| 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 Jul 19];19:102-4. Available from: http://www.sjkdt.org/text.asp?2008/19/1/102/37445
| Introduction|| |
Renal transplantation is a cost effective therapy for chronic renal failure with better quality of life than dialysis.  Allografts from live donors have more advantages than those from cadaver donors.,,,,,,
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|| |
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|| |
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|| |
Several authors stated that open donor nephrectomy (ODN) is better than laparoscopic donor nephrectomy (LDN) for operative duration, warm ischemia time, and vessel length.  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. ,, 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. 
According to these caveats, LDN is not advocated as the procedure of choice, or used as a market differentiator in attracting live-donor patients.  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|| |
|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. |
|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. |
|3.||United Network for Organ Sharing. 1996 Annual Report. p. 195. |
|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. |
|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. [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. [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. |
|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. [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. |
|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. [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. [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. [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. [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. [PUBMED] [FULLTEXT]|
Associate Professor of Urology, Imam Hospital, Tabriz University of Medical Sciences, Tabriz
[Figure - 1], [Figure - 2], [Figure - 3]