Widmer Jeannette D, Schlegel Andrea, Kron Philipp, Schiesser Marc, Brockmann Jens G, Muller Markus K
Department of Surgery, Kantonsspital Frauenfeld, 8500, Frauenfeld, Switzerland.
Division of Visceral and Transplantation Surgery, University Hospital, Zurich, Switzerland.
BMC Urol. 2018 May 10;18(1):39. doi: 10.1186/s12894-018-0355-2.
Living-donor nephrectomy (LDN) is challenging, as surgery is performed on healthy individuals. Minimally invasive techniques for LDN have become standard in most centers. Nevertheless, numerous techniques have been described with no consensus on which is the superior approach. Both hand-assisted retroperitoneoscopic (HARS) and hand-assisted laparoscopic (HALS) LDNs are performed at Zurich University Hospital. The aim of this study was to compare these two surgical techniques in terms of donor outcome and graft function.
Retrospective single-center analysis of 60 consecutive LDNs (HARS n = 30; HALS n = 30) from June 2010 to May 2012, including a one-year follow-up of the recipients.
There was no mortality in either group and little difference in the overall complication rates. Median warm ischemia time (WIT) was significantly shorter in the HARS group. The use of laxatives and the incidence of postoperative vomiting were significantly greater in the HALS group. There was no difference between right- and left-sided nephrectomies in terms of donor outcome and graft function.
Both techniques appear safe for both donors and donated organs. The HARS technique is associated with a shorter WIT and a reduced incidence of postoperative paralytic ileus. Therefore, we consider HARS LDN a valuable alternative to HALS LDN.
活体供肾肾切除术（LDN）具有挑战性，因为手术是在健康个体身上进行的。在大多数中心，LDN的微创技术已成为标准术式。然而，已有多种技术被描述，但对于哪种方法更优尚无共识。苏黎世大学医院同时开展手辅助后腹腔镜（HARS）和手辅助腹腔镜（HALS）LDN手术。本研究的目的是比较这两种手术技术在供体结局和移植肾功能方面的差异。
对2010年6月至2012年5月期间连续进行的60例LDN手术（HARS组n = 30；HALS组n = 30）进行回顾性单中心分析，包括对受者进行为期一年的随访。
两组均无死亡病例，总体并发症发生率差异不大。HARS组的中位热缺血时间（WIT）明显更短。HALS组使用泻药的情况和术后呕吐发生率明显更高。在供体结局和移植肾功能方面，左右侧肾切除术之间没有差异。
两种技术对供体和捐赠器官似乎都是安全的。HARS技术与较短的WIT和术后麻痹性肠梗阻发生率降低相关。因此，我们认为HARS LDN是HALS LDN的一种有价值的替代方法。
