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Living donor of the kidney—open—video

Abstract

Background and aims

Living donor nephrectomy (LDN) has evolved a variety of different surgical techniques. Minimal invasive strategies were introduced to benefit the healthy donors. This paper attempts to identify the best possible practise in live kidney donation with special respect to donor safety.

Materials and methods

We present a single-centre experience of 173 live kidney donations and describe the surgical technique of open retroperitoneal donation in detail and by video sequences. Additionally, the evidence for donor safety (mortality and morbidity) and the integrity of the graft function are reviewed, comparing different surgical techniques for LDN.

Results

Focussing on maximal donor safety, a retroperitoneal access seems mandatory. Very detailed informed consent, including the offer for different retrieval techniques, has led to a total of 163 open and 10 hand-assisted retroperitoneal live kidney donations at our institution. Published and own data reveal longer operating and warm ischaemic times for minimal invasive kidney removal when compared with open technique. Adequate perioperative analgesia (peridural catheter) provides comparable patient comfort, duration of hospital stay, complications and graft function although there are some procedure-associated risks for minimal invasive techniques.

Conclusion

The special ethical situation of live donation necessitates maximal donor safety. Although open antero-lateral incision and retroperitoneal access does provide some inconveniences for the surgeon, we are convinced that this and the hand-assisted retroperitoneal approach are the only two options for LDN.

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References

  1. 1.

    Najarian JS, Chavers BM, McHugh LE et al (1992) 20 years or more of follow-up of living kidney donors. Lancet 340:807–810

  2. 2.

    Bay WH, Hebert LA (1987) The living donor in kidney transplantation. Ann Intern Med 106(5):719–727

  3. 3.

    Blohme I, Fehrman I, Norden G (1992) Living donor nephrectomy. Complication rates in 490 consecutive cases. Scand J Urol Nephrol 26(2):149–153

  4. 4.

    Ratner LE, Kavoussi LR, Sroka M et al (1997) Laparoscopic assisted live donor nephrectomy—a comparison with the open approach. Transplantation 63(2):229–233

  5. 5.

    Yang SC, Lee DH, Rha KH et al (1994) Retroperitoneoscopic living donor nephrectomy: two cases. Transplant Proc 26(4):2409

  6. 6.

    Blohme I, Gabel H, Brynger H (1981) The living donor in renal transplantation. Scand J Urol Nephrol 64(Suppl):143–151

  7. 7.

    Gaur DD, Agarwal DK, Purohit KC (1993) Retroperitoneal laparoscopic nephrectomy: initial case report. J Urol 149(1):103–105

  8. 8.

    Wadstrom J, Lindstrom P (2002) Hand-assisted retroperitoneoscopic living donor nephrectomy: initial 10 cases. Transplantation 73(11):1839–1840

  9. 9.

    Chiu AW, Chang LS, Birkett DH et al (1995) The impact of pneumoperitoneum, pneumoretroperitoneum, and gasless laparoscopy on the systemic and renal hemodynamics. J Am Coll Surg 5:397–406

  10. 10.

    Stridsberg M, Pettersson T, Pettersson K (1997) A two-site delfia immunoassay for measurements of the N-terminal peptide of pro-atrial natriuretic peptide (nANP). Ups J Med Sci 2:99–108

  11. 11.

    Jacobs SC, Cho E, Dunkin BJ et al (2000) Laparoscopic live donor nephrectomy: the University of Maryland 3-year experience. J Urol 164(5):1494–1499

  12. 12.

    Fahlenkamp D, Rassweiler J, Fornara P et al (1999) Complications of laparoscopic procedures in urology: experience with 2,407 procedures at 4 German centers. J Urol 162(3 Pt 1):765–770; discussion 770–771

  13. 13.

    Deziel DJ, Millikan KW, Economou SG et al (1993) Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg 165(1):9–14

  14. 14.

