Elsevier

Urology

Volume 84, Issue 6, December 2014, Pages 1529-1534
Urology

Surgical Techniques in Urology
Hybrid Technique Using a Satinsky Clamp for Right-sided Transperitoneal Hand-assisted Laparoscopic Donor Nephrectomy: Comparison With Left-sided Standard Hand-assisted Laparoscopic Technique

https://doi.org/10.1016/j.urology.2014.09.006Get rights and content

Objective

To introduce our hybrid technique using a Satinsky clamp for right-sided hand-assisted laparoscopic donor nephrectomy (HALDN) and to compare its effectiveness and safety with those of standard left-sided HALDN.

Methods

We conducted a retrospective analysis of 253 patients, who underwent HALDN (51 right and 202 left) from January 2003 to December 2012. Perioperative outcomes including operative time, estimated blood loss, warm ischemic time, hospital stay, complications, and recovery of renal function in recipients were collected and compared between the right hybrid HALDN (rhHALDN) and left-sided HALDN groups.

Results

The procedure was performed successfully in all 253 patients. No statistical difference in the mean operation time (224.3 vs 217.5 minutes), estimated blood loss (128.1 vs 123.6 mL), warm ischemic time (3.3 vs 3.1 minutes), average time to oral intake (2.4 vs 2.1 days), and mean hospital stay (4.9 vs 5.5 days) was observed between the rhHALDN and left-sided HALDN groups (P >.05). Perioperative complication rates were not statistically different between rhHALDN (2 intraoperative, 3 postoperative; 9.8%) and left-sided HALDN (6 intraoperative, 22 postoperative; 13.9%) group (P = .328). No significant difference in mean serum creatinine level and glomerular filtration rate in recipients from postoperative day 1 to 1 year was observed between the 2 groups.

Conclusion

The perioperative outcomes of rhHALDN using a Satinsky clamp were comparable with those of the left-sided standard HALDN. This hybrid technique can be a technically safe and feasible option for minimally invasive organ donation when right kidney donation is indicated.

Section snippets

Methods

This study was approved by the Institutional Review Board of Kyungpook National University Hospital. From January 2003 to December 2012, single surgeon performed 253 HALDNs including 51 (20.2%) cases of right hybrid HALDN (rhHALDN). Each volunteer for kidney donation underwent a standard preoperative immunologic and medical examination to confirm his or her suitability. Conventional renal angiography with magnetic resonance angiography or 3-dimensional spiral computerized tomography was used to

Results

The operation was performed successfully in all 253 patients. The reasons for right-sided donor nephrectomy were multiple left renal vessels (n = 21), a difference in split renal function of >10% as determined by radionuclide renal scan (n = 16), and early left renal artery bifurcation (n = 14). Forty-five patients had single right renal arteries (88.2%), and 6 patients had double right renal arteries (11.8%). Fifty patients had single right renal veins (98.0%), and 1 patient had a double right

Comment

Compared with open donor nephrectomy, laparoscopic donor nephrectomy is associated with less blood loss, decreased analgesic requirement, shorter hospital stay, improved cosmetic results, and earlier return to normal activity.20 Despite the development of surgical technique of laparoscopic donor nephrectomy, most of the donor nephrectomies are performed on the left side, which is preferred owing to longer renal vein and the easier procedure of transplantation.

Mandal et al9 reported a

Conclusion

With respect to donor safety, organ quality, and operative time, the perioperative outcomes of rhHALDN using a Satinsky clamp was comparable with those of left-sided standard HALDN. This hybrid technique can be a technically safe and feasible option for minimally invasive organ donation when right kidney donation is indicated.

References (30)

  • I.S. Gill et al.

    Laparoscopic retroperitoneal live donor right nephrectomy for purposes of allotransplantation and autotransplantation

    J Urol

    (2000)
  • M.D. Stifelman et al.

    Hand assisted laparoscopic donor nephrectomy: a comparison with the open approach

    J Urol

    (2001)
  • B.S. Kim et al.

    Chylous ascites as a complication of laparoscopic nephrectomy

    J Urol

    (2010)
  • L.E. Ratner et al.

    Laparoscopic live donor nephrectomy

    Transplantation

    (1995)
  • J.A. Cadeddu et al.

    Laparoscopic donor nephrectomy

    Semin Laparosc Surg

    (2000)
  • Cited by (8)

    • Endo-Satinsky Clamp Hybrid In Situ Perfusion in Retroperitoneoscopic Donor Nephrectomy For Right-sided Kidney

      2019, Urology
      Citation Excerpt :

      Although most of the recipients showed promising surgical outcomes, it was necessary to monitor the postoperative stricture or thrombosis of the renal vein by doppler ultrasound over a long duration after surgery, and as a result, caused cost increases and prolonged hospital stays. Since 2016, we have worked to establish a modified RDN technique for kidney procurement based on the findings of previous work.10,14 This study provides a feasible alternative of LDN, which better assures the length of renal vein procurement, overall cost reduction, and most importantly, decrease in the risks of postoperative stricture or thrombosis of the renal vein.

    • Open Management of the Renal Vein Is a Safe Modification in Right-Sided Laparoscopic Living Donor Nephrectomy to Maximize Graft Vein Length

      2018, Transplantation Proceedings
      Citation Excerpt :

      To save this length, we have adopted and further modified a technique first described by Ratner et al [16] and later by a Chinese group [17] in 2011 as semi-open retroperitoneal nephrectomy. With this approach, the kidney is dissected laparoscopically, and the vein is managed via an open approach [17]. A Brazilian group described a hand-assisted living donor nephrectomy in which a Satinsky clamp is introduced into the abdominal cavity through the hand port and the inferior vena cava is oversewn laparoscopically [18].

    • Intraoperative conversions in minimally invasive colorectal surgery

      2017, Operative Techniques in Single Incision Laparoscopic Colorectal Surgery
    View all citing articles on Scopus

    Financial Disclosure: The authors declare that they have no relevant financial interests.

    Funding Support: This research was supported by Kyungpook National University Research Fund, 2012.

    View full text