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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2017  |  Volume : 28  |  Issue : 3  |  Page : 661-663
Hand-assisted laparoscopic donor nephrectomy: A single-center study


Department of Urology and Kidney Transplant, Pakistan Kidney Institute, Shifa International Hospital, Islamabad, Pakistan

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Date of Web Publication18-May-2017
 

How to cite this article:
Shohab D, Jamil I, Khan IA, Khawaja MA, Khan MA, Akhter S. Hand-assisted laparoscopic donor nephrectomy: A single-center study. Saudi J Kidney Dis Transpl 2017;28:661-3

How to cite this URL:
Shohab D, Jamil I, Khan IA, Khawaja MA, Khan MA, Akhter S. Hand-assisted laparoscopic donor nephrectomy: A single-center study. Saudi J Kidney Dis Transpl [serial online] 2017 [cited 2019 Nov 18];28:661-3. Available from: http://www.sjkdt.org/text.asp?2017/28/3/661/206455
To the Editor,

The first living kidney transplant was performed in 1952 in Paris, it however had a survival of only three weeks.[1] Living kidney donation has been considered a better choice compared to cadaveric one because of shorter cold ischemia time and the use of perfect kidneys from perfectly healthy donors resulting in better graft outcome.[2]

To increase voluntary living kidney donation, there was always a need to improve nephrec- tomy technique, reducing pain and morbidity of incision and ensuring donor safety.[3] This fact, however, was needed to be balanced with preservation of as much graft function as possible.[3]

With the advent of laparoscopy and its usage for different renal pathologies, there was a tendency toward pure laparoscopic donor nephrec- tomy (PLDN) as well. On one hand, laparos- copic donor nephrectomy was associated with lesser pain, reduced estimated blood loss, and shorter hospital stay; however, on the other hand, there were reports of disadvantages including longer operative and warm ischemia times.[4],[5] Hand-assisted laparoscopic donor nephrectomy (HALDN), a transition from open to simple nephrectomy, gained popularity for harvesting the donor kidney, balancing the safety and betterment of both the graft and donor.[6] We are one of the few centers in Pakistan doing HALDN and share our experience of such donor nephrectomies over the past four years.

This is a retrospective analysis of 172 patients who underwent HALDN in Shifa International Hospitals including 78 (45.3%) males and 94 (54.7%) females. Data were collected by chart review in terms of age, gender operative time, side of donor kidney, number of arteries and veins, warm ischemia time, conversion to open procedure, pre- and post-operative complications and hospital stay, and recipient graft function. Data were analyzed on Statistical Package for the Social Science software version 20.0 (SPSS Inc., Chicago, IL, USA).

One hundred and seventy-two patients with a mean age of 32.13 ± 4.31 years including 78 (45.3%) males and 94 (54.7%) females were included in the study. Right-sided HALDN was performed in 25 (20.3%) patients while left-sided HALDN was performed in 137 (79.6%) patients. Thirty-six (20.9%) donors had more than one renal artery. Mean operative time was 188.23 ± 23.12 min while mean warm ischemia time was 2.16 ± 1.03 min [Table 1]. Eight patients were converted to open procedure mainly due to bleeding. Mean hospital stay was 3.41± 1.01 days. Eleven patients had superficial wound infections and five had prolonged ileus of 72 h postoperatively. Postoperative delayed graft was seen in 17 (9.8%) patients but was reversible in most of the cases [Table 2]. Five grafts were lost in the past four years in the early post-operative period.
Table 1: Patient characteristics.

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Table 2: Complications.

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HALDN is considered a preferred method for removing donor kidney as it has an added advantage of direct tactile feedback and the possibility of manual dissection.[7],[8] It is still recommended in most of the published literatures as a procedure of choice for donor nephrectomy.

Rajab et al share their experience of 1500 HALDN with a mean age of 40.8 ± 10.8 years and body mass index of 27.9 ± 5.0, including 541 males. The left kidney was removed in 1236 patients. Four donors (0.27%) had to be converted to an open technique due to bleeding. Six donors required reoperation; three for small bowel obstruction and three for wound dehiscence. Twenty-seven patients (1.8%) developed incisional hernia and seven donors (0.47%) developed bowel obstruction. Mean hospital stay after donation was 2.1 ± 0.3 days. Twenty-one recipients (1.4%) experienced DGF. Ureteric complications were seen in 17 (1.1%) recipients while there was an early graft loss in 13 patients (0.9%).[9]

Hanif et al in their initial experience of 20 patients with a mean age of 44 ±10 years including 13 females found a mean operative time of 135 ± 33 min and warm ischemia time of 41 ± 16 s. Mean hospital stay was 5 ± 1 days. There were two cases of delayed graft function. They found HALDN to be a safe and effective procedure.[10] Loveland et al in their study of 24 patients found operative time of 188 min and mean hospital stay of 2.5 days. Mean warm ischemia time was 188 s [Table 3].[11] When we compare our data with the rest of the world, we found our donors to be younger than that of the above-mentioned studies. There were more female donors, and left-sided nephrectomy was preferred. Mean warm ischemia time, mean operative time, and mean hospital stay were also comparable [Table 2].
Table 3: Comparison with literature.

