Program optimization of retroperitoneal laparoscopic left living donor nephrectomy: experience in 238 consecutive cases
JIE Junjie1, SHI Bingyi1, LI Gang1, FAN Yu1, LIU Yanzhong1, LUO Yongwen2, YANG Jintao1, LI Chao1, QI Baoyu1, BAI Hongwei1
1Institute of Organ Transplant of The 8th Medical Center of PLA General Hospitaln Beijin 100091, China; 2Department of Urology, Zhongnan Hospital of Wuhan University Wuhan 430071
Abstract：Objective： To discuss the experience and safety of program optimization of retroperitoneal laparoscopic left living donor nephrectomies for 238 consecutive cases. Methods： A total of 238 donors undergoing retroperitoneal laparoscopic left living donor nephrectomy from Nov. 2011 to March 2019 were selected. The operation was performed through 3 lumbar ports. The sequence of donor dissociation was routinized: (1) Make full use of the anatomic level of perirenal vasculature, first dissociate the ventral side of the kidney, quickly expose the ventral side of the renal vein, then dissociate the lower pole, ureter, renal artery and dorsal side of the renal vein, upper pole of the renal vein in the counterclockwise direction, and finally make peace with the ventral side of the renal vein. During the process of kidney dissociation, the treatment of vascular branch and ureter exposure were completed. (2) Retain the fat around the ureter, protect the blood supply of the ureter as far as possible, and free the ureter to cut it across the iliac vessels. (3) After the donor kidney and arteries and veins were fully freed, the ventral Trocar incision was extended for 5 cm. The operator held the kidney with his left hand, pulled the donor kidney vessels, and then Hem-o-lok was used to clip the renal arteries and veins respectively and cut them off. The donor kidney was quickly removed for perfusion and dressing under the stage. Results： The 238 operations were successful, and all donors were safe. There were 30 patients with multiple branches of the left renal artery, including 25 with two branches and 5 with three branches (3 cases were given intraoperative anastomosis, 2 cases had no CTA development of the third branch, and ligation was found to be abandoned by accident during the operation). The operative time was 37-186 min [mean (73±22) min]. The mean time of warm ischemia was 1.1-4.5 min [mean (2.3±0.8) min]. The bleeding was 10-350 mL [mean (45±20) mL]. No blood transfusion was performed. There were 6 cases of surgical complications, including 1 case of lymphatic fistula, obtaining short-term self-healing, 2 cases of lumbar vein injury bleeding, and 3 cases of subcapsular hematoma. There were no serious complications. Postoperative hospital time was 5 to 10 days, with an average of 6.3 days. 238 donors were followed up for 1 to 15 months, with an average of 7 months. Conclusion： It is safe and reliable to perform retroperitoneal laparoscopic living donor nephrectomy, which can reduce the learning curve and improve the quality of donor kidney.
解俊杰, 石炳毅, 李钢, 范宇, 刘炎忠, 罗用文, 杨锦涛, 李超, 齐宝玉, 柏宏伟. 程序优化下后腹腔镜左侧活体供肾切取术238例总结[J]. 微创泌尿外科杂志, 2020, 9(1): 6-11.
JIE Junjie, SHI Bingyi, LI Gang, FAN Yu, LIU Yanzhong, LUO Yongwen, YANG Jintao, LI Chao, QI Baoyu, BAI Hongwei. Program optimization of retroperitoneal laparoscopic left living donor nephrectomy: experience in 238 consecutive cases. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2020, 9(1): 6-11.
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