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Nine‐yr experience of 700 hand‐assisted laparoscopic donor nephrectomies in J apan
Author(s) -
Nakajima Ichiro,
Iwadoh Kazuhiro,
Koyama Ichiro,
Tojimbara Tamotsu,
Teraoka Satoshi,
Fuchinoue Shohei
Publication year - 2012
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2012.01617.x
Subject(s) - medicine , nephrectomy , surgery , body mass index , perioperative , blood loss , kidney transplantation , transplantation , kidney
Objective We reviewed the introduction of a new, minimally invasive, live kidney donation program in our department. Methods The operating times of 700 consecutive hand‐assisted laparoscopic donor nephrectomies ( HALDN ) conducted from F ebruary 2001 to A pril 2010 were examined. The risk factors for prolonging operating times were analyzed and major surgical barriers in HALDN investigated. Results All procedures were successfully performed without the requirement for conversion to open surgery or blood transfusion. The overall prevalence of perioperative complications was 3.0%, with no mortality, in this non‐obese donor population with mean body mass index ( BMI ) as low as 23.2 ± 3.2 kg/m 2 . After the initial learning curve, a second learning plateau was detected until around case 300. Multivariate analyses showed that the significant risk factors were male sex, graft weight, number of renal arteries, right nephrectomy, and previous epigastric surgery (p < 0.05). HALDN provided direct handling of the surgical field, secure vascular control, safe manipulation of adhesive tissues, and served to maintain surgical safety. Mean values of the BMI of donors had a significant positive correlation with the prevalence of complications between large studies (p = 0.042). Conclusions Laparoscopic donor nephrectomy was safely introduced and established in a single institution with the help of the hand‐assistance method.