    Knoepp L, Smith M, Huey J et al (1999) Complication after laparoscopic donor nephrectomy: a case report and review. Transplantation 68(3):449–451

  15. 15.

    Nogueira JM, Cangro CB, Fink JC et al (1999) A comparison of recipient renal outcomes with laparoscopic versus open live donor nephrectomy. Transplantation 67(5):722–728

  16. 16.

    Lindstrom P, Haggman M, Wadstrom J (2002) Hand-assisted laparoscopic surgery (HALS) for live donor nephrectomy is more time- and cost-effective than standard laparoscopic nephrectomy. Surg Endosc 16(3):422–425

  17. 17.

    Ravizzini PI, Shulsinger D, Guarnizo E et al (1999) Hand-assisted laparoscopic donor nephrectomy versus standard laparoscopic donor nephrectomy: a comparison study in the canine model. Tech Urol 5(3):174–178

  18. 18.

    Slakey DP, Wood JC, Hender D et al (1999) Laparoscopic living donor nephrectomy: advantages of the hand-assisted method. Transplantation 68(4):581–583

  19. 19.

    Nakache R, Szold A, Merhav H et al (2000) Kidney graft loss after laparoscopic live donor nephrectomy. Transplant Proc 32(4):683

  20. 20.

    London ET, Ho HS, Neuhaus AM et al (2000) Effect of intravascular volume expansion on renal function during prolonged CO2 pneumoperitoneum. Ann Surg 231(2):195–201

  21. 21.

    Bloomfield GL, Blocher CR, Fakhry IF et al (1997) Elevated intra-abdominal pressure increases plasma renin activity and aldosterone levels. J Trauma 42(6):997–1004

  22. 22.

    Kieran K, Roberts WW (2005) Laparoscopic donor nephrectomy: an update. Curr Opin Nephrol Hypertens 14(6):599–603

  23. 23.

    Desai MM, Strzempkowski B, Matin SF, Steinberg AP, Ng C, Meraney AM, Kaouk JH, Gill IS (2005) Prospective randomized comparison of transperitoneal versus retroperitoneal laparoscopic radical nephrectomy. J Urol 173(1):38–41 (Jan)

  24. 24.

    Merlin TL, Scott DF, Rao MM, Wall DR, Francis DMA et al (2000) The safety and efficacy of laparoscopic live donor nephrectomy: a systematic review. Transplantation 70(12):1659–1666

  25. 25.

    Øyen 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 79:1236–1240

  26. 26.

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

  27. 27.

    Sundqvist P, Feuk U, Häggman M, Persson EA, Stridsberg M, Wadström J (2004) Hand-assisted retroperitoneoscopic live donor nephrectomy in comparison to open and laparoscopic procedures: a prospective study on donor morbidity and kidney function. Transplantation 78(1):147–153

  28. 28.

    Fehrman-Eckholm I, Norden G, Lennerling A, Rizell M, Herlitz H, Nielsen FD, Storkamp O, Deurell SI, Olausson M (2006) Living kidney donors developing end-stage renal disease. Transplant Proc 8:2642–2643

  29. 29.

    Pareek G, Hedican SP, Gee JR, Bruskewitz RC, Nakada SY (2006) Meta-analysis of the complications of laparoscopic renal surgery: comparison of procedures and techniques. J Urol 175(4):1208–1213

  30. 30.

    Hammer C, Hawasli A, Meguid A, Oh H (2006) Degloving of the renal capsule: a rare complication of laparoscopic live donor nephrectomy. J Laparoendosc Adv Surg Tech A 16(4):362–364

  31. 31.

    Irvine J, Aho T, Davidson P, Searle M (2006) Rhabdomyolysis following radical laparoscopic nephrectomy: a case to heighten awareness. Nephrology (Carlton) 11(4):282–284

  32. 32.

