Donor Nephrectomy

Many of the series of donor nephrectomy reported by surgeons who did not start performing the procedure until the advent of hand-assisted laparoscopy have been performed using hand-assisted laparoscopy (Table 5) (39-51). Among these 13 series reporting 454 patients in total, the mean operative time was 224 minutes and the mean warm ischemia time of the harvested kidney was two minutes and 36 seconds. Aside from conversion to open surgery in 2.0% of patients, the minor and major complication rates were 13.2% and 2.7%, respectively. Of the studies, four detailed donor convalescence, reporting a mean return to nonstrenuous activity levels in 8.7 days.

TABLE 5 ■ Published Hand-Assisted Laparoscopy Donor Nephrectomy Series

Mean warm

No. of pts with

No. conversion

Mean

Mean

No. graft

No.

Mean OR

ischemia

minor/major

to open

hospital

graft follow-

ureteral

No. loss

of pts.

time (min)

time (min)

complications

surgery

stay (day)

up (mo)

complications

of graft

Wolf et al. (39)

10

215

2.9

3/0

0

1.8

5

0

0

Kercher et al. (40)

30

275

1.2

7/0

1

3.4

11.5

0

0

Buell et al. (41)

30

246

2.2

-

2

2.9

-

-

1

Wolf et al. (42)

23

206

3.1

4/0

0

1.7

3

2

3

Stifelman et al. (43)

60

240

2

3/3

0

3.5

-

1

0

Ruiz-Deya et al. (44)

23

165

1.6

2/0

1

2

12

0

0

Velidedeoglu et al. (45)

60

260

-

1

2.6

-

-

-

Lindstrom et al. (46)

11

197

3.6

0/0

0

6.2

-

-

-

Gershbein et al. (47)

29

205

2.4

2/0

1

2.3

-

0

0

Wadstrom et al. (48)

10

155

3.0

1/0

0

6.3

-

-

-

Buell et al. (49)

100

234

3.1

16/6

2

2.2

-

-

-

Mateo et al. (50)

18

269

3.4

2/1

1

4.1

-

0

-

Maartense et al. (51)

50

153

3

8/0

0

5

-

2

3

Total

454

224a

2.6a

13.2%/2.7%b

2.0%b

3.0a

8.6a

2.2%b

Percentage occurrence of summed totals. Abbreviation: OR, operating room.

The results of the graft after hand-assisted laparoscopic donor nephrectomy have been excellent, with 97% functioning at a mean follow-up of 8.6 months.

The results of the graft after hand-assisted laparoscopic donor nephrectomy have been excellent, with 97% functioning at a mean follow-up of 8.6 months.

Ureteral complications occurred in 1.7% of recipients. Among the first 200 handassisted laparoscopy donor nephrectomies performed by one of the authors (JSW) at the University of Michigan, the one month, one year, and three year actuarial graft survival rates have been 97%, 96%, and 91%, respectively. The ureteral complication rate has been 6% overall, with a 16% ureteral complication rate prior to modifications in ureteral dissection (first 24 cases) and 4.5% in the 176 cases since then.

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