Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Asian J Endosc Surg. 2021 Oct;14(4):692-699. doi: 10.1111/ases.12922. Epub 2021 Feb 9.
We previously reported that the outcomes of pure retroperitoneoscopic donor nephrectomy are superior to those of hand-assisted retroperitoneoscopic donor nephrectomy. Consequently, we introduced pure retroperitoneoscopic donor nephrectomy in our hospital. Here, we compared perioperative outcomes between hand-assisted intra-abdominal laparoscopic donor nephrectomy and pure retroperitoneoscopic donor nephrectomy.
We retrospectively reviewed data from 315 living-donor kidney transplantation procedures performed between October 2015 and December 2020 (213 involving hand-assisted intra-abdominal laparoscopic donor nephrectomy, October 2015 to June 2019; 102 involving pure retroperitoneoscopic donor nephrectomy, May 2019 to December 2020). After propensity score matching, 90 transplantations were included in each group (n = 180 overall).
Donors in the pure retroperitoneoscopic donor nephrectomy group had longer warm ischemia times (P < .001), lower serum C-reactive protein concentrations and white blood cell counts on postoperative day 1 (P < .001 and P < .001, respectively), and shorter postoperative stays (P < .001) than donors in the hand-assisted intra-abdominal laparoscopic donor nephrectomy group. Five (5.6%) modified Clavien-classifiable complications occurred in the hand-assisted intra-abdominal laparoscopic donor nephrectomy group; no complications occurred in the pure retroperitoneoscopic donor nephrectomy group (P = 0.008). One recipient in the hand-assisted intra-abdominal laparoscopic donor nephrectomy group had donor-related delayed graft function. There were no significant differences between groups in recipient estimated glomerular filtration on postoperative day 7.
The introduction of pure retroperitoneoscopic donor nephrectomy was safe and effective. Moreover, it was less invasive and less harmful for donors, compared with hand-assisted intra-abdominal laparoscopic donor nephrectomy; recipient outcomes were equivalent.
我们之前报告过，单纯后腹腔镜供肾切取术的结果优于手助后腹腔镜供肾切取术。因此，我们在我院引入了单纯后腹腔镜供肾切取术。在这里，我们比较了手助腹腔内腹腔镜供肾切取术和单纯后腹腔镜供肾切取术的围手术期结果。
我们回顾性分析了 2015 年 10 月至 2020 年 12 月期间进行的 315 例活体供肾移植手术的数据（213 例涉及手助腹腔内腹腔镜供肾切取术，2015 年 10 月至 2019 年 6 月；102 例涉及单纯后腹腔镜供肾切取术，2019 年 5 月至 2020 年 12 月）。在进行倾向评分匹配后，每组纳入 90 例移植术（共 180 例）。
单纯后腹腔镜供肾切取术组供者的热缺血时间更长（P < 0.001），术后第 1 天血清 C 反应蛋白浓度和白细胞计数更低（P < 0.001 和 P < 0.001），术后住院时间更短（P < 0.001）。手助腹腔内腹腔镜供肾切取术组发生 5 例（5.6%）改良 Clavien 可分类并发症；单纯后腹腔镜供肾切取术组无并发症（P = 0.008）。手助腹腔内腹腔镜供肾切取术组 1 例受者发生供者相关延迟移植物功能。术后第 7 天，两组受者估算肾小球滤过率无显著差异。
引入单纯后腹腔镜供肾切取术是安全有效的。与手助腹腔内腹腔镜供肾切取术相比，它对供者的创伤更小，危害更小；受者的结果是等效的。
