Mini-incision Living Donor Nephrectomy and Trans-peritoneal Laparoscopic Nephrectomy: Will There Be a Place for New Evidence?

Autor: Nunes-Carneiro D; Urology Department, Hospital de Santo António, Centro Hospitalar do Porto, Portugal. Electronic address: diogocarneiro.urologia@chporto.min-saude.pt., Marques-Pinto A; Urology Department, Hospital de Santo António, Centro Hospitalar do Porto, Portugal., Braga I; Urology Department, Instituto Português de Oncologia do Porto, Portugal., Cabral JF; Urology Department, Hospital de Santo António, Centro Hospitalar do Porto, Portugal., Almeida M; Nephrology and Kidney Transplantation Department, Hospital de Santo António, Centro Hospitalar do Porto, Portugal., Cavadas V; Urology Department, Hospital de Santo António, Centro Hospitalar do Porto, Portugal., de Almeida R; Angiology and Vascular Surgery Department, Hospital de Santo António, Centro Hospitalar do Porto, Portugal., Castro-Henriques A; Nephrology and Kidney Transplantation Department, Hospital de Santo António, Centro Hospitalar do Porto, Portugal., Fraga A; Urology Department, Hospital de Santo António, Centro Hospitalar do Porto, Portugal., Silva-Ramos M; Urology Department, Hospital de Santo António, Centro Hospitalar do Porto, Portugal.
Jazyk: angličtina
Zdroj: Transplantation proceedings [Transplant Proc] 2019 Jun; Vol. 51 (5), pp. 1555-1558. Date of Electronic Publication: 2019 Jan 21.
DOI: 10.1016/j.transproceed.2019.01.044
Abstrakt: Objectives: To compare mini-incision donor nephrectomy (MDN) with laparoscopic donor nephrectomy (LDN) performed by the same surgical team, regarding short- and long-term outcomes.
Methods: Three hundred and five patients, who underwent donor nephrectomy in our institution, through an MDN (n = 141) between January 1998-November 2011 and LDN (n = 164) since June 2010-December 2017, were compared.
Results: The mean operative time for MDN (120 ± 29 minutes) was not significantly different when compared to LDN (113 ± 34 minutes), but when comparing the first 50 LDN and the 50 most recent, we found a reduction in the duration of the procedure. Laparoscopic donors had a shorter warm ischemia time (229 seconds vs 310 seconds, P = .01), particularly the 50 most recent, hospital stay (4.3 days vs 5.9 days, P < .001), and postoperative complications (P = .03). The incidence of graft acute tubular necrosis (ATN) was superior in the MDN (89% vs 25%, P < .001), although there was no significant difference regarding first-year serum creatinine (SCr) and glomerular filtration rate (GFR) (SCr 1.38 mg/dL vs SCr 1.33 mg/dL and GFR 63.7 mL/min vs 63.1 mL/min) comparing the 2 groups. Long-term graft survival did not significantly differ between groups. There was also no relationship between postoperative ATN events and long-term graft function.
Conclusions: With the growing experience of the high-volume centers and with specialized teams, LDN could be considered the most suitable technique for living donor nephrectomy with better results in short-term results (warm ischemia time, hospital stay, and postoperative complications), without difference in long-term outcomes.
(Copyright © 2019. Published by Elsevier Inc.)
Databáze: MEDLINE
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