Summary of Retroperitoneoscopic Nephrectomy for Living Donor Kidney Transplantation in a Single Institution.

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Abstract

Introduction

It is most important team for living donations to make safer and to reduce operating stress. Endoscopic surgery is thought to be a useful operating procedure for solving these problems. For living donor nephrectomy, we have performed retroperitoneoscopic approach (RDN), because of its less intra-abdominal complications such as bleeding and intestinal injury than trans-abdominal approach. However, the frank incision used for retrieving a kidney graft had thought to be more invasive with damages for abdominal muscles by cutting. So, we have used a single-site retroperitoneoscopic living donor nephrectomy (SSRDN) with GelPOINT® (Applied Medical, USA) We report the summary and advantage of SSRDN in our institution in this presentation.

Materials and Procedures

Three hundred and fifty-eight living donors were performed RDN for kidney transplantation at Chiba-East National Hospital between April 2004 and July 2017. Recently, with 30 cases, we performed SSRDN. With this procedure, donors were positioned in the lateral position, and a 7-cm-long flank incision was made in the lateral abdomen. The incision was extended to the retroperitoneal space using the muscle-splitting technique. After expanding the retroperitoneal space, a GelPOINT was placed in the incision. Three ports were placed on the GelPOINT, and subsequent procedure was the same as those used in conventional RDN. In the last of this procedure, kidney graft was directly retrieved through the GelPOINT incision.

Results

Except one case converted for bleeding, 29 cases of SSRDN were performed successfully without any complications and all 30 donors were discharged hospital at estimated day. The mean age and body mass index of the SSRDN donors were 59.6±8.0 years old (55.3±10.8 years old with conventional RDN) and 22.4±2.6 kg/m2 (23.2±3.0 kg/m2), respectively. The mean operative time was 221±53 minutes (227±55 minutes), warm ischemic time was 4.0±1.2 minutes (4.0±1.6 minutes), blood loss was 53±72 mL (58±71 mL) and mean hospital stay after operation was 5.9±0.8 (6.3±1.4 days). No statistical differences were found between SSRDN and conventional RDN. Postoperative graft function (serum creatinine level) was good as conventional RDN and delayed graft function was not observed in any of the SSRDN recipients.

Conclusion

SSRDN would be useful technique for living donor operation of kidney transplantation. We have carried out this operation more safely and less invasively than conventional RDN. In this presentation, we demonstrate that SSRDN would have advantages of safeness, minimal invasion, and short hospital stay in living donor kidney transplantation.

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