On-line version ISSN 2078-5151
S. Afr. j. surg. vol.49 n.1 Cape Town Feb. 2011
UROLOGY - TRANSPLANTATION
J. LovelandI; C. JosephII; D. LiakosIII; R. BothaIV; R. BritzV
IM.B. B.Ch., F.C.S. (S.A.), Cert. Paed. Surg.; Transplant Unit, University of the Witwatersrand and Donald Gordon Medical Centre, Johannesburg
IIM.B. B.Ch., F.C.S. (S.A.), Cert. Gastroenterol.; Transplant Unit, University of the Witwatersrand and Donald Gordon Medical Centre, Johannesburg
IIIB.Sc., M.B. Ch.B.; Transplant Unit, University of the Witwatersrand and Donald Gordon Medical Centre, Johannesburg
IVM.B. B.Ch., F.C.S. (S.A.);Transplant Unit, University of the Witwatersrand and Donald Gordon Medical Centre, Johannesburg
VM.B. B.Ch., F.C.S. (S.A.), Cert. Vasc. Surg.;Transplant Unit, University of the Witwatersrand and Donald Gordon Medical Centre, Johannesburg
The demand for kidneys in South Africa is staggering. Only 38% of the kidney transplants done in 2008 were from related living donors. Laparoscopic living donor nephrectomy has been shown to have the advantages of decreased postoperative pain, better cosmesis and a quicker return to work when compared with the open technique. With limited surgical expertise, a realistic model was needed to overcome the learning curve.
METHODS: A total of 21 nephrectomies were performed on 12 pigs. The transperitoneal hand-assisted laparoscopic technique was used.
RESULTS: The median operative time was 75 minutes and the median warm ischaemic time 88 seconds. Three cases were aborted owing to major vascular injuries.
DISCUSSION: The advent of laparoscopic techniques has been associated with an increase in morbidity and complications in donor and recipient during the initial learning curve. We found that with our porcine model, 21 nephrectomies were adequate in overcoming the learning curve. After 15 nephrectomies no complications were noted.
“Full text available only in PDF format”
1. Organ Donor Foundation. Statistics 2008. www.odf.org.za (accessed 10 June 2009). [ Links ]
2. Ratner LE, Ciseck LJ, Moore RG, Cigarroa FG, Kaufman HS, Kavousssi LR. Laparoscopic live donor nephrectomy. Transplantation 1995; 60: 1047-1049. [ Links ]
3. Wolf JS, Merion RM, Leichtman AB, et al. Randomized controlled trial of hand-assisted laparoscopic versus open surgical live donor nephrectomy. Transplantation 2001; 72: 284-290. [ Links ]
4. Troppmann C, Ormond BD, Perez RV. Laparoscopic (vs. open) live donor nephrectomy: A UNOS database analysis of early graft function and survival. Am J Transplant 2003; 3: 1295-1301. [ Links ]
5. Ratner LE, Kavoussi, Schulam PG, et al. Comparison of laparoscopic live donor nephrectomy versus the standard open approach. Transplant Proc 1997; 29: 138-139. [ Links ]
6. Merlin TL, Scott DF, Rao MM, et al. The safety and efficacy of laparoscopic live donor nephrectomy: a systematic review. Transplantation Overview 2000; 70: 1659-1666. [ Links ]
7. Odland MD, Ney AL, Jacobs DM, et al. Initial experience with live donor nephrectomy. Surgery 1999; 126: 603. [ Links ]
8. Nogueira JM, Cangro CB, Fink JC, et al. A comparison of recipient renal outcomes with laparoscopic versus open live donor nephrectomy. Transplantation 1999; 67: 722. [ Links ]
9. Schweitzer EJ, Wilson J, Jacobs S, CH, et al. Increased rates of donation with laparoscopic donor nephrectomy. Ann Surg 2000; 232: 392-400. [ Links ]
10. Ravizzini PI, Shulsinger D, Guarnizo E, et al. Hand-assisted laparoscopic donor nephrectomy versus standard laparoscopic donor nephrectomy: a comparison study in the canine model. Tech Urol 1999; 5: 174-178. [ Links ]
11. Cavallari G, Tsivian M, Bertelli R, et al. A new swine training model of hand-assisted donor nephrectomy. Transplant Proc 2008; 40: 2035-2037. [ Links ]
12. Leventhal JR, Deeik RK, Joehl RJ, et al. Laparoscopic live donor nephrectomy - is it safe? Transplantation 2000; 70: 602-604. [ Links ]
13. Martin GL, Guise AI, Bernie JE, et al. Laparoscopic donor nephrectomy: effects of learning curve on surgical outcomes. Transplant Proc 2007; 39: 27-29. [ Links ]
14. Cavallari G, Tsivian M, Bertelli R, et al. A new swine training model of hand-assisted donor nephrectomy. Transplant Proc 2008; 40: 2035-2037. [ Links ]
15. Velidedeoglou E, Williams N, Brayman KL, et al. Comparison of open, laparoscopic and hand-assisted live donor nephrectomies. Transplantation 2002; 74: 169-172. [ Links ]
16. Wadström J. Hand-assisted retroperitoneoscopic live donor nephrectomy: experience from the first 75 consecutive cases. Transplantation 2005; 80: 1060-1066. [ Links ]