Laparoscopic vs open donor nephrectomy:Lessons learnt from single academic center experience
|
摘要
AIM To compare laparoscopic and open living donor nephrectomy,based on the results from a single center during a decade.METHODS This is a retrospective review of all living donor nephrectomies performed at the Massachusetts General Hospital,Harvard Medical School,Boston,between 1/1998- 12/2009. Overall there were 490 living donors,with 279 undergoing laparoscopic living donor nephrectomy(LLDN) and 211 undergoing open donor nephrectomy(OLDN). Demographic data,operating room time,the effect of the learning curve,the number of conversions from laparoscopic to open surgery,donor preoperative glomerular filtration rate and creatinine(Cr),donor and recipient postoperative Cr,delayed graft function and donor complications were analyzed. Statistical analysis was performed.RESULTS Overall there was no statistically significant difference between the LLDN and the OLDN groups regarding operating time,donor preoperative renal function,donor and recipient postoperative kidney function,delayed graft function or the incidence of major complications. When the last 100 laparoscopic cases were analyzed,there was a statistically significant difference regarding operating time in favor of the LLDN,pointing out the importance of the learning curve. Furthermore,another significant difference between the two groups was the decreased length of stay for the LLDN(2.87 d for LLDN vs 3.6 d for OLDN).CONCLUSION Recognizing the importance of the learning curve,this paper provides evidence that LLDN has a safety profile comparable to OLDN and decreased length of stay for the donor.
AIM To compare laparoscopic and open living donor nephrectomy,based on the results from a single center during a decade.METHODS This is a retrospective review of all living donor nephrectomies performed at the Massachusetts General Hospital,Harvard Medical School,Boston,between 1/1998- 12/2009. Overall there were 490 living donors,with 279 undergoing laparoscopic living donor nephrectomy(LLDN) and 211 undergoing open donor nephrectomy(OLDN). Demographic data,operating room time,the effect of the learning curve,the number of conversions from laparoscopic to open surgery,donor preoperative glomerular filtration rate and creatinine(Cr),donor and recipient postoperative Cr,delayed graft function and donor complications were analyzed. Statistical analysis was performed.RESULTS Overall there was no statistically significant difference between the LLDN and the OLDN groups regarding operating time,donor preoperative renal function,donor and recipient postoperative kidney function,delayed graft function or the incidence of major complications. When the last 100 laparoscopic cases were analyzed,there was a statistically significant difference regarding operating time in favor of the LLDN,pointing out the importance of the learning curve. Furthermore,another significant difference between the two groups was the decreased length of stay for the LLDN(2.87 d for LLDN vs 3.6 d for OLDN).CONCLUSION Recognizing the importance of the learning curve,this paper provides evidence that LLDN has a safety profile comparable to OLDN and decreased length of stay for the donor.
AIM To compare laparoscopic and open living donor nephrectomy,based on the results from a single center during a decade.METHODS This is a retrospective review of all living donor nephrectomies performed at the Massachusetts General Hospital,Harvard Medical School,Boston,between 1/1998- 12/2009. Overall there were 490 living donors,with 279 undergoing laparoscopic living donor nephrectomy(LLDN) and 211 undergoing open donor nephrectomy(OLDN). Demographic data,operating room time,the effect of the learning curve,the number of conversions from laparoscopic to open surgery,donor preoperative glomerular filtration rate and creatinine(Cr),donor and recipient postoperative Cr,delayed graft function and donor complications were analyzed. Statistical analysis was performed.RESULTS Overall there was no statistically significant difference between the LLDN and the OLDN groups regarding operating time,donor preoperative renal function,donor and recipient postoperative kidney function,delayed graft function or the incidence of major complications. When the last 100 laparoscopic cases were analyzed,there was a statistically significant difference regarding operating time in favor of the LLDN,pointing out the importance of the learning curve. Furthermore,another significant difference between the two groups was the decreased length of stay for the LLDN(2.87 d for LLDN vs 3.6 d for OLDN).CONCLUSION Recognizing the importance of the learning curve,this paper provides evidence that LLDN has a safety profile comparable to OLDN and decreased length of stay for the donor.
