Transplantation rénale à partir de donneurs vivants prélevés sous laparoscopie assistée par robot. À propos d’une série de 35 cas

Abstract

Renal transplantation with living donor is actually the best technique for renal replacement therapy, particularly with the problem of shortage of organs. Laparoscopic nephrectomy is actually developed because of low surgical mortality and morbidity. Our medical centre uses an original removal method: robot-assisted laparoscopic donor nephrectomy. We report our 35 first robot-assisted kidney removals at our centre. After a precise preoperative evaluation, all donors choosed robotic-assisted laparoscopic surgery. The mean hospitalitalization duration was 5,5 days. The serum creatinine level reached respectively 107, 104, 91, 71micromol/l within a period of 1, 2, 3 and 4 years after the operation. None of the recipients required post-transplant dialysis. No vascular complication was listed. The urological complications observed were: six lymphoceles, one ureteral stenosis and one ureteral necrosis. Ten patients (29% of the recipients) showed 16 biopsy-proven episodes of acute rejection. All donors and recipients were alive after a mean graft survival of 3,8+/-1 years. Thirty-four grafts fared well with an average serum creatinine level respectively of 107, 124, 125micromol/l at 1, 2, 3 and 4 years after transplantation. Considering the very low morbidity rate and the positive long term results for donors as well as for recipients, robot-assisted donor laparoscopy seems to be a safe and efficient surgical technique. By offering optimal operative conditions to the urological surgeon, it would serve as a favourable alternative to the present kidney graft shortage.