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Retroperitoneoscopic Hand-Assisted Live Donor Nephrectomy - a Single Center Experience
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Transplantation Surgery.
2013 (English)In: Annals of Saudi Medicine, ISSN 0256-4947, E-ISSN 0975-4466, Vol. 33, no 2, p. S86-S90Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

INTRODUCTION: Hand-assisted retroperitoneoscopic live donor nephrectomy (HARS) increases the safety margin of live kidney donors by combining hand-assistance with pure retroperitoneal access to the kidney. Furthermore, HARS enables effective and safe non-morphine based analgesia with continuous infusion of local anesthetics (CILA), which potentially adds further safety advantage by reduction of morphine-related complications. This report emphasizes the impact of HARS on donor safety and presents a 12-years experience with the procedure at the University Hospital in Uppsala. MATERIAL AND METHODS : A literature review of relevant reports on HARS is presented. Furthermore, latest unpublished in-house data on HARS nephrectomy procedures from 2010 and 2012 are analyzed for operative characteristics, donor outcome as well as kidney function. RESULTS : Since 2000, HARS is the default donor nephrectomy procedure at our center. Within 12 years, 344 HARS nephrectomies were performed. The overall conversion rate to open surgery was 0.3% (1 out of 344). Between January 2010 and December 2012, 122 HARS and 1 open nephrectomy (anterior incision) were performed. Sixteen donors (13%) were right-sided HARS. After matching for sex, BMI and vascular anatomy, the mean operative time for right and left-sided HARS were 125 minutes (75-175) and 153 minutes (113-251), respectively. The overall mean operative time was 150 minutes (60-251). No donor presented early or late intra-abdominal complications, which is in consistent with our previous reports. The overall morbidity rate was 7.2%. All 122 HARS donors were treated with CILA. The overall mean total cumulative consumption of morphine equivalents (CCME) was 12.4 mg (0-240), while 107 donors (87%) received a total CCME of less than 20 mg. Thirty-four donors (28%) received no morphine equivalents during the hospitalization CONCLUSION : HARS is a safe procedure that virtually eliminates the risk for intra-abdominal complications. The intrinsic advantage for non-morphine based analgesia in combination with excellent donor outcome make this technique eligible for a broader implementation.

Place, publisher, year, edition, pages
2013. Vol. 33, no 2, p. S86-S90
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-315325ISI: 000343340000032OAI: oai:DiVA.org:uu-315325DiVA, id: diva2:1073983
Available from: 2017-02-14 Created: 2017-02-14 Last updated: 2017-11-29Bibliographically approved

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