Kumar A, Chaturvedi S, Gulia A, Maheshwari R, Dassi V, Desai P
Department of Urology, Robotic & Renal Transplantation, Max Super Speciality Hospital Saket, New Delhi, India.
Department of Urology, Robotic & Renal Transplantation, Max Super Speciality Hospital Saket, New Delhi, India.
Transplant Proc. 2018 Oct;50(8):2327-2332. doi: 10.1016/j.transproceed.2018.03.034. Epub 2018 Mar 16.
To compare outcomes between right- and left-sided laparoscopic live donor nephrectomy (LDN). Left LDN (LLDN) remains the side of choice whenever possible because the left renal vein is longer; however, there are some donors in whom the right kidney is taken for donation due to anatomical or functional reasons. Right LDN (RLDN) is perceived to be difficult due to anatomical factors. Therefore, many surgeons have a bias for left kidney donation or will do right side donation as an open donor nephrectomy. At our institution, we routinely perform RLDN when indicated and herein compare the outcomes between right- and left-sided LDN.
From January 2007 to January 2017, 1850 laparoscopic donor nephrectomies were conducted at the Max Super Speciality Hospital. Of these, 168 were right-sided donor nephrectomies and 1682 were left-sided donor nephrectomies. All the donor case records were retrospectively reviewed; the operative time, warm ischemia time, intraoperative events, blood loss, and postoperative parameters were recorded. The kidney recipient data were also recorded.
The donor demographic characteristics were comparable between 2 groups. Among other variables, operating time was significantly less in RLDN (120 minutes) versus the LLDN group (146 minutes). Intraoperative estimated blood loss (118 mL in RLDN; 126 mL in LLDN), warm ischemia time (4.8 minutes in RLDN; 5.2 minutes in LLDN) and hospital stay (4.2 days in RLDN; 4.3 days in LLDN) was comparable. Vascular complications occurred in four patients in the RLDN group and six cases in the LLDN group. Recipient outcomes were comparable.
With adequate experience, RLDN can be accomplished in a safe manner with comparable outcomes to LLDN.
比较右侧与左侧腹腔镜活体供肾肾切除术（LDN）的手术结果。只要有可能，左肾LDN（LLDN）仍是首选，因为左肾静脉更长；然而，由于解剖或功能原因，有些供体的右肾会被摘取用于捐赠。由于解剖因素，右肾LDN（RLDN）被认为难度较大。因此，许多外科医生倾向于摘取左肾进行捐赠，或者会选择开放性供肾肾切除术来摘取右肾。在我们机构，我们在有指征时常规进行RLDN，并在此比较右侧与左侧LDN的手术结果。
2007年1月至2017年1月，马克斯超级专科医院共进行了1850例腹腔镜供肾肾切除术。其中，168例为右侧供肾肾切除术，1682例为左侧供肾肾切除术。对所有供体病例记录进行回顾性分析；记录手术时间、热缺血时间、术中情况、失血量和术后参数。同时也记录了肾受者的数据。
两组供体的人口统计学特征具有可比性。在其他变量中，RLDN组的手术时间（120分钟）明显短于LLDN组（146分钟）。术中估计失血量（RLDN组为118 mL；LLDN组为126 mL）、热缺血时间（RLDN组为4.8分钟；LLDN组为5.2分钟）和住院时间（RLDN组为4.2天；LLDN组为4.3天）具有可比性。RLDN组有4例患者发生血管并发症，LLDN组有6例。受者的手术结果具有可比性。
有了足够的经验，RLDN可以安全完成，手术结果与LLDN相当。
