Safe Initiation of a Laparoendoscopic Single Site Living Donor Nephrectomy Program in a Small-volume Transplant Center - 28/07/13
, Bashir R. Sankari a, b, c, Lorie Lipscomb c, Alice M. Jones c, J. Stephen Jones a, bAbstract |
Objective |
To describe keys to successful programmatic implementation of laparoendoscopic single-site (LESS)-living donor nephrectomy (LDN) in a small-volume center. Laparoscopic LDN has become the standard of care. Technically challenging LESS-LDN has been limited to high-volume centers. However, approximately half of all U.S. transplant centers perform ≤15 LDNs/year, including our center.
Methods |
A hand-assisted laparoscopy (HAL) device was used as the LESS platform at a periumbilical midline incision. We used an adhesive drape to cover the platform to prevent gas leakage. A 30° telescope and 3-4 instruments were inserted through its gel-cap. After careful dissection, the kidney was bagged into a recovery device with an external handle before its vessels were ligated with staples and was then removed immediately through the LESS wound.
Results |
LESS-LDN was successful in all of 10 living donors without any multisite laparoscopic or open conversion and without any instruments inserted through extra wounds. No patient had perioperative complications or received transfusions. Median operative time was 271 minutes with a warm ischemia time (WIT) of 3.5 minutes. Hospital stay averaged 2 days with visual analog pain score 4 of 10 at discharge and 2 of 10 at 2 weeks. All recipients recuperated well with immediate graft function.
Conclusion |
Our LESS-LDN technique offers improved cosmesis, favorable perioperative outcomes, and versatile options for conversion, if necessary, making it a viable approach for small-volume centers.
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| Authors' contribution: Concept/design: S.J.C.; Data analysis/interpretation: S.J.C. and B.R.S.; Drafting article: S.J.C.; Critical revision of article: J.S.J.; Approval of article: all authors; Data collection: L.L. and A.M.J. |
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| Financial Disclosure: The authors declare that they have no relevant financial interests. |
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| Funding Support: This work was supported in part by Health Resources and Services Administration contract 234-2005-370011C (OPTN Data Request System). The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. |
Vol 82 - N° 2
P. 352-357 - août 2013 Retour au numéro
Article précédent
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