Do multiple renal arteries restrict laparoscopic donor nephrectomy?

Relationship between surgical difficulty and postoperative complications of hand-assisted laparoscopic living donor nephrectomy and establishment of prediction model

BACKGROUND

Few studies have systematically explored the factors influencing the difficulty of hand-assisted laparoscopic living donor nephrectomy. To investigate the relationship between the difficulty of hand-assisted laparoscopic living donor nephrectomy and postoperative complications of the donor as well as the recipient, and then build a model for predicting the difficulty of surgery.

METHODS

In this study, 60 patients who underwent hand-assisted laparoscopic living donor nephrectomy by the same surgeon from September 2022 to March 2024 were included as the modeling group. 20 patients operated on by another surgeon served as the external validation group. The subjective score (1-3 points) of surgical difficulty was used as the quantitative index of surgical difficulty. Pearson and Spearman correlation tests were used to explore the correlation between preoperative data and surgical difficulty scores of kidney donors, and finally built a prediction model through multiple linear regression analysis.

RESULTS

With the increase in the difficulty of operation, both donors and recipients' complications were increased. Linear regression analysis showed that only the number of renal arteries, visceral fat thickness and MAP score were independent risk factors for the difficulty of hand-assisted laparoscopic living donor nephrectomy. The prediction equation is as follows: Difficulty score = 0.584*Number of renal arteries + 0.731*MAP score + 0.110*visceral fat thickness.

CONCLUSIONS

Donors with higher surgical difficulty are more likely to have serious complications after surgery as well as the recipient. We also established a reliable prediction model for the difficulty of hand-assisted laparoscopic donor nephrectomy.

A Computed Tomography Angiography (CTA): Based score (SGPGI score) to predict level of difficulty, operative, and postoperative outcomes for right-sided radical nephrectomy

OBJECTIVE

With the advent of laparoscopic approach for the large (T1b-T3a ± N1) right renal masses, higher rates of complications and conversion to open surgery are being reported. The role of preoperative angioembolization (PAE), which has increased cost and inherent morbidity but may help in select circumstances has also not been clearly defined in the literature. We therefore devised a scoring system (SGPGI score) based on pre-operative Computed Tomography Angiography (CTA) to predict the level of difficulty of radical nephrectomy and enhance its safety and efficacy which could also be used for the judicious use of PAE in selected cases.

METHODS

In a prospective observational study on 52 patients with right renal masses from January 2014 to July 2018, we calculated a score based on CTA parameters. The patients were stratified for type and duration of surgery, blood loss, postoperative stay, and Clavien-Dindo grade of postoperative complications.

RESULTS

Patients were classified into three groups based on our scoring system. Progressively groups with higher score had higher blood loss, operating time, complications and hospital stay, and were more likely to have undergone conversion to open surgery (Area under curve 0.8625 for a cut off score of 10). Intraclass Correlation Coefficient (ICC) was 0.678-1 for the different components of our score.

CONCLUSION

The pre-operative CTA based SGPGI score evaluates right renal masses and is able to predict intra-operative difficulties effectively, leading to enhancement of surgery safety and efficacy. It also helps judiciously use PAE.

Nefrectomía laparoscópica en un programa de donante vivo en la Costa Caribe de Colombia

La nefrectomía laparoscópica en donante vivo es la mejor opción en el proceso del trasplante para pacientes con enfermedad renal crónica en estadio cuatro y cinco. El objetivo del artículo es describir la experiencia en el programa de donante vivo de riñón entre el 2013 y el 2018 en Colombiana de Trasplantes en la costa Caribe colombiana. Se realizó un estudio descriptivo que incluyó una muestra consecutiva de 55 donantes vivos de riñón operados por Colombiana de Trasplantes, entre enero de 2013 y enero de 2018; se llevó a cabo el análisis estadístico de las variables relevantes. La media de la edad fue de 41 años. El 57,4% de los donantes fueron mujeres. El tiempo de cirugía tuvo una media de 1,9 horas. Ninguno de los pacientes falleció en el seguimiento a los seis meses y el promedio de la estancia hospitalaria posterior a la cirugía fue de dos días. Las variables relevantes y los desenlaces de los pacientes son similares a los de otros grupos de trasplantes, sin embargo, hay características específicas que pueden ayudar a mejorar las estrategias en salud en la costa Caribe colombiana.

