Laparoendoscopic single-site donor nephrectomy (LESSDN) is a feasible and effective procedure because of its non-invasiveness and better cosmetic outcomes. However, there have been few multi-institutional studies conducted by multiple surgeons on LESSDN. We retrospectively compared the clinical data and outcomes between LESSDN and conventional laparoscopic donor nephrectomy (LDN) at multiple institutes in Japan.
From 2009 to 2015, the clinical data of 223 donors who underwent LESSDN and 151 donors who underwent LDN were collected from 10 institutes. All LESSDNs were performed transperitoneally, whereas LDNs were performed transperitoneally (P-LDN) in 75 patients and retroperitoneally (R-LDN) in 76 patients.
In the LESSDN group, the single-incision site was pararectal in 155 (69.5%) patients and umbilical in 65 (29.1%) patients. Multiple surgeons (one to eight per institute) performed the LESSDN. No significant differences were observed between the three groups regarding estimated blood loss and warm ischemic time. The operative time was significantly shorter in the LESSDN group than in the R-LDN group (p = 0.018). No significant differences were observed regarding the rates of blood transfusion, open conversion, visceral injuries, and postoperative complications. Furthermore, no significant differences were observed regarding the dose of analgesic and the rate of delayed graft function. One patient required open conversion due to injury to the renal artery. Selection of LESS procedure was not an independent risk factor for the median serum creatinine level of above 1.27 mg/dL in recipients at 1 year after kidney transplantation.
The results showed the technical feasibility of LESSDN compared with the standard LDNs in a multi-institutional and multi-surgeon setting. A few observed non-negligible complications and the significantly higher levels of serum creatinine in patients who underwent LESSDN indicate that this procedure should be employed cautiously when performed by surgeons without ample experience in performing LESS procedures.
Surgical endoscopy. 2019 Sep 23 [Epub ahead of print]
Takamitsu Inoue, Masayoshi Miura, Masaaki Yanishi, Junya Furukawa, Fuminori Sato, Masahiro Nitta, Koji Yoshimura, Jun Hagiuda, Kazunobu Shinoda, Takashi Kobayashi, Akira Miyajima, Ken Nakagawa, Mototsugu Oya, Osamu Ogawa, Hiromitsu Mimata, Hiro-Omi Kanayama, Masato Fujisawa, Toshiro Terachi, Tadashi Matsuda, Tomonori Habuchi, LESS and RPS Research Group in Japanese Society of Endourology
Department of Urology, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita, 010-8543, Japan., Department of Urology, Sapporo Hokuyu Hospital, Sapporo, Japan., Department of Urology and Andrology, Kansai Medical University, Hirakata, Japan., Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe, Japan., Department of Urology, Oita University Faculty of Medicine, Oita, Japan., Department of Urology, Tokai University School of Medicine, Isehara, Japan., Department of Urology, Shizuoka General Hospital, Shizuoka, Japan., Department of Urology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan., Department of Urology, Keio University School of Medicine, Tokyo, Japan., Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan., Department of Urology, Tokushima University Graduate School of Medicine, Tokushima, Japan., Beppu Bay Urology Hospital, Beppu, Japan., Department of Urology, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita, 010-8543, Japan. .