Benefit of Live Donor Transplantation Hand-Assisted Laparoscopic

Abstract

One of the major differences between cadaveric and live organ] donation is that the well-being of the donor is equal to the well-being of the recipient after transplantation. Laparoscopic live donor nephrectomy in particular is considered from the donor perspective. In Japan, >1,000 live donor kidney transplantations have been performed. The organ transplantation law was revised in July 2010, and brain death is now considered human death. In comparison to the pre-organ transplantation law era, brain death donations have increased to approximately 170. In addition to eliminating the long wait associated with cadaveric organ donation, a major advantage of live donation is the prevention of ischemia. Despite the apparent benefits of laparoscopic nephrectomy, this procedure is technically more difficult to perform and is associated with a steeper learning curve. We chose healthy volunteers between 20 and 70 years of age as donors. We performed 86 hand-assisted laparoscopic donor nephrectomies (HALDNx) from July 2003 to December 2011. Results: HALDNx was successfully performed in all 100 cases, and no patients required conversion to laparotomy. The estimated blood loss was 43.4 g, and no patient required a transfusion. In comparison with OPN x, the blood loss was 426.5 ± 247.6 g (p < 0.001). The mean operating time was 188.4 min with HALDNx and 228.4 min with OPNx (p < 0.01). The postoperative hospitalization period was 7.9 days with HALDNx and 13.0 days with OPNx (p < 0.001). Conclusions: HALDNx is superior in terms of operating time, blood loss, postoperative hospitalization, and recovery. We obtained better results in terms of a shorter operating time and hospital stay as well as less blood loss]. As we gained experience with this technique, we could change with no drainage technique in 20 cases from 2010. Laparoscopic living donor nephrectomy, like its counterpart laparoscopic cholecystectomy, represents an important advancement in surgical technology. It has significantly eased the discomfort and time required to donate a kidney. The procedure is technically demanding and should only be performed by surgeons with advanced laparoscopic skills. We recently performed a hybrid technique involving a combination of pure laparoscopy and HALDNx. In the first half of the operation, we performed exfoliation and isolation of a kidney graft by using a 12-mm port through a gel port. In the second half of the operation, the essential scene, HALDNx, was performed after isolation of the hilum of the kidney. Overall, donor satisfaction was better in the HALDNx group. HALDNx is a safe procedure that makes kidney donation more appealing to potential live donors and has increased the living donor pool at our center.