Rally Sahil, Sharma Ashish, Singh Sarbpreet, Patil Shivakumar S, Pandey Gaurav Shankar, Kapoor Kunal, Seth Abhinav, Kenwar Deepesh Benjamin
Department of Renal Transplant Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Renal Transplant Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Transplant Proc. 2020 Jul-Aug;52(6):1671-1674. doi: 10.1016/j.transproceed.2020.03.016. Epub 2020 May 21.
Laparoscopic donor nephrectomy (LDN) is considered the gold standard for live donor nephrectomies owing to lesser pain, shorter hospitalization, and earlier return to normal activities, yet it remains a technically challenging surgery. Repetition of a highly skilled task such as LDN should lead to improved performance reflected in shorter surgery times and a decrease in adverse events.
The records of over 2524 LDNs from February 2004 to June 2019 were evaluated for duration of surgery (from incision time to clamping of the renal artery) and occurrence of complications.
The mean duration of surgery ± SD from incision to clamp time for the first 100 cases at the inception of LDN was 166.13 ± 33.28 minutes whereas it was 124.59 ± 35.91 minutes for the best 100 consecutive cases in 2015 with a decrease of 41 minutes duration of surgery from incision to artery clamping. The adverse events were accessory renal artery injury (n = 10), splenic laceration (n = 2), bowel and mesocolon injuries (n = 12), venous or arterial clip slippage (n = 4), inferior vena cava tear (n = 2) pneumothorax (during stapler application, n = 1), missing gauze counts (n = 1), chylous ascites (n = 1), ureteric thermal injury (n = 2), and renal parenchyma injury (n = 3).
LDN is a technically demanding surgery where surgeon experience appears to affect operative metrics such as operative time. The occurrence of intraoperative complications appears to be acceptably low, although serious complications are a possibility.
腹腔镜供肾切除术（LDN）因疼痛较轻、住院时间较短且能更早恢复正常活动，被视为活体供肾切除术的金标准，但它仍是一项技术要求较高的手术。重复进行诸如LDN这样的高技能任务应会使手术表现得到改善，表现为手术时间缩短和不良事件减少。
对2004年2月至2019年6月期间超过2524例LDN手术的记录进行评估，分析手术时长（从切开时间到肾动脉夹闭时间）及并发症发生情况。
LDN开展初期的前100例手术，从切开到夹闭的平均手术时长±标准差为166.13±33.28分钟，而2015年连续最佳的100例手术，该时长为124.59±35.91分钟，从切开到动脉夹闭的手术时长减少了41分钟。不良事件包括副肾动脉损伤（n = 10）、脾撕裂伤（n = 2）、肠和结肠系膜损伤（n = 12）、静脉或动脉夹滑脱（n = 4）、下腔静脉撕裂（n = 2）、气胸（在使用吻合器时，n = 1）、纱布计数错误（n = 1）乳糜腹水（n = 1）、输尿管热损伤（n = 2）以及肾实质损伤（n = 3）。
LDN是一项技术要求高的手术，外科医生的经验似乎会影响手术指标，如手术时间。术中并发症的发生率似乎较低，但仍有可能发生严重并发症。
