Research Of Retroperitoneoscopic Living Related Donor Nephrectomy

Purpose:To assess the safety, feasibility, and usefulness of retroperitoneoscopic living related donor nephrectomy(RPLDN).Patients and Methods:From January 2007 to September 2009, retroperitoneoscopic living related donor nephrectomy (RPLDN) was performed in 50 consecutive patients (group 1)in General Hospital of Jinan Military Region. The results of these RPLDNs were compared with those of 50 patients (group 2)who underwent conventional open live donor nephrectomy (OLDN) between August 2008 and December 2009 at the same institution. The average age of the group 1 donors(36 male and 14 female) was 43.2 years (range,29～64years) ,while of the group 2 (30 male and 20 female) was 30.3 (range,30～67years). There was no significant difference between the groups in sex or age,Extensive evaluation of the donors was performed by medical history, physical examination, electrocardiogram, hematology and coagulation studies, blood chemistry, urinalysis, chest radiography,and immunologic studies, CTA examination. Donors with positive cross-match, malignancy, reduced renal function (creatinine clearance <70 mL/min), urologic anomalies in the donor kidney and urolithiasis were exclused.Results:Results:50 ceases of RPLDN were performed successfully without donor death,conversion to open surgery or other serious operation complications. 50 ceases of OLDN were performed successfully as well. The mean operation time was(125.9士31.0)minutes (range 87～245 minutes) and (115.2士26.5) minutes (range 65～180 minutes) in the RPLDN and OLDN groups, respectively (P=0.067). There was no significant difference between the RPLDN and OLDN groups in mean warm ischemia time (2.88 versus 2.74 minutes,P=0.361). The mean estimated blood loss in the RPLDN group was fewer than that in the OLDN group (57.2 versus 122.7ml, P<0.001). The mean SCr of the donors in the RPLDN group was (74.0士13.9)umol/L before operation,while(106.9士21.0)umol/L and (93.1士18.0)umol/L on postoperative day 1 and day 7 respectively.The mean SCr of the donors in the OLDN group was (73.0士12.9)umol/L before operation,while(101.3士17.0)umol/L and (92.7士18.1)umol/L on postoperative day 1 and day 7 respectively. There was no significant difference of the Scr change between the two groups. Mean hospitalization time was shorter after RPLDN (11.4士2.4 days) than that of OLDN(13.8士3.2days) (P<0.001).There was no significant difference in the rate of complications between the two groups (RPLDN 6% versus OLDN 8%,P = 0.695). The mean serum creatinine level in the recipients on preoperative day and postoperatively 1 day,3 day,7 day, 1month,6 month,1 year(:879.9士248.6)umol/L(,337.4士122.9)umol/L,(142.1士54.4)umol/L,(130.1士65.0)umol/L,(101.8士27.7)umol/L,(98.2士22.4)umol/L,(99.1士21.4)umol/L in the RPLDN group;(920.7士258.9)umol/L(,361.2士143.1)umol/L(,162.1士77.5)umol/L(,133.5士56.6)umol/L,(110.2士30.8)umol/L,(106.5士29.3)umol/L,(102.7士27.4)umol/L respectively in the OLDN group.No hypertension ,proteinuria and renal function abnormality were observed during 12～36 months follow-up.The recipients were administrated by conventional immunosuppressive drug, The survival rate of human/renal of 1 year was 100%/100%.Conclusions:Compared with OLDN, RPLDN was advantaged in smaller incision, blood loss, hospitalization time and recovery period. RPLDN did not affect donor kidney function. It is concluded that RPLDN could be a better substitition of OLDN...