From the Department of Urology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
From the Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Exp Clin Transplant. 2022 Jul;20(7):657-662. doi: 10.6002/ect.2022.0086.
Living donor transplant techniques must ensure donor safety and minimize complications. To achieve this goal, in 2003, we developed a new surgical procedure named video-assisted mini-laparotomy surgery for living donor nephrectomy. Video-assisted mini-laparotomy surgery standardizes the retroperitoneal mini-laparotomy technique as an alternative to open surgery. We have previously reported on video-assisted mini-laparotomy surgery techniques for use in kidney surgery. However, there are no reports of video-assisted mini-laparotomy surgery performed at other institutions. Therefore, we introduced video-assisted mini-laparotomy surgery at another institution, and here, we report on our experience.
We evaluated a consecutive series of 38 donors who underwent video-assisted mini-laparotomy living donor nephrectomy at National Health Insurance Service Ilsan Hospital from August 2016 to November 2019. All 38 patients were enrolled. Perioperative data and outcomes were retrospectively analyzed. We recorded perioperative and postoperative data, including operative time, estimated blood loss, and duration of hospital stay.
The mean operative time was 144.35 ± 22.79 minutes, and the mean warm ischemia time was 184.35 ± 4.97 seconds. Mean estimated blood loss was 72.85 ± 60.81 mL. At 12 months after video-assisted mini-laparotomy surgery, the mean posttransplant serum creatinine level was 1.05 ± 0.18 mg/dL, and estimated glomerular filtration rate (according to the Modification of Diet in Renal Disease study equation) was 71.9 ± 10.34 mL/min/1.73 m2. There was no intraoperative or postoperative complication.
Previous studies reported that video- assisted mini-laparotomy surgery has a steep learning curve and is difficult to reproduce. However, video- assisted mini-laparotomy surgery is a feasible and safe technique at our institution. Video-assisted mini- laparotomy surgery is a solo surgery that can be safely performed by any surgeon with prior kidney surgery experience.
活体供者移植技术必须确保供者安全并将并发症降至最低。为实现这一目标，我们于 2003 年开发了一种新的手术程序，即视频辅助小切口腹腔镜活体供肾切除术。视频辅助小切口腹腔镜手术使后腹腔镜小切口技术标准化，成为开放手术的替代方法。我们之前已经报道了用于肾脏手术的视频辅助小切口腹腔镜手术技术。然而，没有其他机构实施视频辅助小切口腹腔镜手术的报道。因此，我们在另一家机构引入了视频辅助小切口腹腔镜手术，在此报告我们的经验。
我们评估了 2016 年 8 月至 2019 年 11 月在韩国保健福祉部国立健康保险服务公社 Ilsan 医院接受视频辅助小切口腹腔镜活体供肾切除术的 38 例连续供者。所有 38 例患者均纳入研究。回顾性分析围手术期数据和结果。我们记录了围手术期和术后数据，包括手术时间、估计失血量和住院时间。
平均手术时间为 144.35 ± 22.79 分钟，平均热缺血时间为 184.35 ± 4.97 秒。平均估计失血量为 72.85 ± 60.81mL。视频辅助小切口手术后 12 个月，平均移植后血清肌酐水平为 1.05 ± 0.18mg/dL，肾小球滤过率（根据肾脏病饮食改良公式计算）为 71.9 ± 10.34mL/min/1.73m2。无术中或术后并发症。
既往研究报道称，视频辅助小切口手术具有陡峭的学习曲线，难以重现。然而，视频辅助小切口手术在我们机构是一种可行且安全的技术。视频辅助小切口手术是一种单人手术，任何具有肾脏手术经验的外科医生都可以安全地进行。
