Abstract
BackgroundLiving-donor nephrectomy (LDN) is challenging, as surgery is performed on healthy individuals. Minimally invasive techniques for LDN have become standard in most centers. Nevertheless, numerous techniques have been described with no consensus on which is the superior approach. Both hand-assisted retroperitoneoscopic (HARS) and hand-assisted laparoscopic (HALS) LDNs are performed at Zurich University Hospital. The aim of this study was to compare these two surgical techniques in terms of donor outcome and graft function.MethodRetrospective single-center analysis of 60 consecutive LDNs (HARS n = 30; HALS n = 30) from June 2010 to May 2012, including a one-year follow-up of the recipients.ResultsThere was no mortality in either group and little difference in the overall complication rates. Median warm ischemia time (WIT) was significantly shorter in the HARS group. The use of laxatives and the incidence of postoperative vomiting were significantly greater in the HALS group. There was no difference between right- and left-sided nephrectomies in terms of donor outcome and graft function.ConclusionsBoth techniques appear safe for both donors and donated organs. The HARS technique is associated with a shorter WIT and a reduced incidence of postoperative paralytic ileus. Therefore, we consider HARS LDN a valuable alternative to HALS LDN.
Highlights
Living-donor nephrectomy (LDN) is challenging, as surgery is performed on healthy individuals
There was no difference between right- and left-sided nephrectomies in terms of donor outcome and graft function
The hand-assisted retroperitoneoscopic (HARS) technique is associated with a shorter warm ischemia time (WIT) and a reduced incidence of postoperative paralytic ileus
Summary
Living-donor nephrectomy (LDN) is challenging, as surgery is performed on healthy individuals. Numerous techniques have been described with no consensus on which is the superior approach Both hand-assisted retroperitoneoscopic (HARS) and hand-assisted laparoscopic (HALS) LDNs are performed at Zurich University Hospital. The aim of this study was to compare these two surgical techniques in terms of donor outcome and graft function. The outcome of living-donor kidney transplantation is superior to transplantation of deceased donor kidneys in terms of improved long-term recipient survival, quality of life, early graft function and better graft survival [4,5,6]. Living-donor nephrectomy (LDN) remains a surgical challenge in terms of minimizing postoperative complications as it is performed on healthy individuals. The surgical technique must result in the least possible risk of morbidity without compromising the functional outcome of grafts
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