引文
1 Ratner LE,Ciseck LJ,Moore RG,Cigarroa FG,Kaufman HS,Kavoussi LR.Laparoscopic live donor nephrectomy.Transplantation1995;60:1047-1049[PMID:7491680]
2 Wolf JS,Tchetgen MB,Merion RM.Hand-assisted laparoscopic live donor nephrectomy.Urology 1998;52:885-887[PMID:9801121DOI:10.1016/S0090-4295(98)00389-6]
3 Slakey DP,Wood JC,Hender D,Thomas R,Cheng S.Laparoscopic living donor nephrectomy:advantages of the hand-assisted method.Transplantation 1999;68:581-583[PMID:10480421 DOI:10.1097/00007890-199908270-00024]
4 Leventhal JR,Kocak B,Salvalaggio PR,Koffron AJ,Baker TB,Kaufman DB,Fryer JP,Abecassis MM,Stuart FP.Laparoscopic donor nephrectomy 1997 to 2003:lessons learned with 500 cases at a single institution.Surgery 2004;136:881-890[PMID:15467675 DOI:10.1016/j.surg.2004.06.025]
5 Su LM,Ratner LE,Montgomery RA,Jarrett TW,Trock BJ,Sinkov V,Bluebond-Langner R,Kavoussi LR.Laparoscopic live donor nephrectomy:trends in donor and recipient morbidity following 381consecutive cases.Ann Surg 2004;240:358-363[PMID:15273562DOI:10.1097/01.sla.0000133351.98195.1c]
6 Jacobs SC,Cho E,Foster C,Liao P,Bartlett ST.Laparoscopic donor nephrectomy:the University of Maryland 6-year experience.J Urol 2004;171:47-51[PMID:14665841 DOI:10.1097/01.ju.0000100221.20410.4a]
7 Living Kidney Donor Follow-Up Conference Writing Group,Leichtman A,Abecassis M,Barr M,Charlton M,Cohen D,Confer D,Cooper M,Danovitch G,Davis C,Delmonico F,Dew MA,Garvey C,Gaston R,Gill J,Gillespie B,Ibrahim H,Jacobs C,Kahn J,Kasiske B,Kim J,Lentine K,Manyalich M,Medina-Pestana J,Merion R,Moxey-Mims M,Odim J,Opelz G,Orlowski J,Rizvi A,Roberts J,Segev D,Sledge T,Steiner R,Taler S,Textor S,Thiel G,Waterman A,Williams E,Wolfe R,Wynn J,Matas AJ.Living kidney donor follow-up:state-of-the-art and future directions,conference summary and recommendations.Am J Transplant 2011;11:2561-2568[PMID:22054039]
8 Wright AD,Will TA,Holt DR,Turk TM,Perry KT.Laparoscopic living donor nephrectomy:a look at current trends and practice patterns at major transplant centers across the United States.J Urol 2008;179:1488-1492[PMID:18295274 DOI:10.1016/j.juro.2007.11.066]
9 Shokeir AA.Open versus laparoscopic live donor nephrectomy:a focus on the safety of donors and the need for a donor registry.J Urol 2007;178:1860-1866[PMID:17868736 DOI:10.1016/j.juro.2007.07.008]
10 Nanidis TG,Antcliffe D,Kokkinos C,Borysiewicz CA,Darzi AW,Tekkis PP,Papalois VE.Laparoscopic versus open live donor nephrectomy in renal transplantation:a meta-analysis.Ann Surg 2008;247:58-70[PMID:18156924]
11 Shafizadeh S,Mc Evoy JR,Murray C,Baillie GM,Ashcraft E,Sill T,Rogers J,Baliga P,Rajagopolan PR,Chavin K.Laparoscopic donor nephrectomy:impact on an established renal transplant program.Am Surg 2000;66:1132-1135[PMID:11149584]
12 Melcher ML,Carter JT,Posselt A,Duh QY,Stoller M,Freise CE,Kang SM.More than 500 consecutive laparoscopic donor nephrectomies without conversion or repeated surgery.Arch Surg2005;140:835-839;discussion 839-840[PMID:16172291 DOI:10.1001/archsurg.140.9.835]
13 Matas AJ,Bartlett ST,Leichtman AB,Delmonico FL.Morbidity and mortality after living kidney donation,1999-2001:survey of United States transplant centers.Am J Transplant 2003;3:830-834[PMID:12814474]
