Boentoro Senohadi, Wahyudi Irfan, Mochtar Chaidir A, Hamid Agus Rizal Ah
Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Res Rep Urol. 2020 Jan 15;12:1-5. doi: 10.2147/RRU.S229431. eCollection 2020.
Laparoscopic surgery has been acknowledged to reduce the morbidity rate thus improving patient safety. During the LLDN, the most frequent complication is renal vessels injuries, which often requires a blood transfusion. Besides the need for a blood transfusion, major bleeding caused by renal vessels injuries requires open conversion and repair. Thus, this study would like to descript and analyze the need for blood transfusion in laparoscopic living donor nephrectomy surgery in our center.
We performed a retrospective cohort study in the Department of Urology at Cipto Mangunkusumo National Hospital. The records of all kidney transplantation donor patients who underwent LLDN procedures carried out at our institution from November 2011 to October 2017 were reviewed. Data including donor age, preoperative hemoglobin level, postoperative hemoglobin level, intraoperative bleeding, number of artery(ies), number of vein(s), donor side, conversion to open surgery, surgery duration, and donor BMI were collected and analyzed. These data were further correlated with the transfusion rate.
There were 500 patients underwent laparoscopic living donor nephrectomy procedure at our institution. All of the patients had LLDN with a transperitoneal approach. The difference in blood transfusion rate proportion between male patients with 0.9% compared to 0.6% in female patients was not significant (=0.782). There is no significant difference in blood transfusion rate proportion regarding renal side (=0.494), number of artery (=0.362), age (=0.978), BMI (=0.569), and preoperative hemoglobin (=0.766). Median estimated blood loss in patients who received intraoperative blood transfusion was significantly much greater than in patients who did not receive a blood transfusion (<0.001).
Based on this study, we suggest that in our institution, preoperative blood products are not necessarily needed. The surgeon's learning curve and technique play a significant role in preventing intraoperative complications and blood loss.
腹腔镜手术已被公认为可降低发病率，从而提高患者安全性。在活体供肾腹腔镜肾切除术（LLDN）中，最常见的并发症是肾血管损伤，这通常需要输血。除了需要输血外，肾血管损伤导致的大出血需要转为开放手术并进行修复。因此，本研究旨在描述和分析我们中心腹腔镜活体供肾肾切除术患者的输血需求。
我们在西爪哇省国立医院泌尿外科进行了一项回顾性队列研究。回顾了2011年11月至2017年10月在我们机构接受LLDN手术的所有肾移植供体患者的记录。收集并分析了包括供体年龄、术前血红蛋白水平、术后血红蛋白水平、术中出血情况、动脉数量、静脉数量、供体侧别、转为开放手术情况、手术持续时间和供体体重指数（BMI）等数据。这些数据进一步与输血率相关联。
我们机构有500例患者接受了腹腔镜活体供肾肾切除术。所有患者均采用经腹途径进行LLDN。男性患者输血率为0.9%，女性患者为0.6%，两者差异不显著（P=0.782）。在肾侧别（P=0.494）、动脉数量（P=0.362）、年龄（P=0.978）、BMI（P=0.569）和术前血红蛋白（P=0.766）方面，输血率比例无显著差异。接受术中输血患者的中位估计失血量显著高于未接受输血的患者（P<0.001）。
基于本研究，我们建议在我们机构，术前不一定需要备血制品。外科医生的学习曲线和技术在预防术中并发症和失血方面起着重要作用。
