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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2008  |  Volume : 19  |  Issue : 1  |  Page : 102-104
Modified Anterior Abdominal Donor Nephrectomy in Comparison with Laparoscopic Donor Nephrectomy


Urology Department, Imam Hospital, Tabriz University of Medical Sciences, Tabriz, Iran

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   Abstract 

Recently with introduction of laparoscopic nephrectomy, the procedure has become more appealing to living donors because of smaller laparoscopic incision and decreased length of hospital stay. However, because of the relatively prolonged warm ischemia time, increased operating time, and delayed graft function, the current laparoscopic donor nephrectomy is still subject to further development. We introduced a modified anterior abdomen incision for donor nephrectomy with advantages of laparoscopic procedure but with shorter warm ischemia and operation time. In 15 donors, a 10 cm incision was performed in the upper side of the abdomen between the rectus muscle and the tip of the ribs, while the donor was in flank position. Then, the kidney was exposed and freed followed by ureter nephrectomy. Afterwards, the abdominal wall was repaired without drain. The time of operation (from incision skin to suturing of skin) was from 1-1.5 hours with a few seconds of warm ischemia time. The donors experienced tolerable pain and all of them were discharged from hospital two days post operation. all grafts in recipients started to diurese immediately. Cosmetic appearance of wounds after operation and six months later were good. In conclusion, the modified anterior abdominal incision is safe and comparable with the conventional laparoscopic procedure in the size of the incision, the cosmetic appearance, the incision pain, and time of discharge. It may be advised as an alternative laparoscopic nephrectomy procedure.

Keywords: Donor nephrectomy, minimal invasive, anterior abdomen, unrelated donor

How to cite this article:
Zomorrodi A, Bohluli A. Modified Anterior Abdominal Donor Nephrectomy in Comparison with Laparoscopic Donor Nephrectomy. Saudi J Kidney Dis Transpl 2008;19:102-4

How to cite this URL:
Zomorrodi A, Bohluli A. Modified Anterior Abdominal Donor Nephrectomy in Comparison with Laparoscopic Donor Nephrectomy. Saudi J Kidney Dis Transpl [serial online] 2008 [cited 2019 Sep 21];19:102-4. Available from: http://www.sjkdt.org/text.asp?2008/19/1/102/37445

   Introduction Top


Renal transplantation is a cost effective therapy for chronic renal failure with better quality of life than dialysis. [1] Allografts from live donors have more advantages than those from cadaver donors.[2],[3],[4],[5],[6],[7],[8]

Laparascopic donor nephrectomy has been introduced for convenience to the donors, and resulted in increasing allografts' donation due to its less invasive technique than the conven­tional open surgery; small incision, early dis­charge, less pain and better cosmetic appea­rance of the wound.

We studied the effect of possibly better technique for laparoscopic nephrectomy with a flank approach for the introducing incision that could minimize the pain, and may result in less hospital stay than the current approach


   Materials and Methods Top


Fifteen living unrelated donors (11 males and 4 females), with mean age 25.8 years ages and range from 23-35 years, were referred for kidney transplantation service at Imam Hospital, Tabriz, Iran during 2007; all of them completely evaluated per the standard criteria for donors' selection. After applying general anesthesia, the donors were placed in flank position, and a 10 cm introducing incision for laparoscopic nephrectomy was performed in the upper side of the abdomen between the rectus muscle and the tip of the ribs [Figure - 1]. Then, the prospective kidney was exposed and excised with a very short warm ischemia time without rib resection, or inserting drain [Figure - 2]. For comparison, [Figure - 3] shows the long incision for the con­ventional open surgical donor nephrectomy.


   Results Top


The time of operation (from incision skin to suturing of skin) was from 1-1.5 hours with a few seconds of warm ischemia time. The donors experienced tolerable pain and all of them were discharged from hospital two days post operation, and sutures were removed after 7 days. All grafts in recipients started to diurese immediately. Cosmetic appearance of wounds after operation and six months later were good.


   Discussion Top


Several authors stated that open donor nephrectomy (ODN) is better than laparo­scopic donor nephrectomy (LDN) for operative duration, warm ischemia time, and vessel length. [9] In one study, the warm ischemia time was longer in the LDN group, but was acceptably low and appeared to cause no significant renal ischemia injury or affect early graft outcome. Although in this study the donor operative duration in the LDN group was significantly longer than in the ODN group, the mean operative duration was <3 hours, which compares favorably with other published series. [10],[11],[12] In our suggested technique, the operating time was 1.5 hours and ischemia time was very short, which was important in the outcome of donors and recipients.