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A more recent trend is toward pure laparoscopic and robotic donor nephrectomies. Especially with betterment of instruments and more and more learning experiences, PLDNs have been gaining grounds reducing operation- related pain and morbidity to minimum. Choi et al found no significant differences in surgical outcomes, complication rates, postoperative parameters, recipient graft function, and morbidity between the HALDN and PLDN groups.[12] Safety and feasibility of robot-assisted nephrectomy are pointed out in all the reviewed articles, and is now employed for donor nephrectomy as well.[13] So we can say that both hand- assisted and totally robotic technique may be the future of donor nephrectomy.

In conclusion, HALDN is a safe procedure with fewer complications in all living renal donors, and until there is more and more evidence in favor of pure laparoscopic and robotic approach, HALDN will continue to be the main stay for donor nephrectomy.

Conflict of interest: None declared.

 
   References Top

1.
Legendre Ch, Kreis H. A tribute to Jean Hamburger’s contribution to organ transplantation. Am J Transplant 2010;10:2392-5.  Back to cited text no. 1
[PUBMED]    
2.
Greco F, Hoda MR, Alcaraz A, Bachmann A, Hakenberg OW, Fornara P. Laparoscopic living-donor nephrectomy: Analysis of the existing literature. Eur Urol 2010;58:498-509.  Back to cited text no. 2
    
3.
You D, Lee C, Jeong IG, Han DJ, Hong B. Transition from hand-assisted to pure laparos- copic donor nephrectomy. JSLS 2015;19. pii: E2015.00044.  Back to cited text no. 3
    
4.
Wilson CH, Sanni A, Rix DA, Soomro NA. Laparoscopic versus open nephrectomy for live kidney donors. Cochrane Database Syst Rev 2011;11 :CD006124.  Back to cited text no. 4
    
5.
Simforoosh N, Basiri A, Shakhssalim N, et al. Long-term graft function in a randomized clinical trial comparing laparoscopic versus open donor nephrectomy. Exp Clin Transplant 2012;10:428-32.  Back to cited text no. 5
    
6.
Wolf JS Jr., Tchetgen MB, Merion RM. Hand- assisted laparoscopic live donor nephrectomy. Urology 1998;52:885-7.  Back to cited text no. 6
    
7.
Ozdemir-van Brunschot DM, Koning GG, van Laarhoven KC, et al. A comparison of technique modifications in laparoscopic donor nephrectomy: A systematic review and meta- analysis. PLoS One 2015;10:e0121131.  Back to cited text no. 7
    
8.
Alberts V, Idu MM, Minnee RC. Risk factors for perioperative complications in hand- assisted laparoscopic donor nephrectomy. Prog Transplant 2014;24:192-8.  Back to cited text no. 8
    
9.
Rajab A, Pelletier RP. The safety of hand- assisted laparoscopic living donor nephrec- tomy: The Ohio State University experience with 1500 cases. Clin Transplant 2015;29:204- 10.  Back to cited text no. 9
    
10.
Hanif F, Clancy MJ. Hand-assisted laparos- copic living donor nephrectomy: Initial Glasgow experience. Scott Med J 2013;58: 237-40.  Back to cited text no. 10
    
11.
Loveland J, Liakos D, Joseph C, Botha JR, Britz R. Hand-assisted laparoscopic live donor nephrectomy-initial experience. S Afr J Surg 2011;49:18-21.  Back to cited text no. 11
    
12.
Choi SW, Kim KS, Kim S, et al. Hand-assisted and pure laparoscopic living donor nephrec- tomy: A matched-cohort comparison over 10 year at a single institute. Clin Transplant 2014; 28:1287-93.  Back to cited text no. 12
    
13.
Janki S, Klop KW, Hagen SM, et al. Robotic surgery rapidly and successfully implemented in a high volume laparoscopic center on living kidney donation. Int J Med Robotics Comput Assist Surg 2016. doi: 10.1002/rcs.1743.  Back to cited text no. 13
    

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Correspondence Address:
Dr. Durre Shohab
Department of Urology and Kidney Transplant, Pakistan Kidney Institute, Shifa International Hospital, Islamabad
Pakistan
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DOI: 10.4103/1319-2442.206455

PMID: 28540911

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