Difficulties in laparoscopic live donor nephrectomy

Jihad H. Kaouk, Wesley White

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

End stage renal disease (ESRD) is a leading cause of morbidity and death among Americans and represents a significant financial burden to the health care system of the United States.1 Traditionally, renal replacement therapy has come in the form of hemodialysis or renal transplantation. Certainly, the latter is associated with not only significantly better longevity but also a tangibly improved quality of life.2,3 Unfortunately, the pervasiveness of hypertensive and diabetic nephropathy in the Western culture has disproportionately exceeded the supply of available allografts.4 Within the context of this mounting shortage, the rate of deceased donor renal transplants has remained relatively stagnant.5 As a consequence, there exists a distinct and pressing need for increased accrual of living kidney donors. Live donor nephrectomy was originally achieved through an open transperitoneal subcostal or extraperitoneal flank incision. While graft outcomes were excellent with this approach, these positive results came at the expense of considerable morbidity to the donor, including significant postoperative pain, prolonged convalescence, and poor cosmesis.6,7 Indeed, the morbidity of live open donor nephrectomy was considered a major deterrent to kidney donation and an obstacle to its widespread application. In response to this public health concern, Gill and colleagues performed the first laparoscopic donor nephrectomy in an animal model in 1994.8 One year later, Ratner et al. published their series on laparoscopic live donor nephrectomy in humans.9 Evidence-based research over the ensuing decade ultimately confirmed laparoscopic live donor nephrectomy as a safe, feasible, and less morbid alternative to open procurement.10,11 In 2007, the United Network for Organ Sharing (UNOS) reported 6,041 live donor kidney transplants with the vast majority of these allografts procured laparoscopically.12 Despite improvements in instrumentation, refinements in technique, and mounting experience, laparoscopic live donor nephrectomy remains one of the most challenging and admittedly stressful urologic procedures to perform. Although the common difficulties with laparoscopic donor nephrectomy are analogous to those of laparoscopic simple and radical nephrectomy, the nature of the operation engenders little margin for error and the implications of technical misadventures are profoundly magnified.13 The operating surgeon is not only responsible for the safety of the donor who is altruistically undergoing a fundamentally elective procedure, but also for the quality and health of the allograft that will offer the recipient an improved and sustained life. Laparoscopic live donor nephrectomy demands attention to detail, technical proficiency and rigueur, and a thorough comprehension of the common difficulties experienced during the operation. This chapter will describe the authors' cumulative experience with laparoscopic live donor nephrectomy, offer insight into the nature and causes of difficulties experienced during the procedure, and tender practical suggestions on how to best avoid intra-operative complications.

Original languageEnglish (US)
Title of host publicationDifficult Conditions in Laparoscopic Urologic Surgery
PublisherSpringer London
Pages91-101
Number of pages11
ISBN (Print)9781848821040
DOIs
StatePublished - Dec 1 2011
Externally publishedYes

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Nephrectomy
Tissue Donors
Kidney
Morbidity
Transplants
Allografts
Renal Replacement Therapy
Living Donors
Diabetic Nephropathies
Postoperative Pain
Kidney Transplantation
Chronic Kidney Failure
Renal Dialysis
Cause of Death
Animal Models
Public Health
Delivery of Health Care
Safety

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Kaouk, J. H., & White, W. (2011). Difficulties in laparoscopic live donor nephrectomy. In Difficult Conditions in Laparoscopic Urologic Surgery (pp. 91-101). Springer London. https://doi.org/10.1007/978-1-84882-105-7_9

Difficulties in laparoscopic live donor nephrectomy. / Kaouk, Jihad H.; White, Wesley.

Difficult Conditions in Laparoscopic Urologic Surgery. Springer London, 2011. p. 91-101.

Research output: Chapter in Book/Report/Conference proceedingChapter

Kaouk, JH & White, W 2011, Difficulties in laparoscopic live donor nephrectomy. in Difficult Conditions in Laparoscopic Urologic Surgery. Springer London, pp. 91-101. https://doi.org/10.1007/978-1-84882-105-7_9
Kaouk JH, White W. Difficulties in laparoscopic live donor nephrectomy. In Difficult Conditions in Laparoscopic Urologic Surgery. Springer London. 2011. p. 91-101 https://doi.org/10.1007/978-1-84882-105-7_9
Kaouk, Jihad H. ; White, Wesley. / Difficulties in laparoscopic live donor nephrectomy. Difficult Conditions in Laparoscopic Urologic Surgery. Springer London, 2011. pp. 91-101
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