Top

Published in:

01-12-2008 | Topic Paper

Complications of retroperitoneoscopic living donor nephrectomy: single center experience after 164 cases

Authors: Alexander Bachmann, Stephen Wyler, Thomas Wolff, Lorenz Gürke, Jürg Steiger, Christoph Kettelhack, Thomas C. Gasser, Robin Ruszat

Published in: World Journal of Urology | Issue 6/2008

Abstract

Objectives

Retroperitoneoscopic living donor nephrectomy (RLDN) is used by only a few centers worldwide. Similar to laparoscopic living donor nephrectomy it offers the donor rapid convalescence and excellent cosmetic results. However, concerns have been expressed over the safety of endoscopic living donor nephrectomy.

Methods

We review the results of 164 consecutive RLDN from November 2001 to November 2007. Complications were classified into intra- and early postoperative.

Results

Mean donor age was 53.4 ± 10.7 years (27–79). Left kidneys were harvested in 76% of cases. Mean operation time was 146 ± 44 min (55–270), and warm ischemia time 131 ± 45 s (50–280). In two patients (1.2%) conversion to open nephrectomy was necessary. The intraoperative complication rate was 3.0%. In the postoperative period we observed in 17.7% minor complications with no persisting impairments for the donor. The rate of major complications in the early postoperative period was 4.3%. Three patients (1.8%) necessitated revision, due to laceration of the external iliac artery in one patient and chyloretroperitoneum in two patients. Mean donor creatinine was 113.1 ± 26.6 mg/dl (63–201) on the first postoperative day, and 102.0 ± 22.2 mg/dl (68–159) on the fifth postoperative day.

Conclusion

Retroperitoneoscopic living donor nephrectomy can be performed with acceptable intraoperative and early postoperative morbidity. Operation times and warm ischemia times are comparable to the open approach.

Ratner LE, Ciseck LJ, Moore RG, Cigarroa FG, Kaufman HS, Kavoussi LR (1995) Laparoscopic live donor nephrectomy. Transplantation 60(9):1047–1049PubMed

Gill IS, Uzzo RG, Hobart MG, Streem SB, Goldfarb DA, Noble MJ (2000) Laparoscopic retroperitoneal live donor right nephrectomy for purposes of allotransplantation and autotransplantation. J Urol 164(5):1500–1504PubMedCrossRef

Bachmann A, Dickenmann M, Gurke L, Giannini O, Langer I, Gasser TC, Steiger J, Sulser T (2004) Retroperitoneoscopic living donor nephrectomy: a retrospective comparison to the open approach. Transplantation 78(1):168–171PubMedCrossRef

Ratner LE, Kavoussi LR, Sroka M, Hiller J, Weber R, Schulam PG, Montgomery R (1997) Laparoscopic assisted live donor nephrectomy—a comparison with the open approach. Transplantation 63(2):229–233PubMedCrossRef

Wolf JS Jr, Marcovich R, Merion RM, Konnak JW (2000) Prospective, case matched comparison of hand assisted laparoscopic and open surgical live donor nephrectomy. J Urol 163(6):1650–1653PubMedCrossRef

Stifelman MD, Hull D, Sosa RE, Su LM, Hyman M, Stubenbord W, Shichman S (2001) Hand assisted laparoscopic donor nephrectomy: a comparison with the open approach. J Urol 166(2):444–448PubMedCrossRef

Velidedeoglu E, Williams N, Brayman KL, Desai NM, Campos L, Palanjian M, Wocjik M, Bloom R, Grossman RA, Mange K, Barker CF, Naji A, Markmann JF (2002) Comparison of open, laparoscopic, and hand-assisted approaches to live-donor nephrectomy. Transplantation 74(2):169–172PubMedCrossRef

Chung E, Grant AB, Hibberd AD, Sprott P (2007) Why potential live renal donors prefer laparoscopic nephrectomy: a survey of live donor attitudes. BJU Int 100(6):1344–1346PubMedCrossRef

Giessing M, Reuter S, Deger S, Tullmann M, Hirte I, Budde K, Fritsche L, Slowinski T, Dragun D, Neumayer HH, Loening SA, Schonberger B (2005) Laparoscopic versus open donor nephrectomy in Germany: impact on donor health-related quality of life and willingness to donate. Transplant Proc 37(5):2011–2015PubMedCrossRef

10.

