Skip to main content
Erschienen in: World Journal of Urology 6/2008

01.12.2008 | Topic Paper

Complications of retroperitoneoscopic living donor nephrectomy: single center experience after 164 cases

verfasst von: Alexander Bachmann, Stephen Wyler, Thomas Wolff, Lorenz Gürke, Jürg Steiger, Christoph Kettelhack, Thomas C. Gasser, Robin Ruszat

Erschienen in: World Journal of Urology | Ausgabe 6/2008

Einloggen, um Zugang zu erhalten

Abstract

Objectives

Retroperitoneoscopic living donor nephrectomy (RLDN) is used by only a few centers worldwide. Similar to laparoscopic living donor nephrectomy it offers the donor rapid convalescence and excellent cosmetic results. However, concerns have been expressed over the safety of endoscopic living donor nephrectomy.

Methods

We review the results of 164 consecutive RLDN from November 2001 to November 2007. Complications were classified into intra- and early postoperative.

Results

Mean donor age was 53.4 ± 10.7 years (27–79). Left kidneys were harvested in 76% of cases. Mean operation time was 146 ± 44 min (55–270), and warm ischemia time 131 ± 45 s (50–280). In two patients (1.2%) conversion to open nephrectomy was necessary. The intraoperative complication rate was 3.0%. In the postoperative period we observed in 17.7% minor complications with no persisting impairments for the donor. The rate of major complications in the early postoperative period was 4.3%. Three patients (1.8%) necessitated revision, due to laceration of the external iliac artery in one patient and chyloretroperitoneum in two patients. Mean donor creatinine was 113.1 ± 26.6 mg/dl (63–201) on the first postoperative day, and 102.0 ± 22.2 mg/dl (68–159) on the fifth postoperative day.