    Rehman J, Boglia J, Cbugbtai B, Sukkarieb T, Khan SA, Lewis R, Darras F, Wadhwa NK, Samadi DB, Waltzer WC (2006) High body mass index in muscular patients and flank position are risk factors for rhabdomyolysis: case report after laparoscopic live-donor nephrectomy. J Endourol 20(9):646–650

  33. 33.

    Boghossian T, Henri M, Dubé S, Bendavid Y, Morin M (2005) Laparoscopic nephrectomy donor death due to cerebral gas embolism in a specialized transplant center: risk zero does not exist. Transplantation 79(2):258–259

  34. 34.

    Derweesh IH, Goldfarb DA, Abreu SC, Goel M, Flechner SM, Modlin C, Zhou L, Streem SB, Novick AC, Gill IS (2003) Laparoscopic live donor nephrectomy has equivalent early and late renal function outcomes compared with open donor nephrectomy. Arch Surg 118:336–339

  35. 35.

    Nakache R, Szold A, Merhav H, Klausner JM (2000) Kidney graft loss after laparoscopic live donor nephrectomy. Transplant Proc 32(4):683

  36. 36.

    Caumartin Y, Pouliot F, Sabbagh R, Dujardin T (2005) Chylous ascites as a complication of laparoscopic donor nephrectomy. Transpl Int 18(12):1378–1381

  37. 37.

    Ruiz-Deya G, Cheng S, Palmer E, Thomas R, Slakey D (2001) Open donor, laparoscopic donor and hand assisted donor nephrectomy: a comparison of outcomes. J Urol 166(4):1270–1273; discussion 173–174

  38. 38.

    El-Galley R, Hood N, Young CJ, Deierhoi M, Urban DA (2004) Donor nephrectomy: a comparison of techniques and results of open, hand assisted and full laparoscopic nephrectomy. J Urol 171(1):40–43

  39. 39.

    Lind MY, Zur Borg IM, Hazebroek EJ, Hop WC, Alwayn IP, Weimar W, Ijzermans JN (2005) The effect of laparoscopic and open donor nephrectomy on the long-term renal function in donor and recipient: a retrospective study. Transplantation 80(5):700–703

  40. 40.

    Derweesh IH, Goldfarb DA, Abreu SC, Goel M, Flechner SM, Modlin C, Zhou L, Sreem SB, Novick AC, Gill IS (2005) Laparoscopic live donor nephrectomy has equivalent early and late renal function outcomes compared with open donor nephrectomy. Urology 65:862–866

  41. 41.

    Burgos FJ, Linares A, Pascual J, Marcen R, Villafruela J, Zamora J, Cuevas B, Correa C, Gomez V (2005) Modifications of renal blood flow and serum interleukin levels induced by laparoscopic and open living donor nephrectomies for kidney transplant: an experimental study. Transplant Proc 37(9):3676–3678

  42. 42.

    Giessing M, Reuter S, Deger S, Tüllmann M, Hirte I, Budde K, Fritsche L, Slowinski T, Dragun D, Neumayer HH, Loening SA, Schönberger B (2005) Laparoscopic verses open donor nephrectomy in Germany: impact on donor health-related quality of life and willingness to donate. Transplant Proc 37:211–215

  43. 43.

    Dahm F, Weber M, Müller B, Pradel FG, Laube GF, Neuhaus TJ, Cao C, Wutbrich RP, Thiel GT, Clavien PA (2006) Open and laparoscopic living donor nephrectomy in Switzerland: a retrospective assessment of clinical outcomes and the motivation to donate. Nephrol Dial Transplant 21(9):2563–2568

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Correspondence to Jens G. Brockmann.

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Brockmann, J.G., Senninger, N. & Wolters, H.H. Living donor of the kidney—open—video. Langenbecks Arch Surg 392, 219–225 (2007). https://doi.org/10.1007/s00423-007-0162-9

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Keywords

  • Kidney
  • Living donation
  • Surgery
  • Techniques
  • Transplantation