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Retroperitoneoscopic Live Donor Nephrectomy (RPLDN): Establishment and Initial Experience of RPLDN at a Single Center
0022-5347/05/1743-1018/0 THE JOURNAL OF UROLOGY® Copyright © 2005 by AMERICAN UROLOGICAL ASSOCIATION
Vol. 174, 1018 –1019, September 2005 Printed in U.S.A.
DOI: 10.1097/01.ju.0000174051.51176.64
Urological Survey RENAL TRANSPLANTATION AND RENOVASCULAR HYPERTENSION Retroperitoneoscopic Live Donor Nephrectomy (RPLDN): Establishment and Initial Experience of RPLDN at a Single Center K. TANABE, N. MIYAMOTO, H. ISHIDA, T. TOKUMOTO, H. SHIRAKAWA, H. YAMAMOTO, T. KONDO, H. OKUDA, H. SHIMMURA, N. ISHIKAWA, T. NOZAKI AND H. TOMA, Section of Renal Transplantation/Renovascular Surgery, Department of Urology, Kidney Center, Tokyo Women’s Medical University, Tokyo, Japan Am J Transplant, 5: 739 –745, 2005 We tried to establish the technique of retroperitoneoscopic live donor nephrectomy (RPLDN). Between July 2001 and March 2004, 135 renal transplant donors underwent RPLDN. Low (average: 7 mmHg) CO2 gas pressure was employed during the procedure. All procedures were performed through a three-port retroperitoneal approach without opening the peritoneal cavity. The hand-assisted technique was not used. One hundred and twenty-seven cases were of left and eight cases were of right nephrectomy. Donor nephrectomy was carried out successfully in all patients. In one donor, the procedure was changed to open donor nephrectomy because of severe adhesion around the renal vein due to previous surgery. No serious complications, such as massive bleeding or bowel injury were encountered. Return of bowel function took 0.7 days on average. Post-operative hospital stay was 4.9 days on average, and return to work was 12 days on average. Ureteral complications occurred in 2 patients and were treated with temporally retrograde ureteral stenting. Average serum creatinine levels were 1.5 mg/dL, 1.3 mg/dL and 1.3 mg/dL at 3, 7 and 14 days after transplantation, respectively. No patients required hemodialysis after transplantation due to acute tubular necrosis. RPLDN could be an option for laparoscopic live donor nephrectomy. Editorial Comment: This is a large, single center experience that replicates the standard open surgical procedure (flank extraperitoneal donor nephrectomy) for living donor nephrectomy using a laparoscopic approach. Specifically, the main advantage of this approach is minimization of intraperitoneal complications such as bowel obstruction. The authors describe their experience with 135 retroperitoneoscopic donor nephrectomies, the majority of which were left sided procedures. They report limited donor morbidity, although they did note 1 case of pulmonary embolism. Notably, the recipient results were excellent. There was no delayed graft function or technical loss. Only 4% of recipients had slow graft function. Favorable results may have been facilitated by the fact that the average body mass index was 22. It will be interesting to see if United States based centers can reproduce such an experience. David A. Goldfarb, M.D.
Obesity in Living Kidney Donors: Clinical Characteristics and Outcomes in the Era of Laparoscopic Donor Nephrectomy J. K. HEIMBACH, S. J. TALER, M. PRIETO, F. G. COSIO, S. C. TEXTOR, Y. C. KUDVA, G. K. CHOW, M. B. ISHITANI, T. S. LARSON AND M. D. STEGALL, Department of Transplant Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota Am J Transplant, 5: 1057–1064, 2005 Acceptance of obese individuals as living kidney donors is controversial related to possible increased risk for surgical complications and concern that obesity may contribute to long-term renal disease. We retrospectively examined 553 consecutive hand-assisted laparoscopic living kidney donations between October 1, 1999 and April 1, 2003. We stratified donors into quartiles by baseline body mass index (BMI) assessing perioperative complications and 6 –12 months post-donation metabolic and renal function. Compared to BMI ⬍25 kg/m(2), high BMI donors (⬎ or ⫽35 kg/m(2)) had slightly longer operative times (mean increase 19 min), more overall perioperative complications (mostly minor wound complications), yet the same low rate of major surgical complications (conversion to open and reoperation) and similar length-of-stay (2.3 vs. 2.4 days). At 6 –12 months after donation (mean 11 months), renal function and microalbuminuria did not differ with BMI. These results suggest that laparoscopic donor nephrectomy is generally safe in selected obese donors and does not result in a high rate of major perioperative complications. Obese donors have higher baseline cardiovascular risk and warrant risk reduction for long-term health. While early results are 1018
Vol. 174, 1018 –1019, September 2005 Printed in U.S.A.
