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Extending Anatomic Barriers to Right Laparoscopic Live Donor Nephrectomy.
MedLine Citation:
PMID:  22173171     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: To analyze the effects of a right-sided-complex laparoscopic live donor nephrectomy, defined as bifurcation of the right renal artery behind the inferior vena cava. Right-sided laparoscopic live donor nephrectomy is now a widely accepted procedure when complex anatomy is encountered on the left. TECHNICAL CONSIDERATIONS: The present retrospective case note review involved 59 of 303 laparoscopic live donor nephrectomy procedures performed in a single center from January 2001 to April 2010 (group 1, simple, n = 48; and group 2, complex, n = 11). The effect of a donor right procedure on warm ischemia, graft function, and donor/recipient complications was analyzed. RESULTS: No difference in donor or recipient age or first and second warm ischemic times was found between the 2 groups. No difference was found in the estimated glomerular filtration rate or serum creatinine at 1 week and 3 and 6 months [estimated glomerular filtration rate (6/12), 49 ± 15 vs 60 ± 9 mL/min, P = .087; and serum creatinine (6 months), 159 ± 116 vs 120 ± 25 μmol/L; P = .356]. No cases of delayed graft function were reported, and none of the grafts developed vascular thrombosis. The cumulative estimated glomerular filtration rate at 6/12 was 51 ± 15 mL/min and the serum creatinine was 153 ± 108 μmol/L. Two patients (4%) required conversion to open surgery in group 1, and the cumulative conversion rate was 3.3%. In the complex group with retrocaval dissection, 8 kidneys were retrieved with a single artery and 3 had multiple vessels (2 with 2 vessels and 1 with 3 vessels; anastomotic time 26 ± 6 minutes). CONCLUSION: Complex vasculature in a right-sided donation should not be considered a contraindication, because the kidneys procured had excellent function compared with those with single vasculature with no increase in the conversion or vascular thrombosis rate. In addition, the described techniques permit improved arterial length and, importantly, organs procured with a single artery.
Authors:
Atul Bagul; Jodie H Frost; Umasankar Mathuram Thiyagarajan; Ismail H Mohamed; Michael L Nicholson
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-12-13
Journal Detail:
Title:  Urology     Volume:  -     ISSN:  1527-9995     ISO Abbreviation:  -     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0366151     Medline TA:  Urology     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Affiliation:
Transplant Department, University Hospitals of Leicester, Leicester General Hospital, Leicester, United Kingdom.
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