曲线的重要性，本文提供了证据表明LLDN与OLDN具有相当的安全性，且供者住院时间缩短。
