Complications of Retroperitoneoscopic Living Donor Nephrectomy
- VernacularTitle:后腹腔镜活体供肾切取术手术并发症分析
- Author:
Guoliang WANG
;
Lulin MA
;
Lei ZHAO
- Publication Type:Journal Article
- Keywords:
Laparoscopy;
Living donor;
Nephrectomy;
Complication
- From:
Chinese Journal of Minimally Invasive Surgery
2001;0(03):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To report our initial experience on the complications of retroperitoneoscopic live donor nephrectomy(RPLDN)and their managements in 117 cases.Methods From December 2003 to January 2009,117 cases of RPLDNs were carried out in our hospital.The operation was performed through 3 lumbar ports,after the kidney was liberated fully and the ureter was severed 7-8 cm under the lower pole of the kidney,the renal artery and vein were blocked with Endo-cut or Hem-o-lok and then cut off.Endo-cut was used in 3 patients and Hem-o-lok in 114 donors.Afterwards,the kidney was taken out quickly from the donor and infused with 4℃ kidney preserving fluid(HCA)immediately.We reviewed the intraoperative and postoperative complications in the donors and the grafts and the managements of the cases.Results All the 117 operations were successfully completed.No patients died during the operation or had delayed graft function recovery postoperation.No one was converted to an open surgery or needed blood transfusion during the procedure.Surgery-related complications occurred in 5 donors(4.3%)including intraoperative bleeding in 2(cured by hemostasis during the operation)and retroperitoneal hematoma in 3(cured by conservative management).Graft-related complications occurred in 8(6.8%)cases;among which extra arteries in the graft owning to endovascular stapler was found in 1 patient(who had a short common stem of the main renal artery,the three branches were anastomosed with the external iliac artery and 2 branches of internal iliac artery respectively);two graft kidneys were lacerated by laparoscopic instruments superficially and were repaired using absorbable sutures;renal subcapsular hematoma was noted in 2 grafts,capsulotomy was performed in one of them while the other received no treatment,both the cases had normal function of the transplanted kidneys;ureteral complications occurred in 3 grafts,in which vesico-urethral anastomotic leakage was developed in 10 days after withdrawal of the double J stents,they were cured by ureteral re-implantation.All the donors and recipients with complications were followed up for an average of 50 months(range 15-62 months).No other complications were found in the cases.During the follow-up,blood and urine routine,liver and renal functions,and blood glucose level are all in a normal range,abdominal B-ultrasonography revealed no abnormalities.B-ultrasonography of the implanted kidneys showed normal morphology and renal functions.Conclusions RPLDN is a safe and reliable method.Most of its complications complications may be attributed to the learning curve.Refinements in surgical techniques may decrease the rates of both donor and graft complications.
