Hand-Assisted Laparoscopic Nephrectomy for Live Donor Kidney Transplantation

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.

Hand-assisted Laparoscopic Nephrectomy: Evaluation of the Learning Curve

BACKGROUND

Hand-assisted laparoscopic donor nephrectomy (HALDN) has rapidly become the best alternative to open nephrectomy for living kidney donation. As more centers continue to adopt the laparoscopic technique, the safety of the initial transplants must be ensured while ascending the learning curve (LC). This study looks to determine the safety of HALDN and to describe the results of the LC in our center.

METHODS

We conducted a retrospective review of 500 HALDNs performed in our center from July 2003 to July 2017. We analyzed demographic and perioperative characteristics and complications during the first postoperative month. We divided HALDNs into 2 groups: before and after completing the LC (50 nephrectomies). For each group, we assessed operating room time, estimated blood loss, length of stay, and complication and conversion rates.

RESULTS

A total of 500 HALDNs were performed in the study period. Of those, 454 were analyzed in the 2 groups. The median operating room time was 2 hours, length of stay was 2 days, and blood loss was 50 cc. The overall rate of complication was 6.8%. There were significant differences between the 2 groups in operating time, blood loss, and length of stay (P < .05). No differences were found in terms of complication (P = .42) and conversion (P = .28) rates.

CONCLUSION

There was a significant decrease in operating time, blood loss, and length of stay in patients who underwent laparoscopic donor nephrectomy by an experienced laparoscopist. However, no differences were found in complication and conversion rates, which suggests that improvement in surgical training can be accomplished without altering the donor safety.