Kuo PC, Johnson LB (2000) Laparoscopic donor nephrectomy increases the supply of living donor kidneys: a center-specific microeconomic analysis. Transplantation 69(10):2211–2213PubMedCrossRef

11.

Schweitzer EJ, Wilson J, Jacobs S, Machan CH, Philosophe B, Farney A, Colonna J, Jarrell BE, Bartlett ST (2000) Increased rates of donation with laparoscopic donor nephrectomy. Ann Surg 232(3):392–400PubMedCrossRef

12.

Nanidis TG, Antcliffe D, Kokkinos C, Borysiewicz CA, Darzi AW, Tekkis PP, Papalois VE (2008) Laparoscopic versus open live donor nephrectomy in renal transplantation: a meta-analysis. Ann Surg 247(1):58–70PubMedCrossRef

13.

Goldfarb DA (2001) Are concerns over right laparoscopic donor nephrectomy unwarranted? J Urol 166(6):2558–2559PubMedCrossRef

14.

Murray JE, Harrison JH (1963) Surgical management of fifty patients with kidney transplants including eighteen pairs of twins. Am J Surg 105:205–218PubMedCrossRef

15.

Bachmann A, Wolff T, Ruszat R, Giannini O, Dickenmann M, Gurke L, Steiger J, Gasser TC, Stief CG, Sulser T (2005) Retroperitoneoscopic donor nephrectomy: a retrospective, non-randomized comparison of early complications, donor and recipient outcome with the standard open approach. Eur Urol 48(1):90–96PubMedCrossRef

16.

Oyen O, Andersen M, Mathisen L, Kvarstein G, Edwin B, Line PD, Scholz T, Pfeffer PF (2005) Laparoscopic versus open living-donor nephrectomy: experiences from a prospective, randomized, single-center study focusing on donor safety. Transplantation 79(9):1236–1240PubMedCrossRef

17.

Simforoosh N, Basiri A, Tabibi A, Shakhssalim N, Hosseini Moghaddam SM (2005) Comparison of laparoscopic and open donor nephrectomy: a randomized controlled trial. BJU Int 95(6):851–855PubMedCrossRef

18.

Bachmann A, Giannini O, Wolff T, Dickenmann M, Ruszat R, Langer I, Gurke L, Gasser TC, Reich O, Stief CG, Steiger J, Sulser T (2005) Retroperitoneoscopic living donor nephrectomy: a comparison with the open approach in respect of early postoperative pain management. Transplant Proc 37(2):609–612PubMedCrossRef

19.

Ng CS, Abreu SC, bou El-Fettouh HI, Kaouk JH, Desai MM, Goldfarb DA, Gill IS (2004) Right retroperitoneal versus left transperitoneal laparoscopic live donor nephrectomy. Urology 63(5):857–861PubMedCrossRef

20.

Tanabe K, Miyamoto N, Ishida H, Tokumoto T, Shirakawa H, Yamamoto H, Kondo T, Okuda H, Shimmura H, Ishikawa N, Nozaki T, Toma H (2005) Retroperitoneoscopic live donor nephrectomy (RPLDN): establishment and initial experience of RPLDN at a single center. Am J Transplant 5(4 Pt 1):739–745PubMedCrossRef

21.

Wadstrom J (2005) Hand-assisted retroperitoneoscopic live donor nephrectomy: experience from the first 75 consecutive cases. Transplantation 80(8):1060–1066PubMedCrossRef

22.

