2002 Volume 93 Issue 7 Pages 721-726
(Purpose) Laparoscopic nephrectomy is being employed in renal transplantation because of its minimal invasiveness, and several modifications in surgical procedures have been proposed. We devised a new technique of retroperitoneoscopic hand-assisted nephrectomy (RHAN) for live donor. We report the early experiences with this technique in 5 cases of live renal graft donor.
(Techniques and Subjects) The donors are placed in a modified decubitus position under general anesthesia, and all the laparoscopic surgical procedures were performed retroperitoneally using 3 port sites and a sealing device (LAP DISC™) under a pressure of 10mmHg. The LAP DISC™ is placed through a para-rectus abdominal skin incision of approximately 8cm in length into the retroperitoneal cavity and used as a rout for instrumental as well as hand-assisted manipulations during the surgery. The hand-assistance through the LAP DISC™ made the surgical manipulation considerably easier and allowed the immediate removal of the graft after the interruption of the renal blood flow. This procedure was applied to 5 subjects, 4 in the left and one in the right kidney.
(Results) The operating data were 264-359min for operating time, 0.9-3.9min for warm ischemic time and 40-755ml for intra-operative blood loss, respectively. The serum creatinine level of the recipients at day 7 was 0.9-2.7mg/dl. These values, except for operating time, were at the same range as those of the open live donor nephrectomy in our clinic. The 5 donors discharged 7-9 days after RHAN without any surgical complications.
(Conclusion) Our technique of RHAN will be a minimal invasive one in terms of both for the donors and the grafts, and be widely acceptable for donor nephrectomy on either side.