[Renal, vascular and urological variations and abnormalities in living kidney donor candidates]

INTRODUCTION

The aim of this study was to determine the prevalence of anatomic variations (renal, vascular and urological) and acquired renal pathologies in living kidney donor candidates (LKDC).

METHODS

This is a retrospective study of all LKDC referred to our center between April 2003 and September 2014. Of the 491 LKDC, 189 were initially excluded for medical reasons (n=140) or others reasons (n=49), without undergoing a radiological assessment. In total, 302 had a radiological assessment (angio-CT or MRI) in anticipation of the donation and 226/302 (73.5%) could donate a kidney.

RESULTS

One or more anatomical variations and/or acquired abnormalities were observed in 178/302 (58.9%) of the LKDC. The most frequent were arterial variations or abnormalities (multiple arteries, fibrodysplasia, aneurysms, stenosis≥70%) which where observed in 39.3% of the LKDC, followed by the venous abnormalities (27.8%). Kidney stones were observed in 5.6% of the LKDC and the urinary abnormalities (duplication/ureteral bifidity) were found in 3% of the LKDC. No malignant tumour was diagnosed, while 4 benign tumours (1.3%) were identified, and one of them required additional investigations.

CONCLUSION

We found a high prevalence of anatomical variations and acquired abnormalities in a population of LKDC. However, these findings resulted in the exclusion of only 4% of the candidates, because they did not contraindicate the donation or, in most of cases, the contralateral kidney could be used.

LEVEL OF EVIDENCE

3.

Morphological and clinical aspects of the occurrence of accessory (multiple) renal arteries

Renal vascularization variants vastly differ between individuals due to the very complex embryogenesis of the kidneys. Moreover, each variant may have implications for clinical and surgical interventions. The number of operating procedures continues to grow, and includes renal transplants, aneurysmorrhaphy and other vascular reconstructions. In any surgical technique, unawareness of the presence of multiple renal arteries may result in a fatal outcome, especially if laparoscopic methods are used. The aim of this review is to comprehensively identify the variation within multiple renal arteries and to highlight the connections between the presence of accessory renal arteries and the coexistence of other variants of vascularization. Another aim is to determine the potential clinical implications of the presence of accessory renal arteries. This study is of particular importance for surgeons, intervention radiologists, nephrologists and vascular surgeons.

Selection Criteria for Kidney Laterality in Retroperitoneoscopic Living Donor Nephrectomy and the Usefulness of Pretransplant Intervention

OBJECTIVES

To evaluate the selection criteria for kidney laterality and the usefulness of pretransplant intervention in living donor nephrectomy.

METHODS

We compared conventional and revised criteria. The conventional criteria were that left kidneys were chosen in preference and provided the kidney with the fewest structural abnormalities and lowest functional decline and that most renal arteries remained in the donor. From April 2013, we allowed the use of left kidneys with double renal arteries. Patient characteristics and surgical outcomes were retrospectively compared between right and left retroperitoneoscopic living donor nephrectomies.

RESULTS

We compared data for 30 right kidney and 222 left kidney nephrectomies. Right kidneys were selected because of multiple renal arteries (n = 18), structural abnormalities (n = 10) of the left kidney, or functional decline (n = 2) of the right kidney. Right retroperitoneoscopic nephrectomies were associated with significantly longer operating times (267 minutes vs 241 minutes), larger blood losses (240 g vs 55 g), and higher open conversion rates (10% vs 0.9%). Pretransplant intervention was necessary for structural abnormalities in right kidneys, but the amended selection criteria resulted in fewer right nephrectomies. Pretransplant intervention was still necessary by ex vivo arterial anastomosis for multiple left renal arteries, which increased the total ischemia time (94 minutes vs 64 minutes); however, post-transplantation renal function was not significantly different.

CONCLUSIONS

Pretransplant intervention was beneficial both for repairing structural abnormalities and for reducing the difficulties of retroperitoneoscopic living donor nephrectomy.

