Introduction and Objectives
Despite observed huge progress in understanding the immunological basis of transplantation and the development of new immunosuppressive agents that have significantly improved both the patient and graft survival, still the kidney donation from live volunteers remains the most consistent factor which affects the long-term survival. The first living-related donor nephrectomy was performed in 1953. Since then open surgery has become the standard for many years and thereby, due to the morbidity associated with this technique of organ retrieval, many possible kidney donors were reluctant to donate. The laparoscopic live-donor nephrectomy is the alternative for open approach. We present the first Polish experience of two living-donor laparoscopic nephrectomies performed in our center.
Material and Methods
In 2008 we have performed two living donor nephrectomies using this technique. In both cases left kidney was removed. The first donor was 56 year-old woman, a mother of chronically sick daughter, the second women, 42 year-old, gave her kidney to her husband. The donors were evaluated preoperatively in the nephrology department. The evaluation included medical, surgical and psychosocial suitability for live donation. In both cases we applied the retroperitoneal access which has been routinely used in our center. The kidneys were dissected between the perirenal fatty tissue and the fibrous capsule. The renal artery was identified from its posterior aspect and freed from the surrounding fatty and lymphatic tissue. The renal vein was dissected in order to gain the full, proper length at the level of transsection. Before final retrieving the organ 6cm muscle-splitting incision was made in left inguinal area.
Warm ischemia time in both cases did not exceed over 2 minutes. Operation time was 210 and 190 minutes and the blood loss was 250 and 100 ml, respectively. The condition of ureters and the vessels in both retrieved kidneys were excellent and it allowed for easy and safe anastomosis with internal iliac vessels and bladder. The postoperative courses were uncomplicated, slightly elevated creatinine level was only observed up to 1.17 and 1.37 ng/ml. The kidneys were implanted in transplantological departments and their immediate function was noted. Currently both donors and recipients are well.
Living donor nephrectomy is a challenging and difficult procedure which should be performed only in centers with experience in laparoscopy of upper urinary tract. Despite efforts of many organizations the situation in Poland concerning organ donation is not satisfactory. One of the reason may be the fear of surgical trauma caused by open nephrectomy and the lack of knowledge about health condition after kidney donating. Applying the laparoscopic approach for living donor nephrectomy can have a positive effect on rate of kidney donation in Poland.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.