Document Detail


Modified laparoscopic splenectomy: a beneficial technique for ABO-incompatible living donor renal transplantation candidates on hemodialysis.
MedLine Citation:
PMID:  18937721     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Advances in laparoscopy have enabled minimally invasive surgical treatment of splenic diseases. Even with these advances, laparoscopic splenectomy in patients on dialysis can be difficult because of tissue fragility due to the underlying renal disease. We report a safe surgical technique for laparoscopic splenectomy in patients on maintenance dialysis that is suitable for use before ABO-incompatible living donor renal transplantation (LDRTx). Between June 1972 and December 2006, a total of 800 patients underwent LDRTx in our department, including 82 patients who underwent ABO-incompatible LDRTx. Between April 2001 and December 2006 we performed laparoscopic splenectomy in 48 hemodialysis patients as a pretreatment before ABO-incompatible LDRTx. Under general anesthesia the operation was performed using a new technique, referred to as the "splenic hilum lump method." We evaluated the surgical outcomes, such as the operative time, amount of blood loss, efficacy, and complications. The mean operative time was 131.6 +/- 38.4 min and mean blood loss was 126 +/- 395 mL. Blood transfusion was required in three patients. All cases had satisfactory kidney function after LDRTx and none developed kidney graft failure due to acute rejection. Almost all patients could walk the day after laparoscopic splenectomy and were satisfied with the cosmetic appearance of the scar after wound healing. The surgical technique we report here can be safely performed on patients with renal failure who require caution because of tissue fragility. Laparoscopic splenectomy is a safe, effective and less invasive operative procedure as a pretreatment for ABO-incompatible LDRTx.
Authors:
Susumu Matsuoka; Kazuharu Uchida; Yoshihiro Tominaga; Nobuaki Uno; Syuichi Simabukuro; Takahisa Hiramitsu; Norihiko Goto; Tetsuhiko Sato; Takaharu Nagasaka; Yoshihiko Watarai
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy     Volume:  12     ISSN:  1744-9987     ISO Abbreviation:  Ther Apher Dial     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-10-21     Completed Date:  2009-01-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101181252     Medline TA:  Ther Apher Dial     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  381-4     Citation Subset:  IM    
Affiliation:
Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan. matsuoka@nagoya2.jrc.or.jp
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MeSH Terms
Descriptor/Qualifier:
ABO Blood-Group System / immunology*
Adult
Blood Group Incompatibility / immunology,  surgery*
Cohort Studies
Female
Follow-Up Studies
Graft Rejection
Graft Survival
Humans
Japan
Kidney Failure, Chronic / immunology,  surgery
Kidney Transplantation / methods*
Laparoscopy / methods
Length of Stay
Living Donors*
Male
Middle Aged
Retrospective Studies
Risk Assessment
Splenectomy / methods*
Treatment Outcome
Chemical
Reg. No./Substance:
0/ABO Blood-Group System

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


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