Outcome of Living Donor Transplant Kidneys With Multiple Arteries

BACKGROUND

Living donor transplantation (LDT) using kidneys with multiple arteries (MA) has previously been reported to be associated with increased complications and poorer outcomes in recipients. The objective of this study was to investigate outcomes of LDT with MA at the National University Hospital of Singapore, an institution with modest kidney transplant volumes.

METHODS

From 2007 to 2014, a total of 109 consecutive living donor kidney transplantations were performed. Of the nephrectomies, 91% were left sided. A total of 19 cases involved MA, of which 7 with small polar vessels (<2 mm) were ligated and 12 were revascularized. Baseline characteristics and outcomes were comparable between donor-recipient pairs with MA and single artery (SA). Both groups had equivalent induction and maintenance immunosuppressive regimens.

RESULTS

Mean warm ischemia time (minutes) was similar for kidneys with MA and SA (4.3 ± 3.2 vs 3.9 ± 3.2, P = .38). Operative time (minutes) in the recipients was also equivalent (P > .05) for MA and SA (158 ± 39.2 and 145 ± 57.2, respectively). The MA kidney recipients had a lower estimated glomerular filtration rate (eGFR) on postoperative day 5 compared to SA (56.6 ± 24.2 vs 74.1 ± 35.9 mL/min/1.73 m(2), P = .058). However, eGFR at 1 year was the similar for both groups (64.9 ± 16.2 vs 66.4 ± 18.1 mL/min/1.73 m(2), respectively, P = .76). Delayed graft function rates were 5.6% and 6.6% for MA and SA, respectively (P = .9). There were no surgical complications for LDT recipients within the MA group. Patient and graft survival was 100% in the MA group compared with 98% in the SA group (P > .05).

CONCLUSIONS

With current surgical techniques, LDT with MA can achieve equally good functional outcomes at 1 year as SA kidneys, with minimal surgical complications.

Shifting paradigms in eligibility criteria for live kidney donation: a systematic review

As the organ shortage increases, inherently the demand for donor kidneys continues to rise. Thus, live kidney donation is essential for increasing the donor pool. In order to create successful expansion, extended criteria live kidney donors should be considered. This review combines current guidelines with all available literature in this field, trying to seek and establish the optimal extended criteria. Comprehensive searches were carried out in major databases until November 2013 to search for articles regarding older age, overweight and obesity, hypertension, vascular anomalies/multiplicity, nulliparous women, and minors as donors. Of the 2079 articles found, 152 fell within the scope of the review. Five major guidelines were included and reviewed. Based on the literature search, live kidney donation in older donors (up to 70 years of age) seems to be safe as outcome is comparable to younger donors. Obese donors have comparable outcome to lean donors, in short- and mid-term follow-up. Since little literature is available proving the safety of donation of hypertensive donors, caution is advised. Vascular multiplicity poses no direct danger to the donor and women of childbearing age can be safely included as donors. Although outcome after donation in minors is shown to be comparable to adult donors, they should only be considered if no other options exist. We conclude that the analyzed factors above should not be considered as absolute contraindications for donation.

Laparoscopic donor nephrectomy: The Middle East experience

OBJECTIVES

To summarize the experience of the Middle East in laparoscopic donor nephrectomy (LDN), to discuss the associated advantages and salient problems, to examine the learning curve encountered compared with that of the pioneering centres in the West, and the contribution of the regional centres to the worldwide experience.

METHODS

We searched Medline and PubMed for all centres performing LDN in the Middle East. Questionnaires were e-mailed to the regional transplantation centres, and programme directors, and leading urological and transplant surgeons were contacted by telephone.

RESULTS

LDN in the Middle East was first introduced in 2000; this approach has been pioneered and practised at seven transplant centres within five countries in the region, and was restricted to only three Arab countries, i.e. Lebanon, Egypt and Kuwait. Data collection yielded a total of 888 procedures over one decade, representing only 2% of the total of ≈50,000 transplants during the same period. Despite variability of accurate reporting the overall outcomes were similar to those of open DN. The spectrum of complications was comparable to that from major centres in the USA during their learning curve.

