Pure versus hand-assisted retroperitoneoscopic live donor nephrectomy: a retrospective cohort study of 1508 transplants from two centers.
BACKGROUND
Although minimally invasive procedures have been established as the standard for a donor nephrectomy, there are many different surgical techniques described in the literature. The aim of this study is to compare the outcomes of kidney transplant procedures using the pure retroperitoneoscopic donor nephrectomy (PRDN) and hand-assisted retroperitoneoscopic donor nephrectomy (HARDN) techniques.


METHODS
A retrospective study involving 1508 transplant procedures was conducted; 874 were PRDN procedures; and 634 were HARDN. We reviewed the outcomes of the PRDN and HARDN groups, which were performed at two different centers over an identical time period.


RESULTS
Donors in the PRDN group had a longer operation time (P < 0.0001), reduced estimated blood loss (P < 0.0001), less open conversion (P = 0.0002), lower postoperative serum C-reactive protein levels (P < 0.0001), and a shorter postoperative hospital stay (P < 0.0001) than the HARDN group. Recipients in the PRDN group had lower serum creatinine levels at postoperative day 1-6 and the decreased incidence of slow graft function (P = 0.0017) than the HARDN group. The HARDN procedure was an independent risk factor for the incidence of acute rejection (P = 0.0211) and graft loss (P = 0.0193).


CONCLUSIONS
Our study suggests that the PRDN procedure is less invasive for donors as it results in reduced blood loss, lower postoperative serum CRP levels, and a shorter postoperative stay than the HARDN procedure. Additionally, PRDN provides a better outcome for recipients as it lowers the incidence of acute rejection and improves graft survival compared to HARDN.
['Noguchi|Hiroshi|H|0000-0001-9187-6611', 'Kakuta|Yoichi|Y|', 'Okumi|Masayoshi|M|', 'Omoto|Kazuya|K|', 'Okabe|Yasuhiro|Y|', 'Ishida|Hideki|H|', 'Nakamura|Masafumi|M|', 'Tanabe|Kazunari|K|']
D000328:Adult D004724:Endoscopy D005260:Female D006084:Graft Rejection D006801:Humans D007564:Japan D016030:Kidney Transplantation D019520:Living Donors D008297:Male D008875:Middle Aged D009392:Nephrectomy D011183:Postoperative Complications D012189:Retrospective Studies D020858:Tissue and Organ Harvesting
Hand-assisted Kidney transplantation Retroperitoneoscopic donor nephrectomy Acute rejection Minimally invasive surgery