14 Ahearn AJ,Posselt AM,Kang SM,Roberts JP,Freise CE.Experience with laparoscopic donor nephrectomy among more than 1000 cases:low complication rates,despite more challenging cases.Arch Surg 2011;146:859-864[PMID:21768434 DOI:10.1001/archsurg.2011.156]
15 Friedman AL,Peters TG,Jones KW,Boulware LE,Ratner LE.Fatal and nonfatal hemorrhagic complications of living kidney donation.Ann Surg 2006;243:126-130[PMID:16371747 DOI:10.1097/01.sla.0000193841.43474.ec]
16 Dols LF,Kok NF,Alwayn IP,Tran TC,Weimar W,Ijzermans JN.Laparoscopic donor nephrectomy:a plea for the right-sided approach.Transplantation 2009;87:745-750[PMID:19295321 DOI:10.1097/TP.0b013e318198a3a6]
17 Keller JE,Dolce CJ,Griffin D,Heniford BT,Kercher KW.Maximizing the donor pool:use of right kidneys and kidneys with multiple arteries for live donor transplantation.Surg Endosc 2009;23:2327-2331[PMID:19263162 DOI:10.1007/s00464-009-0330-9]
18 Tsoulfas G,Agorastou P,Ko D,Hertl M,Elias N,Cosimi AB,Kawai T.Laparoscopic living donor nephrectomy:is there a difference between using a left or a right kidney?Transplant Proc 2012;44:2706-2708[PMID:23146499 DOI:10.1016/j.transproceed.2012.09.019]
19 Mandelbrot DA,Pavlakis M,Danovitch GM,Johnson SR,Karp SJ,Khwaja K,Hanto DW,Rodrigue JR.The medical evaluation of living kidney donors:a survey of US transplant centers.Am JTransplant 2007;7:2333-2343[PMID:17845567 DOI:10.1111/j.1600-6143.2007.01932.x]
20 Rodrigue JR,Pavlakis M,Danovitch GM,Johnson SR,Karp SJ,Khwaja K,Hanto DW,Mandelbrot DA.Evaluating living kidney donors:relationship types,psychosocial criteria,and consent processes at US transplant programs.Am J Transplant 2007;7:2326-2332[PMID:17845566 DOI:10.1111/j.1600-6143.2007.01921.x]
21 Cherikh WS,Young CJ,Kramer BF,Taranto SE,Randall HB,Fan PY.Ethnic and gender related differences in the risk of end-stage renal disease after living kidney donation.Am J Transplant 2011;11:1650-1655[PMID:21672160 DOI:10.1111/j.1600-6143.2011.03609]
22 Reese PP,Feldman HI,Mc Bride MA,Anderson K,Asch DA,Bloom RD.Substantial variation in the acceptance of medically complex live kidney donors across US renal transplant centers.Am J Transplant 2008;8:2062-2070[PMID:18727695 DOI:10.1111/j.1600-6143.2008.02361]
23 Lentine KL,Schnitzler MA,Xiao H,Saab G,Salvalaggio PR,Axelrod D,Davis CL,Abbott KC,Brennan DC.Racial variation in medical outcomes among living kidney donors.N Engl J Med 2010;363:724-732[PMID:20818874 DOI:10.1056/NEJMoa1000950]
24 Nogueira JM,Weir MR,Jacobs S,Breault D,Klassen D,Evans DA,Bartlett ST,Cooper M.A study of renal outcomes in obese living kidney donors.Transplantation 2010;90:993-999[PMID:20844468DOI:10.1097/TP.0b013e3181f6a058]
25 Matas AJ,Garvey CA,Jacobs CL,Kahn JP.Nondirected donation of kidneys from living donors.N Engl J Med 2000;343:433-436[PMID:10933745 DOI:10.1056/NEJM200008103430611]
26 Gentry SE,Montgomery RA,Swihart BJ,Segev DL.The roles of dominos and nonsimultaneous chains in kidney paired donation.Am J Transplant 2009;9:1330-1336[PMID:19656136 DOI:10.1111/j.1600-6143.2009.02622]
27 Manyalich M,Ricart A,Martínez I,Balleste C,Paredes D,Vilardell J,Avsec D,Dias L,Fehrman-Eckholm I,Hiesse C,Kyriakides G,Line PD,Maxwell A,Nanni Costa A,Paez G,Turcu R,Walaszewski J.EULID project:European living donation and public health.Transplant Proc 2009;41:2021-2024[PMID:19715823 DOI:10.1016/j.transproceed.2009.05.021]
