Introduction of Laparoscopic Donor Nephrectomy: Challenges, Outcomes and Success Strategies.

IF 0.3 Q4 TRANSPLANTATION
Y Saifee, S Bhatia, C S Chamania, P Salgia, J Kriplani, A Sepaha
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引用次数: 0

Abstract

Background: Laparoscopic live donor nephrectomy (LLDN) has become the standard of care and is popular among most of the transplant centers across the globe. Despite proven advantages of LLDN, some transplantation centers hesitate to start the program because of issues concerning donor safety and allograft function.

Objective: To discusses the main barriers for creating a successful LLDN program, strategies that allowed us to start a successful LLDN program along with the study results.

Methods: The donors undergoing LLDN from December 2016 to February 2018 were enrolled in the study and prospectively evaluated. LLDN were performed by two senior surgeons alternately with assistance by the laparoscopic urologist in all cases. Also, in the present study, two technical alterations were done in the standard surgical technique of transperitoneal LDN. The first important modification made was the use of two additional ports for use by laparoscopic urologists. The second modification involved dissection on both poles of the kidney before hilar dissection.

Results: A total of 112 transperitoneal LLDN were performed during the study period. The mean (range) of operation time was 117.5 (81-158) min; the ischemia time was 194 (171-553) sec. Only one patient needed conversion to open surgery. No other major peri-operative or posto-perative complications occurred. All kidney grafts were functioning well.

Conclusion: With proper planning, team approach, and few technical modifications, introduction of LLDN is safe and effective.

腹腔镜供体肾切除术:挑战、结果和成功策略。
背景:腹腔镜活体供肾切除术(LLDN)已成为标准的护理,并在全球大多数移植中心流行。尽管LLDN已被证明具有优势,但由于供体安全性和同种异体移植物功能等问题,一些移植中心对启动该计划犹豫不决。目的:讨论创建一个成功的LLDN计划的主要障碍,使我们能够启动一个成功的LLDN计划的策略以及研究结果。方法:将2016年12月至2018年2月接受LLDN的供体纳入研究并进行前瞻性评估。LLDN由两名资深外科医生交替进行,所有病例均由腹腔镜泌尿科医生协助。此外,在本研究中,对经腹膜LDN的标准手术技术进行了两项技术改变。第一个重要的修改是使用两个额外的端口供腹腔镜泌尿科医生使用。第二种改良是在肾门分离之前先在肾的两极分离。结果:研究期间共行经腹腔LLDN 112例。手术时间平均(范围)为117.5 (81 ~ 158)min;缺血时间为194(171-553)秒。只有1例患者需要转开手术。无其他主要围手术期或术后并发症发生。所有移植肾功能良好。结论:通过合理的计划,团队合作,较少的技术修改,LLDN的引入是安全有效的。
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来源期刊
CiteScore
1.60
自引率
0.00%
发文量
0
审稿时长
12 weeks
期刊介绍: The International Journal of Organ Transplantation Medicine (IJOTM) is a quarterly peer-reviewed English-language journal that publishes high-quality basic sciences and clinical research on transplantation. The scope of the journal includes organ and tissue donation, procurement and preservation; surgical techniques, innovations, and novelties in all aspects of transplantation; genomics and immunobiology; immunosuppressive drugs and pharmacology relevant to transplantation; graft survival and prevention of graft dysfunction and failure; clinical trials and population analyses in the field of transplantation; transplant complications; cell and tissue transplantation; infection; post-transplant malignancies; sociological and ethical issues and xenotransplantation.
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