Document Detail


Mini-incision for strictly retroperitoneal nephrectomy in living kidney donation vs flank incision.
MedLine Citation:
PMID:  16891649     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Mini-incision donor nephrectomies (MIDNs) were established during the last decade, as an alternative to traditional open donor nephrectomy (ODN) via flank incision. In this study, we investigated intra-operative and post-operative data on outcome following MIDN in comparison with ODN data. METHODS: Data of 70 living kidney donations, performed at the University of Regensburg Medical Center since 1996, were evaluated. Donor operation was performed as either strictly retroperitoneal MIDN (n = 34) or as traditional ODN (n = 36) via flank incision. Total operation time, warm ischaemia time (WIT), perioperative pain-medication usage and creatinine levels as well as length of hospital stay, return to complete enteral nutrition and regular digestion were evaluated retrospectively. RESULTS: Total operation times were similar in MIDN, n = 34 (132 +/- 26 min) and in ODN, n = 36 (140 +/- 37 min) (P = 0.424). WIT was also similar in both: MIDN (0.9 +/- 0.4 min) and ODN (0.9 +/- 0.4 min) (P = 0.568). The requirement for post-operative opioids in morphine equivalent doses was significantly lower in MIDN (8.4 +/- 16 mg) compared with ODN (44 +/- 57 mg) (P = 0.001). Additional application of non-opioids (metamizole) (MIDN: 4.8 +/- 6.3 g, ODN: 3.4 +/- 3.9 g) and non-steroidal antirheumatic (NSAR) (diclofenac) (MIDN: 322 +/- 361 mg, ODN: 247 +/- 474 mg) revealed no significant differences between the groups. The hospital stay was 4.9 +/- 1.4 days in MIDN which was significantly shorter than that in ODN (9.3 +/- 3.3 days) (P = 0.001). Patients achieved fully independent mobility earlier in MIDN than in ODN (P = 0.934). Start of enteral nutrition with fluids was significantly quicker in MIDN (1.9 +/- 7 h) compared with ODN (12 +/- 13 h) (P = 0.05). Full enteral nutrition was accomplished significantly earlier in MIDN (1.6 +/- 0.8 days) (P = 0.023). Return to normal digestion revealed no significant differences between groups. Serum creatinine levels of all kidney donors were in the normal range (66 +/- 18 micromol/l) one day before nephrectomy, increased on day 1 after surgery (119 micromol/l +/- 31 micromol/l) and were stable on day 3 (115 micromol/l +/- 30 micromol/l) without significant differences. CONCLUSION: Strictly, retroperitoneal MIDN in living kidney donation is a fast and safe method for the procurement of a living donor graft, giving the patient a significantly shorter period of recovery, and thus is an attractive and recommendable alternative to traditional ODN procedures.
Authors:
A A Schnitzbauer; M Loss; M Hornung; G Glockzin; L Mantouvalou; B Krüger; B K Krämer; H J Schlitt; A Obed
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Publication Detail:
Type:  Journal Article     Date:  2006-08-05
Journal Detail:
Title:  Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association     Volume:  21     ISSN:  0931-0509     ISO Abbreviation:  Nephrol. Dial. Transplant.     Publication Date:  2006 Oct 
Date Detail:
Created Date:  2006-09-20     Completed Date:  2007-04-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8706402     Medline TA:  Nephrol Dial Transplant     Country:  England    
Other Details:
Languages:  eng     Pagination:  2948-52     Citation Subset:  IM    
Affiliation:
University of Regensburg Medical Center, Department of Surgery, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany. andreas.schnitzbauer@klinik.uni-regensburg.de
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MeSH Terms
Descriptor/Qualifier:
Adult
Analgesia / methods
Creatine / blood
Female
Humans
Kidney Transplantation / methods*
Length of Stay
Living Donors*
Male
Middle Aged
Models, Anatomic
Nephrectomy / methods*
Outcome Assessment (Health Care)
Postoperative Complications
Reproducibility of Results
Retroperitoneal Space / surgery*
Surgical Procedures, Minimally Invasive / methods
Chemical
Reg. No./Substance:
57-00-1/Creatine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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