Video-assisted retroperitoneal minilaparotomy surgery for 615 living donors

[Clark]

http://onlinelibrary.wiley.com/doi/10.1111/j.1432-2277.2011.01295.x/abstract

Standardized video-assisted retroperitoneal minilaparotomy surgery for 615 living donor nephrectomies
Kyung Hwa Choi1, Seung Choul Yang1, Seung Ryeol Lee2, Hwang Gyun Jeon2, Dong Suk Kim3, Dong Jin Joo4, Myoung Soo Kim4, Yu Seun Kim4, Soon Il Kim4, Woong Kyu Han1
DOI: 10.1111/j.1432-2277.2011.01295.x
Transplant International
Volume 24, Issue 10, pages 973–983, October 2011

Summary
To increase the rate of living kidney donation, the long-term safety of nephrectomy must be demonstrated to potential donors. We analyzed long-term donor outcomes and evaluated the standardization of surgical technique. We evaluated 615 donors who underwent Video-assisted minilaparotomy living donor nephrectomy (VLDN) at Yonsei Severance Hospital between 2003 and 2009. Perioperative data and predictors of outcomes were prospectively analyzed. The mean operative time and mean warm ischemia time were 192.7 and 2.2 min, respectively. Mean estimated blood loss was 195.3 ml. The mean post-transplant serum creatinine levels and Modification of Diet in Renal Disease study equation for estimating glomerular filtration rate were 1.1 mg/dl and 68 ml/min/1.73 m2, respectively at 5 years after VLDN. The intra-operative and postoperative complication rate were 3.1% and 6.3%, respectively. Delayed renal function, 5-year graft survival, and complication rates of recipients were 1.1%, 98.4%, and 0.4%, respectively. Predictors of operative time were medical history, vessel anomaly, and surgeon experience (>50 cases). The single predictor of intra-operative complications was vessel anomaly. Standardized VLDN is feasible and safe. Our data on long-term outcomes can assist in demonstrating the long-term safety of donor nephrectomy to potential donors. To compare VLDN to other types of donor nephrectomy, a prospective multicenter study must be performed.