Laparoscopic donor nephrectomy has the potential to lessen the burden placed on live kidney donors. This study describes the first British comparison of donor morbidity and recovery following conventional open donor nephrectomy (ODN) and laparoscopic donor nephrectomy (LDN). An initial series of LDN (n=20) was compared to a historical control group of ODN (n=34). Laparoscopic operations were performed via a transperitoneal approach, the kidney being removed through a 6–12 cm Pfannensteil incision. Open operations were performed using a retroperitoneal flank approach with resection of the 12th rib. Postoperatively, donors were managed with a patient controlled analgesia system. LDN was associated with shorter mean (SD) inpatient stay (6 (2) v 4 (1) days; p=0.0001) and lower parenteral narcotic requirements (morphine 179 (108) v 67 (54) mg; p=0.0001). Laparoscopic donors started driving their cars sooner (2 (1.5) v 6 (4) weeks; p=0.0001) and returned to work more quickly (5 (3) v 12 (6) weeks; p=0.0001) than open nephrectomy donors. There were no differences in recipient serum creatinine levels at three months post-transplant but two recipients of transplant kidneys retrieved laparoscopically (10%) developed ureteric obstruction, whereas this complication did not occur after ODN (p=0.13). LDN is associated with less postoperative pain and a substantial improvement in donor recovery times. It is not yet clear whether or not the outcome of the recipient kidney transplants are the same after ODN and LDN and much more experience is required before the place of this new technique can be defined.
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机译:腹腔镜供体肾切除术有可能减轻活体肾脏供体的负担。这项研究描述了传统的开放供体肾切除术(ODN)和腹腔镜供体肾切除术(LDN)后,供体发病率和恢复情况的首次英国比较。将LDN的初始系列(n = 20)与ODN的历史对照组(n = 34)进行了比较。腹腔镜手术通过腹膜入路进行,通过6–12 cm Pfannensteil切口切除肾脏。使用腹膜后腹入路切除第十二肋骨进行开放手术。术后,使用患者自控镇痛系统管理供体。 LDN与较短的平均住院时间(SD)(6(2)v 4(1)天; p = 0.0001)和较低的肠胃外麻醉要求(吗啡179(108)v 67(54)mg; p = 0.0001)相关。与开放式肾切除术捐献者相比,腹腔镜捐献者开始开车的时间更快(2(1.5)v 6(4)周; p = 0.0001),并且返回工作的速度更快(5(3)v 12(6)周; p = 0.0001)。移植后三个月,接受者的血清肌酐水平无差异,但两名接受腹腔镜手术的移植肾接受者(10%)发展为输尿管梗阻,而这种并发症在ODN后未发生(p = 0.13)。 LDN术后疼痛减轻,供体恢复时间大大缩短。尚不清楚在ODN和LDN之后,接受者肾脏移植的结果是否相同,在定义这种新技术之前需要更多的经验。
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