Document Detail


Laparoscopic living donor nephrectomy: is there a difference between using a left or a right kidney?
MedLine Citation:
PMID:  23146499     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: The goal of this study was to review the results of 279 laparoscopic living donor nephrectomies (LLDN) regarding outcomes of using the left or the right kidney.
METHODS: Among 279 patients who underwent LLDN between August 1998 and April 2009, 260 underwent a left (group L) and 19, a right (group R) nephrectomy. The two groups were compared regarding intra- and postoperative parameters, including pre- and postoperative renal function, length of surgery, conversion to an open approach, delayed graft function, and complications.
RESULTS: There were no significant differences between the two groups regarding preoperative glomerular filtration rate (L = 129.5 ± 32 mL/min versus group R = 127.3 ± 26 mL/min), length of surgery (group L = 228 ± 58 minutes versus group R = 226 ± 62 minutes group), postoperative donor creatinine (group L = 1.36 ± 0.9 mg/dL versus group R = 1.48 ± 0.8 mg/dL), conversion to open (group L = 6.6% versus group R = 5.3%), delayed graft function (group L = 7.2% versus group R = 6.3%) and recipient postoperative creatinine at 1 month (group L = 1.54 ± 1.4 mg/dL versus group R = 1.32 ± 1.1 mg/dL). There were three intraoperative donor complications in group L (bleeding in one donor required transfusion), and none in group R. Similarly, there was a great albeit not a significant difference in the number of major postoperative donor complications among group L (n = 16) versus group R (n = 2). The right kidney was chosen because of the number of vessels (n = 5), presence of cysts (n = 5), size and renal function (n = 6), presence of renal stones (n = 2), and tortuous ureter (n = 1). The reasons for conversion to open included bleeding, anatomic issues, and presence of adhesions. It should be noted that during the last 3 years there were no conversions to open, whereas the only conversion among group R was the first case.
CONCLUSIONS: Intra- and postoperative parameters were comparable between the groups. Considering the limitations of the small sample size of right LLDNs in this study, it appears that it is as safe and effective as a left procedure. The learning curve is extremely important, as can be seen by the lack of conversion in the last 3 years.
Authors:
G Tsoulfas; P Agorastou; D Ko; M Hertl; N Elias; A B Cosimi; T Kawai
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Transplantation proceedings     Volume:  44     ISSN:  1873-2623     ISO Abbreviation:  Transplant. Proc.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0243532     Medline TA:  Transplant Proc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2706-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
Affiliation:
Department of Surgery, Aristoteleion University of Thessaloniki, Thessaloniki, Greece. Electronic address: tsoulfasg@gmail.com.
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