DOI: 10.1097/01.ju.0000174051.51176.64
Urological Survey RENAL TRANSPLANTATION AND RENOVASCULAR HYPERTENSION Retroperitoneoscopic Live Donor Nephrectomy (RPLDN): Establishment and Initial Experience of RPLDN at a Single Center K. TANABE, N. MIYAMOTO, H. ISHIDA, T. TOKUMOTO, H. SHIRAKAWA, H. YAMAMOTO, T. KONDO, H. OKUDA, H. SHIMMURA, N. ISHIKAWA, T. NOZAKI AND H. TOMA, Section of Renal Transplantation/Renovascular Surgery, Department of Urology, Kidney Center, Tokyo Women’s Medical University, Tokyo, Japan Am J Transplant, 5: 739 –745, 2005 We tried to establish the technique of retroperitoneoscopic live donor nephrectomy (RPLDN). Between July 2001 and March 2004, 135 renal transplant donors underwent RPLDN. Low (average: 7 mmHg) CO2 gas pressure was employed during the procedure. All procedures were performed through a three-port retroperitoneal approach without opening the peritoneal cavity. The hand-assisted technique was not used. One hundred and twenty-seven cases were of left and eight cases were of right nephrectomy. Donor nephrectomy was carried out successfully in all patients. In one donor, the procedure was changed to open donor nephrectomy because of severe adhesion around the renal vein due to previous surgery. No serious complications, such as massive bleeding or bowel injury were encountered. Return of bowel function took 0.7 days on average. Post-operative hospital stay was 4.9 days on average, and return to work was 12 days on average. Ureteral complications occurred in 2 patients and were treated with temporally retrograde ureteral stenting. Average serum creatinine levels were 1.5 mg/dL, 1.3 mg/dL and 1.3 mg/dL at 3, 7 and 14 days after transplantation, respectively. No patients required hemodialysis after transplantation due to acute tubular necrosis. RPLDN could be an option for laparoscopic live donor nephrectomy. Editorial Comment: This is a large, single center experience that replicates the standard open surgical procedure (flank extraperitoneal donor nephrectomy) for living donor nephrectomy using a laparoscopic approach. Specifically, the main advantage of this approach is minimization of intraperitoneal complications such as bowel obstruction. The authors describe their experience with 135 retroperitoneoscopic donor nephrectomies, the majority of which were left sided procedures. They report limited donor morbidity, although they did note 1 case of pulmonary embolism. Notably, the recipient results were excellent. There was no delayed graft function or technical loss. Only 4% of recipients had slow graft function. Favorable results may have been facilitated by the fact that the average body mass index was 22. It will be interesting to see if United States based centers can reproduce such an experience. David A. Goldfarb, M.D.
Obesity in Living Kidney Donors: Clinical Characteristics and Outcomes in the Era of Laparoscopic Donor Nephrectomy J. K. HEIMBACH, S. J. TALER, M. PRIETO, F. G. COSIO, S. C. TEXTOR, Y. C. KUDVA, G. K. CHOW, M. B. ISHITANI, T. S. LARSON AND M. D. STEGALL, Department of Transplant Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota Am J Transplant, 5: 1057–1064, 2005 Acceptance of obese individuals as living kidney donors is controversial related to possible increased risk for surgical complications and concern that obesity may contribute to long-term renal disease. We retrospectively examined 553 consecutive hand-assisted laparoscopic living kidney donations between October 1, 1999 and April 1, 2003. We stratified donors into quartiles by baseline body mass index (BMI) assessing perioperative complications and 6 –12 months post-donation metabolic and renal function. Compared to BMI ⬍25 kg/m(2), high BMI donors (⬎ or ⫽35 kg/m(2)) had slightly longer operative times (mean increase 19 min), more overall perioperative complications (mostly minor wound complications), yet the same low rate of major surgical complications (conversion to open and reoperation) and similar length-of-stay (2.3 vs. 2.4 days). At 6 –12 months after donation (mean 11 months), renal function and microalbuminuria did not differ with BMI. These results suggest that laparoscopic donor nephrectomy is generally safe in selected obese donors and does not result in a high rate of major perioperative complications. Obese donors have higher baseline cardiovascular risk and warrant risk reduction for long-term health. While early results are 1018