28 Gill IS,Canes D,Aron M,Haber GP,Goldfarb DA,Flechner S,Desai MR,Kaouk JH,Desai MM.Single port transumbilical(E-NOTES)donor nephrectomy.J Urol 2008;180:637-641;discussion 641[PMID:18554653]
29 John Hopkins Medical Institutions.Healthy Kidney Removed Through Donor’s Vagina 2009.[accessed 2015 Jul 10].Available from:URL:http://esceincenews.com/articles/2009/02/02/hopkins.transplant.surgeons.remove.healthy.kidney.through.donors.vagina
30 Olakkengil SA,Rao MM.Evolution of minimally invasive surgery for donor nephrectomy and outcomes.JSLS 2011;15:208-212[PMID:21902977 DOI:10.4293/108680811X13071180406637]
31 Mahid SS,Hornung CA,Minor KS,Turina M,Galandiuk S.Systematic reviews and meta-analysis for the surgeon scientist.Br JSurg 2006;93:1315-1324[PMID:17058324]
32 Oxman AD.Checklists for review articles.BMJ 1994;309:648-651[PMID:8086990 DOI:10.1136/bmj.309.6955.648]
33 Horgan S,Benedetti E,Moser F.Robotically assisted donor nephrectomy for kidney transplantation.Am J Surg 2004;188:45S-51S[PMID:15476651]
34 Hubert J,Renoult E,Mourey E,Frimat L,Cormier L,Kessler M.Complete robotic-assistance during laparoscopic living donor nephrectomies:an evaluation of 38 procedures at a single site.Int JUrol 2007;14:986-989[PMID:17956521 DOI:10.1111/j.1442-2042.2007.01876.x]
35 Renoult E,Hubert J,Ladrière M,Billaut N,Mourey E,Feuillu B,Kessler M.Robot-assisted laparoscopic and open live-donor nephrectomy:a comparison of donor morbidity and early renal allograft outcomes.Nephrol Dial Transplant 2006;21:472-477[PMID:16204289 DOI:10.1093/ndt/gfi150]
2 Wolf JS,Tchetgen MB,Merion RM.Hand-assisted laparoscopic live donor nephrectomy.Urology 1998;52:885-887[PMID:9801121DOI:10.1016/S0090-4295(98)00389-6]
3 Slakey DP,Wood JC,Hender D,Thomas R,Cheng S.Laparoscopic living donor nephrectomy:advantages of the hand-assisted method.Transplantation 1999;68:581-583[PMID:10480421 DOI:10.1097/00007890-199908270-00024]
4 Leventhal JR,Kocak B,Salvalaggio PR,Koffron AJ,Baker TB,Kaufman DB,Fryer JP,Abecassis MM,Stuart FP.Laparoscopic donor nephrectomy 1997 to 2003:lessons learned with 500 cases at a single institution.Surgery 2004;136:881-890[PMID:15467675 DOI:10.1016/j.surg.2004.06.025]
5 Su LM,Ratner LE,Montgomery RA,Jarrett TW,Trock BJ,Sinkov V,Bluebond-Langner R,Kavoussi LR.Laparoscopic live donor nephrectomy:trends in donor and recipient morbidity following 381consecutive cases.Ann Surg 2004;240:358-363[PMID:15273562DOI:10.1097/01.sla.0000133351.98195.1c]
6 Jacobs SC,Cho E,Foster C,Liao P,Bartlett ST.Laparoscopic donor nephrectomy:the University of Maryland 6-year experience.J Urol 2004;171:47-51[PMID:14665841 DOI:10.1097/01.ju.0000100221.20410.4a]
7 Living Kidney Donor Follow-Up Conference Writing Group,Leichtman A,Abecassis M,Barr M,Charlton M,Cohen D,Confer D,Cooper M,Danovitch G,Davis C,Delmonico F,Dew MA,Garvey C,Gaston R,Gill J,Gillespie B,Ibrahim H,Jacobs C,Kahn J,Kasiske B,Kim J,Lentine K,Manyalich M,Medina-Pestana J,Merion R,Moxey-Mims M,Odim J,Opelz G,Orlowski J,Rizvi A,Roberts J,Segev D,Sledge T,Steiner R,Taler S,Textor S,Thiel G,Waterman A,Williams E,Wolfe R,Wynn J,Matas AJ.Living kidney donor follow-up:state-of-the-art and future directions,conference summary and recommendations.Am J Transplant 2011;11:2561-2568[PMID:22054039]