Conclusion

Retroperitoneoscopic living donor nephrectomy can be performed with acceptable intraoperative and early postoperative morbidity. Operation times and warm ischemia times are comparable to the open approach.
Literatur
1.
Zurück zum Zitat Ratner LE, Ciseck LJ, Moore RG, Cigarroa FG, Kaufman HS, Kavoussi LR (1995) Laparoscopic live donor nephrectomy. Transplantation 60(9):1047–1049PubMed Ratner LE, Ciseck LJ, Moore RG, Cigarroa FG, Kaufman HS, Kavoussi LR (1995) Laparoscopic live donor nephrectomy. Transplantation 60(9):1047–1049PubMed
2.
Zurück zum Zitat Gill IS, Uzzo RG, Hobart MG, Streem SB, Goldfarb DA, Noble MJ (2000) Laparoscopic retroperitoneal live donor right nephrectomy for purposes of allotransplantation and autotransplantation. J Urol 164(5):1500–1504PubMedCrossRef Gill IS, Uzzo RG, Hobart MG, Streem SB, Goldfarb DA, Noble MJ (2000) Laparoscopic retroperitoneal live donor right nephrectomy for purposes of allotransplantation and autotransplantation. J Urol 164(5):1500–1504PubMedCrossRef
3.
Zurück zum Zitat Bachmann A, Dickenmann M, Gurke L, Giannini O, Langer I, Gasser TC, Steiger J, Sulser T (2004) Retroperitoneoscopic living donor nephrectomy: a retrospective comparison to the open approach. Transplantation 78(1):168–171PubMedCrossRef Bachmann A, Dickenmann M, Gurke L, Giannini O, Langer I, Gasser TC, Steiger J, Sulser T (2004) Retroperitoneoscopic living donor nephrectomy: a retrospective comparison to the open approach. Transplantation 78(1):168–171PubMedCrossRef
4.
Zurück zum Zitat Ratner LE, Kavoussi LR, Sroka M, Hiller J, Weber R, Schulam PG, Montgomery R (1997) Laparoscopic assisted live donor nephrectomy—a comparison with the open approach. Transplantation 63(2):229–233PubMedCrossRef Ratner LE, Kavoussi LR, Sroka M, Hiller J, Weber R, Schulam PG, Montgomery R (1997) Laparoscopic assisted live donor nephrectomy—a comparison with the open approach. Transplantation 63(2):229–233PubMedCrossRef
5.
Zurück zum Zitat Wolf JS Jr, Marcovich R, Merion RM, Konnak JW (2000) Prospective, case matched comparison of hand assisted laparoscopic and open surgical live donor nephrectomy. J Urol 163(6):1650–1653PubMedCrossRef Wolf JS Jr, Marcovich R, Merion RM, Konnak JW (2000) Prospective, case matched comparison of hand assisted laparoscopic and open surgical live donor nephrectomy. J Urol 163(6):1650–1653PubMedCrossRef
6.
Zurück zum Zitat Stifelman MD, Hull D, Sosa RE, Su LM, Hyman M, Stubenbord W, Shichman S (2001) Hand assisted laparoscopic donor nephrectomy: a comparison with the open approach. J Urol 166(2):444–448PubMedCrossRef Stifelman MD, Hull D, Sosa RE, Su LM, Hyman M, Stubenbord W, Shichman S (2001) Hand assisted laparoscopic donor nephrectomy: a comparison with the open approach. J Urol 166(2):444–448PubMedCrossRef
7.
Zurück zum Zitat Velidedeoglu E, Williams N, Brayman KL, Desai NM, Campos L, Palanjian M, Wocjik M, Bloom R, Grossman RA, Mange K, Barker CF, Naji A, Markmann JF (2002) Comparison of open, laparoscopic, and hand-assisted approaches to live-donor nephrectomy. Transplantation 74(2):169–172PubMedCrossRef Velidedeoglu E, Williams N, Brayman KL, Desai NM, Campos L, Palanjian M, Wocjik M, Bloom R, Grossman RA, Mange K, Barker CF, Naji A, Markmann JF (2002) Comparison of open, laparoscopic, and hand-assisted approaches to live-donor nephrectomy. Transplantation 74(2):169–172PubMedCrossRef
8.
Zurück zum Zitat Chung E, Grant AB, Hibberd AD, Sprott P (2007) Why potential live renal donors prefer laparoscopic nephrectomy: a survey of live donor attitudes. BJU Int 100(6):1344–1346PubMedCrossRef Chung E, Grant AB, Hibberd AD, Sprott P (2007) Why potential live renal donors prefer laparoscopic nephrectomy: a survey of live donor attitudes. BJU Int 100(6):1344–1346PubMedCrossRef
9.
