V1724: Laparoscopic live related renal transplantation- a feasible option?
VideoIntroduction and Objectives
Laparoscopic donor nephrectomy is a standard of care approach for renal harvest for transplantation purposes. Contrastingly engraftment has been traditionally achieved through incisional approach. Thereby the allograft recipient is subjected to access related morbidity in addition to procedural morbidity. We evaluate the feasibility of renal transplantation through laparoscopic approach.
Live related subjects planned for left donor nephrectomy with favorable vascular anatomy (single renal artery and vein) was selected. Organ harvest was performed through laparoscopic approach. During bench preparation three orientation stitches were made at apex of renal artery, vein and upper pole of graft to maintain the orientation during laparoscopic engraftment. A peritoneal flap was raised in the graft recipient to place the graft in extraperitoneal location. The graft was inserted through a Pfannenstiel incision. Vascular anastomosis was carried out followed by nonrefluxing ureteroneocystostomy. The peritoneal flap was reattached. Operative and postoperative parameters were recorded.
3 patients underwent laparoscopic renal transplantation. Mean age was 32.33 years, mean BMI 22.07 kg/m2. Mean cold ischemia time was 55.33 minutes, mean blood loss was 150 milliliters and mean operation duration was 210 minutes. All patients demonstrated satisfactory graft function immediately. All patients exhibited early oral intake and diminished pain perception. Mean time to creatinine normalization was 5.33 days. Mean duration of hospital stay was 7.33 days. All patients revealed satisfactory vascular flow pattern in postoperative Doppler. No major operative or postoperative events were recorded. Mean creatinine of recipient 3 months post transplant was 1.2 milligrams/deciliter.
Although technically demanding, the preliminary results of laparoscopic renal transplantation are encouraging. The procedure offers a superior morbidity profile. The graft function is acceptable.