Abstract
BACKGROUND.: Retroperitoneoscopic live donor nephrectomy (RetroNeph) offers an intrinsic advantage over conventional transperitoneal laparoscopic nephrectomy (LapNeph) because of the potentially lower risk for early and late intraperitoneal donor complications. RetroNeph, however, is infrequently performed and has not been systematically and directly compared with LapNeph in nonselected donors. METHODS.: In November 2007, after 10 years of programmatic experience with transperitoneal LapNeph, we implemented RetroNeph at once for all live donor nephrectomies. Donor selection criteria, laparoscopic port positions, and hand-assistance mode were identical for RetroNeph and preceding LapNeph donors. We compared outcomes of retroperitoneoscopically completed cases with those of previous transperitoneal LapNeph cases that were pair matched for donor sex, body mass index, and donor kidney laterality. RESULTS.: Of the first 52 donor nephrectomies (48 left, 4 right) consecutively started with the intent to perform a RetroNeph November 2007 to April 2009, 45 (87%) were completed retroperitoneoscopically, and seven (13%) were switched intraoperatively to transperitoneal LapNeph. We observed no conversions to open nephrectomy, donor blood transfusions, readmissions, or reoperations. Matched-pair analysis of the 45 RetroNeph versus 45 LapNeph cases showed no significant differences for warm ischemia time and other donor outcomes, delayed graft function rates, recipient creatinine at 1 week, and 1-year graft survival. CONCLUSIONS.: Implementation of a RetroNeph program had no adverse impact on donor morbidity and quality of early graft function. Our pilot experience suggests that the RetroNeph learning curve is short. Given the potential advantages of an extraperitoneal approach for the donor, RetroNeph is an attractive alternative to LapNeph, particularly for surgeons with previous LapNeph experience.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 858-863 |
| Number of pages | 6 |
| Journal | Transplantation |
| Volume | 89 |
| Issue number | 7 |
| DOIs | |
| State | Published - Apr 2010 |
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Keywords
- Kidney graft survival
- Kidney transplantation
- Laparoscopy
- Live donor nephrectomy
- Retroperitoneoscopy
ASJC Scopus subject areas
- Transplantation
Cite this
The transition from laparoscopic to retroperitoneoscopic live donor nephrectomy : A matched pair pilot study. / Troppmann, Christoph; Daily, Michael F.; McVicar, John; Troppmann, Kathrin L; Perez, Richard V.
In: Transplantation, Vol. 89, No. 7, 04.2010, p. 858-863.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The transition from laparoscopic to retroperitoneoscopic live donor nephrectomy
T2 - A matched pair pilot study
AU - Troppmann, Christoph
AU - Daily, Michael F.
AU - McVicar, John
AU - Troppmann, Kathrin L
AU - Perez, Richard V
PY - 2010/4
Y1 - 2010/4
N2 - BACKGROUND.: Retroperitoneoscopic live donor nephrectomy (RetroNeph) offers an intrinsic advantage over conventional transperitoneal laparoscopic nephrectomy (LapNeph) because of the potentially lower risk for early and late intraperitoneal donor complications. RetroNeph, however, is infrequently performed and has not been systematically and directly compared with LapNeph in nonselected donors. METHODS.: In November 2007, after 10 years of programmatic experience with transperitoneal LapNeph, we implemented RetroNeph at once for all live donor nephrectomies. Donor selection criteria, laparoscopic port positions, and hand-assistance mode were identical for RetroNeph and preceding LapNeph donors. We compared outcomes of retroperitoneoscopically completed cases with those of previous transperitoneal LapNeph cases that were pair matched for donor sex, body mass index, and donor kidney laterality. RESULTS.: Of the first 52 donor nephrectomies (48 left, 4 right) consecutively started with the intent to perform a RetroNeph November 2007 to April 2009, 45 (87%) were completed retroperitoneoscopically, and seven (13%) were switched intraoperatively to transperitoneal LapNeph. We observed no conversions to open nephrectomy, donor blood transfusions, readmissions, or reoperations. Matched-pair analysis of the 45 RetroNeph versus 45 LapNeph cases showed no significant differences for warm ischemia time and other donor outcomes, delayed graft function rates, recipient creatinine at 1 week, and 1-year graft survival. CONCLUSIONS.: Implementation of a RetroNeph program had no adverse impact on donor morbidity and quality of early graft function. Our pilot experience suggests that the RetroNeph learning curve is short. Given the potential advantages of an extraperitoneal approach for the donor, RetroNeph is an attractive alternative to LapNeph, particularly for surgeons with previous LapNeph experience.
AB - BACKGROUND.: Retroperitoneoscopic live donor nephrectomy (RetroNeph) offers an intrinsic advantage over conventional transperitoneal laparoscopic nephrectomy (LapNeph) because of the potentially lower risk for early and late intraperitoneal donor complications. RetroNeph, however, is infrequently performed and has not been systematically and directly compared with LapNeph in nonselected donors. METHODS.: In November 2007, after 10 years of programmatic experience with transperitoneal LapNeph, we implemented RetroNeph at once for all live donor nephrectomies. Donor selection criteria, laparoscopic port positions, and hand-assistance mode were identical for RetroNeph and preceding LapNeph donors. We compared outcomes of retroperitoneoscopically completed cases with those of previous transperitoneal LapNeph cases that were pair matched for donor sex, body mass index, and donor kidney laterality. RESULTS.: Of the first 52 donor nephrectomies (48 left, 4 right) consecutively started with the intent to perform a RetroNeph November 2007 to April 2009, 45 (87%) were completed retroperitoneoscopically, and seven (13%) were switched intraoperatively to transperitoneal LapNeph. We observed no conversions to open nephrectomy, donor blood transfusions, readmissions, or reoperations. Matched-pair analysis of the 45 RetroNeph versus 45 LapNeph cases showed no significant differences for warm ischemia time and other donor outcomes, delayed graft function rates, recipient creatinine at 1 week, and 1-year graft survival. CONCLUSIONS.: Implementation of a RetroNeph program had no adverse impact on donor morbidity and quality of early graft function. Our pilot experience suggests that the RetroNeph learning curve is short. Given the potential advantages of an extraperitoneal approach for the donor, RetroNeph is an attractive alternative to LapNeph, particularly for surgeons with previous LapNeph experience.
KW - Kidney graft survival
KW - Kidney transplantation
KW - Laparoscopy
KW - Live donor nephrectomy
KW - Retroperitoneoscopy
UR - http://www.scopus.com/inward/record.url?scp=77950944249&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77950944249&partnerID=8YFLogxK
U2 - 10.1097/TP.0b013e3181ca570f
DO - 10.1097/TP.0b013e3181ca570f
M3 - Article
C2 - 20065916
AN - SCOPUS:77950944249
VL - 89
SP - 858
EP - 863
JO - Transplantation
JF - Transplantation
SN - 0041-1337
IS - 7
ER -