CONCLUSIONS

The introduction of LDN in the Middle East has been gratifying. The relative hesitancy in introducing LDN in the rest of the Arab Middle East is multifaceted. The advantages conferred to the donor underscore the need for further expansion of this approach for kidney retrieval.

Outcomes of laparoscopic donor nephrectomy in the presence of multiple renal arteries

Purpose:

Data of laparoscopic donor nephrectomy (LDN) with multiple renal arteries for donor and recipient outcomes were reviewed, with the aim of clarifying whether the laparoscopic approach is safe in the presence of multiple renal arteries.

Materials and Methods:

All donor nephrectomies performed at our institution from 2004 to 2008 were reviewed retrospectively. Results were compared between LDN kidneys with multiple arteries and those with a single renal artery.

Results:

Out of 171 donor nephrectomies, 21 (12%) were performed for kidneys with multiple renal arteries. All of the 150 (88%) donor nephrectomies in the single vessel group were performed laparoscopically. In the multiple artery group, 9 (43%) underwent an open procedure while 12 (57%) underwent a laparoscopic procedure. The warm ischemia time was longer in the multiple artery group than the single artery group, but the difference was not statistically significant (4.25±0.87 min vs. 4.12±0.95 min, respectively). Regarding transplant recipients, the vascular anastomosis time was similar in both groups (30±4.6 min vs. 29.5±3.7 min). The operative blood loss in the transplant recipients was significantly more in the multiple artery group compared to the single artery group (339±292 ml and 130.7±44.8 ml, respectively; P=0.03). The recipient renal function was similar for both the groups at postoperative day 7, 1 month, and at 1 year.

Conclusion:

The data support the fact that the laparoscopic approach to donor nephrectomy in the presence of multiple renal arteries can be performed safely with adequate laparoscopic experience.

Multiple renal arteries challenge in laparoscopic donor nephrectomy: how far can we go?

Purpose

Living donor kidneys with multiple arteries are routinely procured laparoscopically. We aim to present our experience with laparoscopic donor nephrectomy (LDN) and to compare the graft function and outcome between cases with single versus multiple arteries.

Methods

We compared the demographic data, operation time, warm ischemia time, rejection rate, and graft function between LDN kidneys with single artery and those with multiple arteries.

Results

Seventy-three cases with 1 renal artery (group LDN-1), 8 cases with 2 renal arteries (group LDN-2) and 5 cases with 3 or more renal arteries (group LDN-3) were included in the study. The mean operative time was significantly higher in groups LDN-2 (100.3 ± 9.5 minutes) and LDN-3 (120.6 ± 10.3 minutes) compared to group LDN-1 (75.7 ± 10 minutes, P < 0.001). Similar results were detected with respect to the warm ischemia time. There were no statistically significant differences related to graft function and outcome among these groups.

Conclusion

Multiple renal arteries present a special challenge in both donor nephrectomy and renal transplantation. However, laparoscopic procurement of a kidney with multiple renal arteries, regardless of the number, is reliable and has no significant impact on the graft outcome.

The outcomes of living donor renal transplants with multiple renal arteries: a large cohort study with a mean follow-up period of 10 years

BACKGROUND

Living donor kidney transplants with multiple arteries are presumed to be associated with an increased risk of complications.

OBJECTIVES

The aim of the study was to compare the outcomes in living donor transplantation with the specific intention of comparing long-term outcomes in which the donor kidney had 1 or more renal arteries. The study was undertaken in 2 large transplant centers.

METHODS

A retrospective analysis of 201 living donor kidney transplants with multiple arteries that were performed between January 1985 and December 2004 was undertaken. We recorded patient and graft survivals, urological and vascular complications. Kaplan-Meier survival estimates were calculated, and 2-tailed Student t-test was used to compare outcomes. P < .05 was considered statistically significant.

RESULTS

Graft and patient survival at 1 year were 93% and 97% and at 5 years were 87% and 92%. The most common complications were vascular (8.9%), followed by urological (6%), acute tubular necrosis (5.5%), and posttransplant hypertension (4.0%). There was significantly higher incidence of acute tubular necrosis (ATN) in multiple-artery transplants.