8 Wright AD,Will TA,Holt DR,Turk TM,Perry KT.Laparoscopic living donor nephrectomy:a look at current trends and practice patterns at major transplant centers across the United States.J Urol 2008;179:1488-1492[PMID:18295274 DOI:10.1016/j.juro.2007.11.066]
9 Shokeir AA.Open versus laparoscopic live donor nephrectomy:a focus on the safety of donors and the need for a donor registry.J Urol 2007;178:1860-1866[PMID:17868736 DOI:10.1016/j.juro.2007.07.008]
10 Nanidis TG,Antcliffe D,Kokkinos C,Borysiewicz CA,Darzi AW,Tekkis PP,Papalois VE.Laparoscopic versus open live donor nephrectomy in renal transplantation:a meta-analysis.Ann Surg 2008;247:58-70[PMID:18156924]
11 Shafizadeh S,Mc Evoy JR,Murray C,Baillie GM,Ashcraft E,Sill T,Rogers J,Baliga P,Rajagopolan PR,Chavin K.Laparoscopic donor nephrectomy:impact on an established renal transplant program.Am Surg 2000;66:1132-1135[PMID:11149584]
12 Melcher ML,Carter JT,Posselt A,Duh QY,Stoller M,Freise CE,Kang SM.More than 500 consecutive laparoscopic donor nephrectomies without conversion or repeated surgery.Arch Surg2005;140:835-839;discussion 839-840[PMID:16172291 DOI:10.1001/archsurg.140.9.835]
13 Matas AJ,Bartlett ST,Leichtman AB,Delmonico FL.Morbidity and mortality after living kidney donation,1999-2001:survey of United States transplant centers.Am J Transplant 2003;3:830-834[PMID:12814474]
14 Ahearn AJ,Posselt AM,Kang SM,Roberts JP,Freise CE.Experience with laparoscopic donor nephrectomy among more than 1000 cases:low complication rates,despite more challenging cases.Arch Surg 2011;146:859-864[PMID:21768434 DOI:10.1001/archsurg.2011.156]
15 Friedman AL,Peters TG,Jones KW,Boulware LE,Ratner LE.Fatal and nonfatal hemorrhagic complications of living kidney donation.Ann Surg 2006;243:126-130[PMID:16371747 DOI:10.1097/01.sla.0000193841.43474.ec]
16 Dols LF,Kok NF,Alwayn IP,Tran TC,Weimar W,Ijzermans JN.Laparoscopic donor nephrectomy:a plea for the right-sided approach.Transplantation 2009;87:745-750[PMID:19295321 DOI:10.1097/TP.0b013e318198a3a6]
17 Keller JE,Dolce CJ,Griffin D,Heniford BT,Kercher KW.Maximizing the donor pool:use of right kidneys and kidneys with multiple arteries for live donor transplantation.Surg Endosc 2009;23:2327-2331[PMID:19263162 DOI:10.1007/s00464-009-0330-9]
18 Tsoulfas G,Agorastou P,Ko D,Hertl M,Elias N,Cosimi AB,Kawai T.Laparoscopic living donor nephrectomy:is there a difference between using a left or a right kidney?Transplant Proc 2012;44:2706-2708[PMID:23146499 DOI:10.1016/j.transproceed.2012.09.019]
19 Mandelbrot DA,Pavlakis M,Danovitch GM,Johnson SR,Karp SJ,Khwaja K,Hanto DW,Rodrigue JR.The medical evaluation of living kidney donors:a survey of US transplant centers.Am JTransplant 2007;7:2333-2343[PMID:17845567 DOI:10.1111/j.1600-6143.2007.01932.x]
20 Rodrigue JR,Pavlakis M,Danovitch GM,Johnson SR,Karp SJ,Khwaja K,Hanto DW,Mandelbrot DA.Evaluating living kidney donors:relationship types,psychosocial criteria,and consent processes at US transplant programs.Am J Transplant 2007;7:2326-2332[PMID:17845566 DOI:10.1111/j.1600-6143.2007.01921.x]
