Single-Site Retroperitoneoscopic Donor Nephrectomy

Right Living Donor Nephrectomies: Retroperitoneoscopic vs Laparoscopic Transperitoneal Approach

Retroperitoneoscopic right living donor nephrectomy (RLDN) provides direct access to the renal hilum without the need to mobilize the colon. However, factors such as lack of anatomic landmarks to guide orientation, smaller working space, and steep learning curve provided a debate against this approach. In this retrospective study, we reviewed our single-center experience of retroperitoneoscopic RLDN.

MATERIALS AND METHODS

Between January 2015 and January 2017, 10 patients underwent retroperitoneoscopic RLDN by a single surgeon at the National University Hospital, Singapore. Baseline demographics, intraoperative parameters, and both donor and recipient outcomes were retrieved from the database.

RESULTS

Mean (SD) age was 52.7 (13.8) years, mean (SD) body mass index was 25.2 (2.9) kg/m², mean (SD) operating time was 196.8 (38.0) minutes, mean (SD) warm ischemic time was 5.1 (2.1) minutes, and mean (SD) blood loss was 43 (25.0) mL. Mean (SD) renal vein length was 10 (2.5) mm, and mean (SD) renal artery length was 6 (1.8 mm). One patient had to be converted to laparoscopic transperitoneal nephrectomy. No donors developed complications. Mean (SD) hospital stay was 3.5 (1.1) days. All transplanted right kidneys had immediate graft function with no complications. Mean (SD) serum creatinine (at 1 year) was 103.6 (20.3) μmol/L. There is no graft loss among the recipient after 1 year.

CONCLUSIONS

Right donor nephrectomy can be performed safely using retroperitoneoscopic approach. Retroperitoneoscopy offers advantages, especially in a patient who previously had transabdominal surgery or high body mass index. However, transperitoneal approach may be preferable in anomalous situations because it provides instinctive orientation from anatomic landmarks and a greater working space.

A Novel Assessment of Vascular Regions Using an Intraoperative Near-Infrared Fluorescence

INTRODUCTION

The risk of complications and transplant renal function increases in multiple arterial renal transplantations compared with single arterial renal transplantations. Even when multiple arteries are involved, with the introduction of laparoscopic nephrectomy, I mainly choose the left side kidney. Therefore, the number of renal artery reconstructions is increasing, and simultaneous imaging of arterial rebuilding during the donor nephrectomy is important.

MATERIAL

Between 2006 and 2015, we performed 132 living donor kidney transplantations at our center and analyzed 32 cases that were diagnosed pre- and intraoperatively.

METHOD

We compared the single renal artery (SRA) and multiple renal arteries (MRA) groups and analyzed the number of renal arteries, reconstruction methods, donor and recipient ages, sex, total ischemic times, and 1-month serum creatinine values.

RESULT

In the MRA and SRA groups, the average recipient age was 52.3 and 47.0 years, respectively, while the average donor age was 52.9 and 53.1 years, respectively. In SRA and MRA groups, total ischemic time (TIT) was 96.1 and 143.6 min (P < .01). Serum creatinine level 1 month post-transplantation was 1.54 and 1.25, respectively (P < .001). Here we experienced 12 cases of living renal donor nephrectomy with multiple vessels in which the vascular supply territory was first assessed in April 2013 using an intraoperative near-infrared fluorescence camera system. In addition, regarding TIT, it is possible to shorten surgery by using individual anastomosis and ligation.

CONCLUSION

By managing multiple donors; arteries by nephrectomy, it is possible to improve kidney transplantation results.

Retroperitoneal Laparoendoscopic Single-Incision Radical Nephrectomy Without Special Platforms: A Single-Center Initial Experience

OBJECTIVES

To describe the initial experience of retroperitoneal laparoendoscopic single-incision radical nephrectomy (LESI-RN) without special platforms and use of conventional laparoscopic instruments and assess the safety and feasibility of LESI-RN.

SUBJECTS AND METHODS

Twenty patients who underwent LESI-RN were enrolled in this study. A 5-cm arc skin incision was performed at the midpoint between the costal arch and iliac crest on the midaxillary line. Trocars of 10, 5, and 11 mm were placed at the middle, left end, and right end of the arc incision, respectively. Demographic parameters and perioperative data were retrospectively analyzed and compared with the patients who underwent conventional retroperitoneal laparoscopic radical nephrectomy (LRN).

RESULTS

The LESI-RN patients had a significantly lower visual analogue scale (4.4 ± 1.9 versus 5.6 ± 1.4; P = .031) and analgesic requirement (18.5 ± 11.2 versus 28.6 ± 16.1; P = .026) compared with the conventional LRN group. The operation time in the LESI-RN group was longer than that in the conventional LRN group (P = .001). The two procedures were essentially similar in terms of the time to liquid intake and hospital stay after operation (P > .05).

CONCLUSIONS

LESI-RN is a safe and feasible surgical strategy, which combines the common principles of using straight instruments and working triangulation in conventional LRN with advantages of cosmesis and minimal invasiveness in laparoendoscopic single-site surgery. The surgical and oncological efficacy of LESI-RN is similar to that of conventional LRN but with significantly improved control of postoperative pain and cosmetic results.