CONCLUSION

In this large cohort of patients studied, apart from a higher incidence of ATN and vascular complications, it appears that the number of renal arteries did not have any adverse impact on the outcomes. The findings from this study suggest that live donor kidneys with multiple renal arteries can be safely utilized for renal transplantation.

Laparoscopic procurement of single versus multiple artery kidney allografts: is long-term graft survival affected?

BACKGROUND

Living donor kidneys with multiple arteries (MA) are increasingly procured laparoscopically for transplant.

METHODS

We compare long-term graft function and survival of kidneys with single arteries (SA) and MA over a 10-year period.

RESULTS

There were a total of 218 grafts with SA and 60 grafts with MA. The MA group had longer operative and ischemic times than SA group. There was a small increase in ureteral complication (8.3% vs. 2.3% P=0.06) and a significantly higher incidence of rejection (23.3% vs. 10.1%, P=0.01) in MA group than in SA group. Graft function was lower in MA group than SA group. The 5-year graft survival by Kaplan Meier analysis was better in SA group than in MA group (P=0.023). The estimated graft survivals at 1, 3, and 5 year were 94.4%, 90.6%, and 86% for SA group and 89.6%, 83.2%, and 71.8% for MA group. There was a higher percentage of graft loss from chronic allograft nephropathy in MA group than in SA group (16.7% vs. 5.5%, P=0.01). The presence of MA (vs. SA) was an independent risk for acute rejection (OR 3.60, 95% CI 1.59-8.14, P=0.002) and for graft loss (HR 2.31, 95% CI 1.05-5.09, P=0.038).

CONCLUSION

Laparoscopic procurement of living donor kidneys with SA may be associated with a lower risk of rejection, better function, and superior long-term survival when compared with kidneys with MA.

Laparoscopic versus open live donor nephrectomy in renal transplantation: a meta-analysis

OBJECTIVE

The aim of this study was to compare laparoscopic versus open live donor nephrectomy using meta-analytical techniques.

SUMMARY BACKGROUND DATA

Laparoscopic live donor nephrectomy has gained widespread acceptance and is increasingly performed. The body of evidence assessing the safety and efficacy of laparoscopic compared with established open techniques is growing; however, very few randomized control trials exist and individual studies often have small patient numbers with varying results. We combined the available raw data to strengthen the current literature in comparing these techniques.

METHODS

A literature search was performed and comparative studies published between 1997 and 2006 of open versus laparoscopic donor nephrectomy were included. Outcomes evaluated were operative and warm ischemia times, blood loss, donor complications, length of hospital stay, time to return to work, and delayed graft function.

RESULTS

Seventy-three studies matched the selection criteria and included 6594 patients, 3751 (57%) had undergone laparoscopic surgery and 2843 (43%) open nephrectomy. The open nephrectomy group had shorter operative and warm ischemia times by 52 minutes (P < 0.001) and 102 seconds (P < 0.001), respectively. This did not translate into higher delayed graft function or graft loss rates between the 2 groups. Patients in the laparoscopic group had a shorter hospital stay and a faster return to work by 1.58 days (P < 0.001) and 2.38 weeks (P < 0.001), respectively. There was a significantly higher rate of overall donor complications in the open group (P = 0.007), a finding not reproduced in any subsequent sensitivity analyses. When only randomized control trials were considered, there were shorter operative times (P = 0.002) for the open group but nonsignificantly different warm ischemia times. In contrast to the main analysis there were no differences in the overall complication rate, postoperative analgesia, hospital stay, or time taken to return to work.

CONCLUSIONS

Laparoscopic nephrectomy in live donor transplantation is a safe alternative to the open technique. Although open nephrectomy may be associated with shorter operative and warm ischemia times, patients undergoing laparoscopic nephrectomy may benefit from a shorter hospital stay and faster return to work without compromising graft function.