Zurück zum Zitat Giessing M, Reuter S, Deger S, Tullmann M, Hirte I, Budde K, Fritsche L, Slowinski T, Dragun D, Neumayer HH, Loening SA, Schonberger B (2005) Laparoscopic versus open donor nephrectomy in Germany: impact on donor health-related quality of life and willingness to donate. Transplant Proc 37(5):2011–2015PubMedCrossRef Giessing M, Reuter S, Deger S, Tullmann M, Hirte I, Budde K, Fritsche L, Slowinski T, Dragun D, Neumayer HH, Loening SA, Schonberger B (2005) Laparoscopic versus open donor nephrectomy in Germany: impact on donor health-related quality of life and willingness to donate. Transplant Proc 37(5):2011–2015PubMedCrossRef
10.
Zurück zum Zitat Kuo PC, Johnson LB (2000) Laparoscopic donor nephrectomy increases the supply of living donor kidneys: a center-specific microeconomic analysis. Transplantation 69(10):2211–2213PubMedCrossRef Kuo PC, Johnson LB (2000) Laparoscopic donor nephrectomy increases the supply of living donor kidneys: a center-specific microeconomic analysis. Transplantation 69(10):2211–2213PubMedCrossRef
11.
Zurück zum Zitat Schweitzer EJ, Wilson J, Jacobs S, Machan CH, Philosophe B, Farney A, Colonna J, Jarrell BE, Bartlett ST (2000) Increased rates of donation with laparoscopic donor nephrectomy. Ann Surg 232(3):392–400PubMedCrossRef Schweitzer EJ, Wilson J, Jacobs S, Machan CH, Philosophe B, Farney A, Colonna J, Jarrell BE, Bartlett ST (2000) Increased rates of donation with laparoscopic donor nephrectomy. Ann Surg 232(3):392–400PubMedCrossRef
12.
Zurück zum Zitat Nanidis TG, Antcliffe D, Kokkinos C, Borysiewicz CA, Darzi AW, Tekkis PP, Papalois VE (2008) Laparoscopic versus open live donor nephrectomy in renal transplantation: a meta-analysis. Ann Surg 247(1):58–70PubMedCrossRef Nanidis TG, Antcliffe D, Kokkinos C, Borysiewicz CA, Darzi AW, Tekkis PP, Papalois VE (2008) Laparoscopic versus open live donor nephrectomy in renal transplantation: a meta-analysis. Ann Surg 247(1):58–70PubMedCrossRef
13.
Zurück zum Zitat Goldfarb DA (2001) Are concerns over right laparoscopic donor nephrectomy unwarranted? J Urol 166(6):2558–2559PubMedCrossRef Goldfarb DA (2001) Are concerns over right laparoscopic donor nephrectomy unwarranted? J Urol 166(6):2558–2559PubMedCrossRef
14.
Zurück zum Zitat Murray JE, Harrison JH (1963) Surgical management of fifty patients with kidney transplants including eighteen pairs of twins. Am J Surg 105:205–218PubMedCrossRef Murray JE, Harrison JH (1963) Surgical management of fifty patients with kidney transplants including eighteen pairs of twins. Am J Surg 105:205–218PubMedCrossRef
15.
Zurück zum Zitat Bachmann A, Wolff T, Ruszat R, Giannini O, Dickenmann M, Gurke L, Steiger J, Gasser TC, Stief CG, Sulser T (2005) Retroperitoneoscopic donor nephrectomy: a retrospective, non-randomized comparison of early complications, donor and recipient outcome with the standard open approach. Eur Urol 48(1):90–96PubMedCrossRef Bachmann A, Wolff T, Ruszat R, Giannini O, Dickenmann M, Gurke L, Steiger J, Gasser TC, Stief CG, Sulser T (2005) Retroperitoneoscopic donor nephrectomy: a retrospective, non-randomized comparison of early complications, donor and recipient outcome with the standard open approach. Eur Urol 48(1):90–96PubMedCrossRef
16.
Zurück zum Zitat Oyen O, Andersen M, Mathisen L, Kvarstein G, Edwin B, Line PD, Scholz T, Pfeffer PF (2005) Laparoscopic versus open living-donor nephrectomy: experiences from a prospective, randomized, single-center study focusing on donor safety. Transplantation 79(9):1236–1240PubMedCrossRef Oyen O, Andersen M, Mathisen L, Kvarstein G, Edwin B, Line PD, Scholz T, Pfeffer PF (2005) Laparoscopic versus open living-donor nephrectomy: experiences from a prospective, randomized, single-center study focusing on donor safety. Transplantation 79(9):1236–1240PubMedCrossRef