Series from individual units will never be statistically powerful enough to determine differences in serious morbidity (deep vein thrombosis, adjacent organ injury, death) and the documented benefits of LDN must be balanced against these potential risks. [13]

According to these caveats, LDN is not advocated as the procedure of choice, or used as a market differentiator in attracting live-donor patients. [14] Although our sample is small but its outcome is encouraging.

We conclude that anterior abdominal mini invasive technique may be an alternative for laparascopic nepherectomy and it warrants more prospective study.

 
   References Top

1.Cecka JM, Terasaki PI. The UNOS Scientific Renal Transplant Registry. In: Clinical Transplants, Cecka JM, Terasaki PI, eds. UCLA Tissue Typing Lab: Los Angeles; 1995. p. 2.  Back to cited text no. 1    
2.Terasaki PI, Cecka M, Gjertson DW, Takemoto S. High survival rates of kidney transplants from spousal and living unrelated donors. N Engl J Med 1995; 333:333-6.  Back to cited text no. 2    
3.United Network for Organ Sharing. 1996 Annual Report. p. 195.  Back to cited text no. 3    
4.Gaber LW, Gaber AO, Hathaway DK, Vera SR, Shokous-Amiri MH. Routine early biopsy of allografts with delayed function: Correlation of histopathology and transplant outcome. Clin Transpl 1996;10:629-31.  Back to cited text no. 4    
5.Marshall R, Ahsan N, Dhillon S, Holman M, Yang HC. Adverse effect of donor vasopressor support on immediate and one-year kidney allograft function. Surgery 1996;120:663-6.  Back to cited text no. 5  [PUBMED]  
6.Pfaff WW, Howard RJ, Patton PR, Adams VR, Rosen CB, Reed AI. Delayed graft function after renal transplantation. Transplantation 1998;65:219-23.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Troppman C, Gillingham KJ, Benedetti E, et al. Delayed graft function, acute rejection, and outcome after cadaver renal transplantation: A multivariate analysis. Transplantation 1995;59:962-5.  Back to cited text no. 7    
8.Sanfilippo F, Vaughn WK, Spees EK, Lucas BA. The detrimental effects of delayed graft function in cadaver renal transplantation. Transplantation 1984;38: 643-6.  Back to cited text no. 8  [PUBMED]  
9.Oyen O, Andersen M, Mathisen L, et al. Laparoscopic versus open living-donor nephrectomy: Experiences from a pros­pective, randomized, single-center study focusing on donor safety. Transplantation 2005;79:1236-40.  Back to cited text no. 9    
10.Derweesh IH, Goldfarb DA, Abreu SC, et al. Laparoscopic live donor nephrectomy has equivalent early and late renal function outcomes compared with open donor nephrectomy. Urology 2005;65:862-6.  Back to cited text no. 10  [PUBMED]  [FULLTEXT]
11.Simforoosh N, Basiri A, Tabibi A, Shakhssalim N, Hosseini Moghaddam SM. Comparison of laparoscopic and open donor nephrectomy: a randomized controlled trial. BJU Int 2005;95:851-5.  Back to cited text no. 11  [PUBMED]  [FULLTEXT]
12.Wilson CH, Bhatti AA, Rix DA, Soomro NA. Comparison of laparoscopic and open donor nephrectomy: UK experience. BJU Int 2005;95:131-5.  Back to cited text no. 12  [PUBMED]  [FULLTEXT]
13.Matas AJ, Bartlett ST, Leichtman AB, Delmonico FL. Morbidity and mortality after living kidney donation, 1999-2001: Survey of United States transplant centers. Am J Transplant 2003;3:830-4.  Back to cited text no. 13  [PUBMED]  [FULLTEXT]
14.Power RE, Preston JM, Griffin A, Martin I, Wall DR, Nicol DL. Laparoscopic vs open living donor nephrectomy: A contemporary series from one centre. BJU Int 2006;98:133-6.  Back to cited text no. 14  [PUBMED]  [FULLTEXT]

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Correspondence Address:
Afshar Zomorrodi
Associate Professor of Urology, Imam Hospital, Tabriz University of Medical Sciences, Tabriz
Iran
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PMID: 18087135

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    Materials and Me...
    Results
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