Yang SC, Rha KH, Kim YS, Kim SI, Park K (2001) Retroperitoneoscopy-assisted living donor nephrectomy: 109 cases. Transplant Proc 33(1–2):1104–1105PubMedCrossRef

23.

Buell JF, Abreu SC, Hanaway MJ, Ng CS, Kaouk JH, Clippard M, Zaki S, Goldfarb DA, Woodle ES, Gill IS (2004) Right donor nephrectomy: a comparison of hand-assisted transperitoneal and retroperitoneal laparoscopic approaches. Transplantation 77(4):521–525PubMedCrossRef

24.

Jacobs SC, Cho E, Foster C, Liao P, Bartlett ST (2004) Laparoscopic donor nephrectomy: the University of Maryland 6-year experience. J Urol 171(1):47–51PubMedCrossRef

25.

Leventhal JR, Kocak B, Salvalaggio PR, Koffron AJ, Baker TB, Kaufman DB, Fryer JP, Abecassis MM, Stuart FP (2004) Laparoscopic donor nephrectomy 1997 to 2003: lessons learned with 500 cases at a single institution. Surgery 136(4):881–890PubMedCrossRef

26.

Su LM, Ratner LE, Montgomery RA, Jarrett TW, Trock BJ, Sinkov V, Bluebond-Langner R, Kavoussi LR (2004) Laparoscopic live donor nephrectomy: trends in donor and recipient morbidity following 381 consecutive cases. Ann Surg 240(2):358–363PubMedCrossRef

27.

Ruszat R, Sulser T, Dickenmann M, Wolff T, Gurke L, Eugster T, Langer I, Vogelbach P, Steiger J, Gasser TC, Stief CG, Bachmann A (2006) Retroperitoneoscopic donor nephrectomy: donor outcome and complication rate in comparison with three different techniques. World J Urol 24(1):113–117PubMedCrossRef

28.

Buell JF, Hanaway MJ, Potter SR, Cronin DC, Yoshida A, Munda R, Alexander JW, Newell KA, Bruce DS, Woodle ES (2002) Hand-assisted laparoscopic living-donor nephrectomy as an alternative to traditional laparoscopic living-donor nephrectomy. Am J Transplant 2(10):983–988PubMedCrossRef

29.

Ruszat R, Wyler SF, Wolff T, Forster T, Lenggenhager C, Dickenmann M, Eugster T, Gurke L, Steiger J, Gasser TC, Sulser T, Bachmann A (2007) Reluctance over right-sided retroperitoneoscopic living donor nephrectomy: justified or not? Transplant Proc 39(5):1381–1385PubMedCrossRef

30.

Del Pizzo JJ, Jacobs SC, Bishoff JT, Kavoussi LR, Jarrett TW (2003) Pleural injury during laparoscopic renal surgery: early recognition and management. J Urol 169(1):41–44PubMedCrossRef

Title: Complications of retroperitoneoscopic living donor nephrectomy: single center experience after 164 cases
Authors: Alexander Bachmann
Stephen Wyler
Thomas Wolff
Lorenz Gürke
Jürg Steiger
Christoph Kettelhack
Thomas C. Gasser
Robin Ruszat
Publication date: 01-12-2008
Publisher: Springer-Verlag
Published in: World Journal of Urology / Issue 6/2008
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-008-0296-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Complications of retroperitoneoscopic living donor nephrectomy: single center experience after 164 cases

Abstract

Objectives

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2008

The nitric oxide pathway in the human prostate: clinical implications in men with lower urinary tract symptoms

Complications of robotic assisted radical prostatectomy

Microbubbles improve the ablation efficiency of extracorporeal high intensity focused ultrasound against kidney tissues

Complications of laparoscopic pyeloplasty

Urodynamic changes and response rates in patients treated with permanent electrodes compared to conventional wire electrodes in the peripheral nerve evaluation test

Evaluation of complications in endoscopic extraperitoneal radical prostatectomy in a modular training programme: a multicentre experience