17.
Zurück zum Zitat Simforoosh N, Basiri A, Tabibi A, Shakhssalim N, Hosseini Moghaddam SM (2005) Comparison of laparoscopic and open donor nephrectomy: a randomized controlled trial. BJU Int 95(6):851–855PubMedCrossRef Simforoosh N, Basiri A, Tabibi A, Shakhssalim N, Hosseini Moghaddam SM (2005) Comparison of laparoscopic and open donor nephrectomy: a randomized controlled trial. BJU Int 95(6):851–855PubMedCrossRef
18.
Zurück zum Zitat Bachmann A, Giannini O, Wolff T, Dickenmann M, Ruszat R, Langer I, Gurke L, Gasser TC, Reich O, Stief CG, Steiger J, Sulser T (2005) Retroperitoneoscopic living donor nephrectomy: a comparison with the open approach in respect of early postoperative pain management. Transplant Proc 37(2):609–612PubMedCrossRef Bachmann A, Giannini O, Wolff T, Dickenmann M, Ruszat R, Langer I, Gurke L, Gasser TC, Reich O, Stief CG, Steiger J, Sulser T (2005) Retroperitoneoscopic living donor nephrectomy: a comparison with the open approach in respect of early postoperative pain management. Transplant Proc 37(2):609–612PubMedCrossRef
19.
Zurück zum Zitat Ng CS, Abreu SC, bou El-Fettouh HI, Kaouk JH, Desai MM, Goldfarb DA, Gill IS (2004) Right retroperitoneal versus left transperitoneal laparoscopic live donor nephrectomy. Urology 63(5):857–861PubMedCrossRef Ng CS, Abreu SC, bou El-Fettouh HI, Kaouk JH, Desai MM, Goldfarb DA, Gill IS (2004) Right retroperitoneal versus left transperitoneal laparoscopic live donor nephrectomy. Urology 63(5):857–861PubMedCrossRef
20.
Zurück zum Zitat Tanabe K, Miyamoto N, Ishida H, Tokumoto T, Shirakawa H, Yamamoto H, Kondo T, Okuda H, Shimmura H, Ishikawa N, Nozaki T, Toma H (2005) Retroperitoneoscopic live donor nephrectomy (RPLDN): establishment and initial experience of RPLDN at a single center. Am J Transplant 5(4 Pt 1):739–745PubMedCrossRef Tanabe K, Miyamoto N, Ishida H, Tokumoto T, Shirakawa H, Yamamoto H, Kondo T, Okuda H, Shimmura H, Ishikawa N, Nozaki T, Toma H (2005) Retroperitoneoscopic live donor nephrectomy (RPLDN): establishment and initial experience of RPLDN at a single center. Am J Transplant 5(4 Pt 1):739–745PubMedCrossRef
21.
Zurück zum Zitat Wadstrom J (2005) Hand-assisted retroperitoneoscopic live donor nephrectomy: experience from the first 75 consecutive cases. Transplantation 80(8):1060–1066PubMedCrossRef Wadstrom J (2005) Hand-assisted retroperitoneoscopic live donor nephrectomy: experience from the first 75 consecutive cases. Transplantation 80(8):1060–1066PubMedCrossRef
22.
Zurück zum Zitat Yang SC, Rha KH, Kim YS, Kim SI, Park K (2001) Retroperitoneoscopy-assisted living donor nephrectomy: 109 cases. Transplant Proc 33(1–2):1104–1105PubMedCrossRef Yang SC, Rha KH, Kim YS, Kim SI, Park K (2001) Retroperitoneoscopy-assisted living donor nephrectomy: 109 cases. Transplant Proc 33(1–2):1104–1105PubMedCrossRef
23.
Zurück zum Zitat Buell JF, Abreu SC, Hanaway MJ, Ng CS, Kaouk JH, Clippard M, Zaki S, Goldfarb DA, Woodle ES, Gill IS (2004) Right donor nephrectomy: a comparison of hand-assisted transperitoneal and retroperitoneal laparoscopic approaches. Transplantation 77(4):521–525PubMedCrossRef Buell JF, Abreu SC, Hanaway MJ, Ng CS, Kaouk JH, Clippard M, Zaki S, Goldfarb DA, Woodle ES, Gill IS (2004) Right donor nephrectomy: a comparison of hand-assisted transperitoneal and retroperitoneal laparoscopic approaches. Transplantation 77(4):521–525PubMedCrossRef
24.
Zurück zum Zitat Jacobs SC, Cho E, Foster C, Liao P, Bartlett ST (2004) Laparoscopic donor nephrectomy: the University of Maryland 6-year experience. J Urol 171(1):47–51PubMedCrossRef Jacobs SC, Cho E, Foster C, Liao P, Bartlett ST (2004) Laparoscopic donor nephrectomy: the University of Maryland 6-year experience. J Urol 171(1):47–51PubMedCrossRef
25.
