1 Department of General Surgery, Post Graduate Institute of Medical Education and Research , Chandigarh, India .
2 Department of Renal Transplant Surgery, Post Graduate Institute of Medical Education and Research , Chandigarh, India .
J Endourol. 2018 Jun;32(6):496-501. doi: 10.1089/end.2017.0829. Epub 2018 Apr 12.
Laparoscopic donor nephrectomy (LDN) converted a retroperitoneal (RP) procedure into a transperitoneal (TP) operation with reports of bowel and solid organ injuries leading to mortality in occasional cases. Laparoscopic RP donor nephrectomy can reduce these risks but never became popular because of the muscle cutting approach. Lumbotomy incision can be used to approach retroperitoneum by incising fascial planes, eliminating disadvantages of the RP approach. This report compares the outcomes of the standard multiport TP LDN with translumbar laparoendoscopic single-site donor nephrectomy (LESS-DN).
Between January 2016 and June 2017, 50 voluntary kidney donors out of 267 donors were randomized to undergo LESS-DN vs LDN. Donors with body mass index ≥30 kg/m, multiple renal arteries, and right-sided nephrectomy were excluded from the study. Postoperative pain, duration of surgery, length of graft vessels and ureter, warm ischemia time, intraoperative blood loss, incision length, convalescence period, duration of hospital stay, and recipients' creatinine at discharge were compared among both the groups. Pain assessment was done using visual analogue scale (VAS).
The RP group experienced lesser pain (VAS score 0.3 ± 0.3 vs 1.1 ± 0.0, p = 0.000), lesser analgesic requirement (186 ± 51.07 mg vs 254 ± 62.7 mg, p = 0.000), and faster convalescence (7.0 ± 3.0 days vs 10.7 ± 3.3 days, p = 0.00) related to smaller cumulative incision (7.8 ± 0.8 cm vs12.4 ± 2.0 cm, p = 0.00), and had reduced operative time (142 ± 26.2 minutes vs 170.8 ± 34.75 minutes, p = 0.001) and blood loss. Other recorded parameters were similar in both the groups.
The single port RP approach significantly reduced postoperative pain and hastened recovery when compared with the TP approach. Converting to a RP approach presents an opportunity for surgeons to further reduce morbidity associated with the donor nephrectomy.
腹腔镜供肾切除术（LDN）将后腹腔镜（RP）手术转变为经腹腔（TP）手术，有报道称肠道和实体器官损伤导致偶尔发生死亡。腹腔镜 RP 供肾切除术可以降低这些风险，但由于肌肉切割方法，从未普及。腰切开术可以通过切开筋膜平面来接近后腹腔，消除 RP 方法的缺点。本报告比较了标准多端口 TP LDN 与经皮腹腔镜单部位供肾切除术（LESS-DN）的结果。
2016 年 1 月至 2017 年 6 月，267 名供体中有 50 名自愿接受肾切除术的供体随机分为 LESS-DN 组和 LDN 组。本研究排除了 BMI≥30kg/m、多支肾动脉和右侧肾切除术的供体。比较两组术后疼痛、手术时间、移植物血管和输尿管长度、热缺血时间、术中出血量、切口长度、恢复期、住院时间和出院时受者肌酐。使用视觉模拟评分法（VAS）评估疼痛。
RP 组疼痛较轻（VAS 评分 0.3±0.3 对 1.1±0.0，p=0.000），镇痛需求较少（186±51.07mg 对 254±62.7mg，p=0.000），恢复期较快（7.0±3.0 天对 10.7±3.3 天，p=0.00），与较小的累积切口（7.8±0.8cm 对 12.4±2.0cm，p=0.00）和较短的手术时间（142±26.2 分钟对 170.8±34.75 分钟，p=0.00）相关。其他记录的参数在两组间相似。
与 TP 方法相比，单端口 RP 方法显著减轻术后疼痛并加速恢复。转为 RP 方法为外科医生提供了进一步降低供肾切除术相关发病率的机会。