[Laparoscopic nephrectomy in a living donor]

Kidney transplantation is the therapeutic option of choice for patients with end-stage renal disease. With the advent of safer harvesting techniques and immunosuppression, both donor and recipient outcomes have markedly improved in recent years. Kidney donation from Living donors remains the single most important factor responsible for improving patient and graft survival. The laparoscopic donor nephrectomy has revolutionized renal transplantation, allowing expansion of the donor pool by diminishing surgical morbidity while maintaining equivalent recipient outcome. This technique is now becoming the gold-standard harvesting procedure in transplant centres worldwide, despite its technical challenge and ongoing procedural maturation, especially early in the learning curve. Previous contraindications to laparoscopic donor nephrectomy are no longer absolute. In the following analysis, the procedural aspects of the laparoscopic donor nephrectomy are detailed including pre-operative assessment, operative technique and a review of the current literature delineating aspects of both donor and recipient morbidity and mortality compared with open harvesting techniques.

Transperitoneal laparoscopic live donor nephrectomy: Current status

Renal transplantation is the treatment of choice for a suitable patient with end stage renal disease. Unfortunately, the supply of donor organs is greatly exceeded by demand. In many countries the use of kidneys from living donors has been widely adopted as a partial solution. Traditionally donor nephrectomy has been performed via a open flank incision however with some morbidity like pain and a loin scar. Currently, the donor nephrectomy is increasingly being performed laparoscopically with the objective of reducing the morbidity. It is also hoped that this will lead to increasing acceptance of living donation. The first minimally invasive living donor nephrectomy was carried out in 1995 at the Johns Hopkins Medical Center and since then many centers have undertaken laparoscopic living donor nephrectomy. The laparoscopic approach substantially reduces the donor morbidity and wound related problems associated with open nephrectomy. The laparoscopic techniques thus have the potential to increase the number of living kidney donors. The present article attempts to review the safety and efficacy of transperitoneal laparoscopic donor nephrectomy.

Outcome of Renal Transplantation with Multiple Versus Single Renal Arteries After Laparoscopic Live Donor Nephrectomy: A Comparative Study

OBJECTIVES

To compare donor morbidity and recipient outcomes in patients with a single artery versus multiple arteries undergoing laparoscopic donor nephrectomy.

METHODS

A total of 303 consecutive laparoscopic donor nephrectomies were performed. Data from the group with multiple arteries (n = 27) (group I) were compared with those from the groups with single renal artery (n = 245) (group IIA) and early branching renal artery resulting in two artery recipient anastomoses (n = 31) (group IIB), in terms of donor and recipient outcomes.

RESULTS

Laparoscopic donor nephrectomy was technically successful in all 303 patients without need for open conversion. The graft retrieval time was higher in group I and group IIB compared with group IIA (3.9 +/- 1.4 and 3.9 +/- 0.8 versus 3.5 +/- 1.0 minutes). Similarly, warm ischemia time was significantly higher in groups I and IIB versus group IIA (7.2 +/- 1.9 and 6.7 +/- 1.9 versus 5.6 +/- 1.8 minutes). Creatinine level at day 1 was higher in group I compared with group IIA (2.4 +/- 1.4 versus 1.9 +/- 0.7 mg/dL). However, there was no significant difference in creatinine levels at 1 month and 1 year among the three groups. Overall graft survival in groups I, IIA, and IIB was 92%, 94.4%, and 94%, respectively.

CONCLUSIONS

Laparoscopic donor nephrectomy in the presence of multiple renal arteries is feasible and safe. Additionally, long-term graft survival and graft function at 1 month and 1 year are not adversely impacted by the presence of multiple renal arteries in grafts procured laparoscopically.

Ten Years of Laparoscopic Living Donor Nephrectomy: Retrospect and Prospect From the Nephrologist’s Point of View

The laparoscopic living kidney donor nephrectomy introduced in 1995 has become an accepted method of kidney harvest for transplantation. The method has proven its usefulness as well as its superiority compared to open donor nephrectomy. Based on the results of a decade, an overview from a nephrologist's point of view is presented here in; a view that is known to be quite different from (and sometimes contrary to) the surgeon's approach. While urologists and surgeons focus more on the technique and complication rates, the nephrologist tends to estimate the new procedure with regard to his dialysis patients' outcomes (ie, whether it will result in an increased number of kidney transplantations in the long term). The latter aspect has to be the benchmark in the estimation of the effects of this procedure; it is the ultimate goal of every surgery in kidney transplantation. The 10-year results are more than encouraging, but nevertheless it will take at least one more decade for a valid evaluation.