21 Cherikh WS,Young CJ,Kramer BF,Taranto SE,Randall HB,Fan PY.Ethnic and gender related differences in the risk of end-stage renal disease after living kidney donation.Am J Transplant 2011;11:1650-1655[PMID:21672160 DOI:10.1111/j.1600-6143.2011.03609]
22 Reese PP,Feldman HI,Mc Bride MA,Anderson K,Asch DA,Bloom RD.Substantial variation in the acceptance of medically complex live kidney donors across US renal transplant centers.Am J Transplant 2008;8:2062-2070[PMID:18727695 DOI:10.1111/j.1600-6143.2008.02361]
23 Lentine KL,Schnitzler MA,Xiao H,Saab G,Salvalaggio PR,Axelrod D,Davis CL,Abbott KC,Brennan DC.Racial variation in medical outcomes among living kidney donors.N Engl J Med 2010;363:724-732[PMID:20818874 DOI:10.1056/NEJMoa1000950]
24 Nogueira JM,Weir MR,Jacobs S,Breault D,Klassen D,Evans DA,Bartlett ST,Cooper M.A study of renal outcomes in obese living kidney donors.Transplantation 2010;90:993-999[PMID:20844468DOI:10.1097/TP.0b013e3181f6a058]
25 Matas AJ,Garvey CA,Jacobs CL,Kahn JP.Nondirected donation of kidneys from living donors.N Engl J Med 2000;343:433-436[PMID:10933745 DOI:10.1056/NEJM200008103430611]
26 Gentry SE,Montgomery RA,Swihart BJ,Segev DL.The roles of dominos and nonsimultaneous chains in kidney paired donation.Am J Transplant 2009;9:1330-1336[PMID:19656136 DOI:10.1111/j.1600-6143.2009.02622]
27 Manyalich M,Ricart A,Martínez I,Balleste C,Paredes D,Vilardell J,Avsec D,Dias L,Fehrman-Eckholm I,Hiesse C,Kyriakides G,Line PD,Maxwell A,Nanni Costa A,Paez G,Turcu R,Walaszewski J.EULID project:European living donation and public health.Transplant Proc 2009;41:2021-2024[PMID:19715823 DOI:10.1016/j.transproceed.2009.05.021]
28 Gill IS,Canes D,Aron M,Haber GP,Goldfarb DA,Flechner S,Desai MR,Kaouk JH,Desai MM.Single port transumbilical(E-NOTES)donor nephrectomy.J Urol 2008;180:637-641;discussion 641[PMID:18554653]
29 John Hopkins Medical Institutions.Healthy Kidney Removed Through Donor’s Vagina 2009.[accessed 2015 Jul 10].Available from:URL:http://esceincenews.com/articles/2009/02/02/hopkins.transplant.surgeons.remove.healthy.kidney.through.donors.vagina
30 Olakkengil SA,Rao MM.Evolution of minimally invasive surgery for donor nephrectomy and outcomes.JSLS 2011;15:208-212[PMID:21902977 DOI:10.4293/108680811X13071180406637]
31 Mahid SS,Hornung CA,Minor KS,Turina M,Galandiuk S.Systematic reviews and meta-analysis for the surgeon scientist.Br JSurg 2006;93:1315-1324[PMID:17058324]
32 Oxman AD.Checklists for review articles.BMJ 1994;309:648-651[PMID:8086990 DOI:10.1136/bmj.309.6955.648]
33 Horgan S,Benedetti E,Moser F.Robotically assisted donor nephrectomy for kidney transplantation.Am J Surg 2004;188:45S-51S[PMID:15476651]
34 Hubert J,Renoult E,Mourey E,Frimat L,Cormier L,Kessler M.Complete robotic-assistance during laparoscopic living donor nephrectomies:an evaluation of 38 procedures at a single site.Int JUrol 2007;14:986-989[PMID:17956521 DOI:10.1111/j.1442-2042.2007.01876.x]
35 Renoult E,Hubert J,Ladrière M,Billaut N,Mourey E,Feuillu B,Kessler M.Robot-assisted laparoscopic and open live-donor nephrectomy:a comparison of donor morbidity and early renal allograft outcomes.Nephrol Dial Transplant 2006;21:472-477[PMID:16204289 DOI:10.1093/ndt/gfi150]