Zurück zum Zitat Leventhal JR, Kocak B, Salvalaggio PR, Koffron AJ, Baker TB, Kaufman DB, Fryer JP, Abecassis MM, Stuart FP (2004) Laparoscopic donor nephrectomy 1997 to 2003: lessons learned with 500 cases at a single institution. Surgery 136(4):881–890PubMedCrossRef Leventhal JR, Kocak B, Salvalaggio PR, Koffron AJ, Baker TB, Kaufman DB, Fryer JP, Abecassis MM, Stuart FP (2004) Laparoscopic donor nephrectomy 1997 to 2003: lessons learned with 500 cases at a single institution. Surgery 136(4):881–890PubMedCrossRef
26.
Zurück zum Zitat Su LM, Ratner LE, Montgomery RA, Jarrett TW, Trock BJ, Sinkov V, Bluebond-Langner R, Kavoussi LR (2004) Laparoscopic live donor nephrectomy: trends in donor and recipient morbidity following 381 consecutive cases. Ann Surg 240(2):358–363PubMedCrossRef Su LM, Ratner LE, Montgomery RA, Jarrett TW, Trock BJ, Sinkov V, Bluebond-Langner R, Kavoussi LR (2004) Laparoscopic live donor nephrectomy: trends in donor and recipient morbidity following 381 consecutive cases. Ann Surg 240(2):358–363PubMedCrossRef
27.
Zurück zum Zitat Ruszat R, Sulser T, Dickenmann M, Wolff T, Gurke L, Eugster T, Langer I, Vogelbach P, Steiger J, Gasser TC, Stief CG, Bachmann A (2006) Retroperitoneoscopic donor nephrectomy: donor outcome and complication rate in comparison with three different techniques. World J Urol 24(1):113–117PubMedCrossRef Ruszat R, Sulser T, Dickenmann M, Wolff T, Gurke L, Eugster T, Langer I, Vogelbach P, Steiger J, Gasser TC, Stief CG, Bachmann A (2006) Retroperitoneoscopic donor nephrectomy: donor outcome and complication rate in comparison with three different techniques. World J Urol 24(1):113–117PubMedCrossRef
28.
Zurück zum Zitat Buell JF, Hanaway MJ, Potter SR, Cronin DC, Yoshida A, Munda R, Alexander JW, Newell KA, Bruce DS, Woodle ES (2002) Hand-assisted laparoscopic living-donor nephrectomy as an alternative to traditional laparoscopic living-donor nephrectomy. Am J Transplant 2(10):983–988PubMedCrossRef Buell JF, Hanaway MJ, Potter SR, Cronin DC, Yoshida A, Munda R, Alexander JW, Newell KA, Bruce DS, Woodle ES (2002) Hand-assisted laparoscopic living-donor nephrectomy as an alternative to traditional laparoscopic living-donor nephrectomy. Am J Transplant 2(10):983–988PubMedCrossRef
29.
Zurück zum Zitat Ruszat R, Wyler SF, Wolff T, Forster T, Lenggenhager C, Dickenmann M, Eugster T, Gurke L, Steiger J, Gasser TC, Sulser T, Bachmann A (2007) Reluctance over right-sided retroperitoneoscopic living donor nephrectomy: justified or not? Transplant Proc 39(5):1381–1385PubMedCrossRef Ruszat R, Wyler SF, Wolff T, Forster T, Lenggenhager C, Dickenmann M, Eugster T, Gurke L, Steiger J, Gasser TC, Sulser T, Bachmann A (2007) Reluctance over right-sided retroperitoneoscopic living donor nephrectomy: justified or not? Transplant Proc 39(5):1381–1385PubMedCrossRef
30.
Zurück zum Zitat Del Pizzo JJ, Jacobs SC, Bishoff JT, Kavoussi LR, Jarrett TW (2003) Pleural injury during laparoscopic renal surgery: early recognition and management. J Urol 169(1):41–44PubMedCrossRef Del Pizzo JJ, Jacobs SC, Bishoff JT, Kavoussi LR, Jarrett TW (2003) Pleural injury during laparoscopic renal surgery: early recognition and management. J Urol 169(1):41–44PubMedCrossRef
Metadaten
Titel
Complications of retroperitoneoscopic living donor nephrectomy: single center experience after 164 cases
verfasst von
Alexander Bachmann
Stephen Wyler
Thomas Wolff
Lorenz Gürke
Jürg Steiger
Christoph Kettelhack
Thomas C. Gasser
Robin Ruszat
Publikationsdatum
01.12.2008
Verlag
Springer-Verlag
Erschienen in
World Journal of Urology / Ausgabe 6/2008
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-008-0296-6

Weitere Artikel der Ausgabe 6/2008

World Journal of Urology 6/2008 Zur Ausgabe

Update Urologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.