Comparison of Pure Laparo-Endoscopic Single-Site Surgery and Mini-Incision Retroperitoneal Surgery for the Retrieval of a Graft in Living-Donor Kidney Transplantation

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Abstract

Introduction

Live donor nephrectomy is considered to be a unique surgery performed on healthy donor, and should be convinced to provide an excellent graft outcome in a kidney recipient. Laparo-endoscopic single-site surgery has been reported to be a feasible and effective choice of treatment for several kidney diseases such as renal cancer, in terms of cosmetics and less invasiveness. In this study, we evaluated the clinical outcomes of laparo-endoscopic single-site live donor nephrectomy (LESS-DN) in comparison with those of mini-incision retroperitoneal live donor nephrectomy (Mini-DN).

Methods

Between 2009 and 2016, a total of 126 live donor nephrectomies were performed at the Kobe University. They were comprised of 61 cases performed as LESS-DN for the retrieval of left kidney grafts after 2013 (LESS-DN group), and 65 cases performed as Mini-DN for the retrieval of right kidney grafts after 2013 and all grafts before 2013 (Mini-DN group). We compared several clinical parameters such as total operation time (TOP), warm ischemia time (WIT), blood loss, length of hospital stay, complication rate, as well as the function of kidney graft.

Results

TOP and WIT of LESS-DN and Mini-DN group was 256.6±44.8 vs. 247.6±37.9 min, 4.2±1.4 vs. 4.0±1.2 min respectively, observed no significant difference between the groups. Blood loss was significantly less in LESS-DN group compared with that in Mini-DN group (57.1±183.3 vs. 471.5±274.3 ml, P < 0.01). No visceral injuries and intra-operative complications of Clavien-Dindo greater than Grade II was observed in both LESS-DN and Mini-DN group. The dose of analgesics required at discharge was significantly lower in LESS-DN group than that in Mini-DN group (104.9±22.7 vs. 222.9±25.6 mg/day, < 0.01), and the length of hospital stay was significantly shorter in LESS-DN group than that of Mini-DN group (7.1±1.4 vs. 9.3±3.3 days, P=0.04). Serum creatinine level of the recipient at 4 weeks after kidney transplantation was of no difference between the groups (1.11±0.45 vs. 1.18±0.35 mg/dl).

Conclusion

LESS-DN is a safe and feasible method for the retrieval of the graft in living donor kidney transplantation, giving the kidney donor a significantly shorter period of recovery, and also giving the recipient an excellent graft function, and thus, may be an attractive and recommendable procedures.

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