Laparoscopic donor nephrectomy

Of the various options for patients with end stage renal disease, kidney transplantation is the treatment of choice for a suitable patient. The kidney for transplantation is retrieved from either a cadaver or a live donor. Living donor nephrectomy has been developed as a method to address the shortfall in cadaveric kidneys available for transplantation. Laparoscopic living donor nephrectomy (LLDN), by reducing postoperative pain, shortening convalescence, and improving the cosmetic outcome of the donor nephrectomy, has shown the potential to increase the number of living kidney donations further by removing some of the disincentives inherent to donation itself. The technique of LLDN has undergone evolution at different transplant centers and many modifications have been done to improve donor safety and recipient outcome. Virtually all donors eligible for an open surgical procedure may also undergo the laparoscopic operation. Various earlier contraindications to LDN, such as right donor kidney, multiple vessels, anomalous vasculature and obesity have been overcome with increasing experience. Laparoscopic live donor nephrectomy can be done transperitoneally or retroperitoneally on either side. The approach is most commonly transperitoneal, which allows adequate working space and easy dissection. A review of literature and our experience with regards to standard approach and the modifications is presented including a cost saving model for the developing countries. An assessment has been made, of the impact of LDN on the outcome of donor and the recipient.

Laparoscopic Living Donor Nephrectomy for Kidneys With Multiple Arteries

INTRODUCTION

Laparoscopic donor nephrectomy (LDN) involving kidneys with multiple arterial vessels is limited to a small number of reports, with all but two series reporting fewer than 25 patients. Moreover, outside of the pioneering centers at the University of Maryland and Johns Hopkins, no series of at least 25 patients has been published confirming these experience. The present study presents the largest series of LDN of donor kidneys with multiple arterial vessels outside of these two pioneering programs.

METHODS

All LDN performed at the University of Cincinnati from 2000 to 2004 were reviewed. Results between LDN kidneys with a single vessel and those with multiple vessels were compared. Statistical analysis included chi-square and Student t test.

RESULTS

Of 240 LDN, 37 were performed for kidneys with multiple vessels (15%): nine right kidneys (25%) and 28 left kidneys (75%). Cold ischemia time was longer for the multiple vessel organs (46 +/- 24 minutes) than for single vessel organs (35 +/- 13 minutes; P = .001), and warm ischemia time was longer for the multiple vessel kidneys (4:20 +/- 2:05 minutes) than single vessel kidneys (3:13 +/- 0:47 minutes; P = .001). Recipient renal function (serum creatinine) was similar for multiple and single artery donors at postoperative day 7 (1.76 +/- 1.38 and 1.7 +/- 1.47) and at postoperative day 365 (1.06 +/- 0.3 and 1.34 +/- 0.44).

CONCLUSIONS

This experience confirms results from other series in documenting the safety and reproducibility of LDN for kidneys with multiple arterial vessels.

Open versus laparoscopic donor nephrectomy in live related renal transplantation

BACKGROUND

This analysis sought to evaluate the efficiency and safety of laparoscopic nephrectomy (LDN) for the donor, the recipient, and the graft. LDN seems to have advantages over the open donor nephrectomy (ODN) in length of hospital stay, postoperative comfort, and pain control.

METHODS

The results of 40 patients who underwent LDN between October 2000 and September 2003 were compared to those of 40 ODN patients just preceding the LDN patients. Eight laparoscopy patients required conversion to an open procedure due to bleeding (4; two major and two minor), technical problems with the instrument (n = 1) and difficulty in the dissection (n = 3).

RESULTS

The demographic data, percentages of right and left nephrectomy, number of vessels, rates of acute rejection episodes, as well as the rates of urologic and vascular complications were similar between the two groups. The time of hospital stay was shorter, and the duration of the operation and of the warm ischemia time were significantly longer for the LDN group. The postoperative decline in serum creatinine levels were similar for the two groups. Graft survival rates were 91.7% at both the first and third years in the LDN group; 92.5% and 87.0% for the ODN group, a difference that was not statistically significant.

CONCLUSION

LDN is as efficient and safe as ODN for donors, recipients, and grafts.