Laparoscopic Living Donor Nephrectomy: A Look at Current Trends and Practice Patterns at Major Transplant Centers Across the United States

Andrew D. Wright, Thomas A. Will*, David R. Holt, Thomas M.T. Turk, Kent T Perry Jr

*Corresponding author for this work

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Purpose: Laparoscopic living donor nephrectomy is now the preferred technique for living donor renal transplantation. To our knowledge we provide the first published multi-institutional consensus describing practice patterns, technical considerations and interesting controversies involved in laparoscopic living donor nephrectomy. Materials and Methods: We designed a survey with 33 multiple choice questions looking at demographics, patient selection, technical considerations, postoperative care and followup involved in laparoscopic living donor nephrectomy. Surveys were sent to the 58 fellowship training programs in the United States accredited by the American Society of Transplant Surgeons. Results: The 32 responding programs performed approximately 40% of laparoscopic living donor nephrectomies in the United States in 2005. We found that almost all centers used a donor committee to screen candidates, enforce a body mass index cutoff, and use right kidneys when necessary and left kidneys in women of childbearing age. Regarding laparoscopic access, pure laparoscopy was favored 2 to 1 over the hand assisted technique and most of those who use nonbladed trocars do not close the fascia. Most surgeons divide the adrenal vein in left cases, use a vascular stapler on the renal artery and vein, and keep the ureter with the gonadal vein in the specimen. At most centers heparin is given before controlling the vessels. Extraction in pure laparoscopic cases is usually performed using a preplaced entrapment bag through a modified Pfannenstiel incision. Conclusions: Our survey describes how most renal transplant centers with accredited fellowship programs in the United States approach laparoscopic living donor nephrectomy. Specifically trends are revealed regarding patient selection, laparoscopic access and surgical technique.

Original languageEnglish (US)
Pages (from-to)1488-1492
Number of pages5
JournalJournal of Urology
Volume179
Issue number4
DOIs
StatePublished - Apr 1 2008

Fingerprint

Living Donors
Nephrectomy
Transplants
Kidney
Patient Selection
Veins
Renal Veins
Postoperative Care
Fascia
Renal Artery
Ureter
Surgical Instruments
Kidney Transplantation
Laparoscopy
Blood Vessels
Heparin
Body Mass Index
Hand
Demography
Tissue Donors

Keywords

  • kidney
  • laparoscopy
  • nephrectomy
  • tissue donors
  • trends

ASJC Scopus subject areas

  • Urology

Cite this

Wright, Andrew D. ; Will, Thomas A. ; Holt, David R. ; Turk, Thomas M.T. ; Perry Jr, Kent T. / Laparoscopic Living Donor Nephrectomy : A Look at Current Trends and Practice Patterns at Major Transplant Centers Across the United States. In: Journal of Urology. 2008 ; Vol. 179, No. 4. pp. 1488-1492.
@article{6ddfccf6a3134cbbbfcf0edad2327131,
title = "Laparoscopic Living Donor Nephrectomy: A Look at Current Trends and Practice Patterns at Major Transplant Centers Across the United States",
abstract = "Purpose: Laparoscopic living donor nephrectomy is now the preferred technique for living donor renal transplantation. To our knowledge we provide the first published multi-institutional consensus describing practice patterns, technical considerations and interesting controversies involved in laparoscopic living donor nephrectomy. Materials and Methods: We designed a survey with 33 multiple choice questions looking at demographics, patient selection, technical considerations, postoperative care and followup involved in laparoscopic living donor nephrectomy. Surveys were sent to the 58 fellowship training programs in the United States accredited by the American Society of Transplant Surgeons. Results: The 32 responding programs performed approximately 40{\%} of laparoscopic living donor nephrectomies in the United States in 2005. We found that almost all centers used a donor committee to screen candidates, enforce a body mass index cutoff, and use right kidneys when necessary and left kidneys in women of childbearing age. Regarding laparoscopic access, pure laparoscopy was favored 2 to 1 over the hand assisted technique and most of those who use nonbladed trocars do not close the fascia. Most surgeons divide the adrenal vein in left cases, use a vascular stapler on the renal artery and vein, and keep the ureter with the gonadal vein in the specimen. At most centers heparin is given before controlling the vessels. Extraction in pure laparoscopic cases is usually performed using a preplaced entrapment bag through a modified Pfannenstiel incision. Conclusions: Our survey describes how most renal transplant centers with accredited fellowship programs in the United States approach laparoscopic living donor nephrectomy. Specifically trends are revealed regarding patient selection, laparoscopic access and surgical technique.",
keywords = "kidney, laparoscopy, nephrectomy, tissue donors, trends",
author = "Wright, {Andrew D.} and Will, {Thomas A.} and Holt, {David R.} and Turk, {Thomas M.T.} and {Perry Jr}, {Kent T}",
year = "2008",
month = "4",
day = "1",
doi = "10.1016/j.juro.2007.11.066",
language = "English (US)",
volume = "179",
pages = "1488--1492",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "4",

}

Laparoscopic Living Donor Nephrectomy : A Look at Current Trends and Practice Patterns at Major Transplant Centers Across the United States. / Wright, Andrew D.; Will, Thomas A.; Holt, David R.; Turk, Thomas M.T.; Perry Jr, Kent T.

In: Journal of Urology, Vol. 179, No. 4, 01.04.2008, p. 1488-1492.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Laparoscopic Living Donor Nephrectomy

T2 - A Look at Current Trends and Practice Patterns at Major Transplant Centers Across the United States

AU - Wright, Andrew D.

AU - Will, Thomas A.

AU - Holt, David R.

AU - Turk, Thomas M.T.

AU - Perry Jr, Kent T

PY - 2008/4/1

Y1 - 2008/4/1

N2 - Purpose: Laparoscopic living donor nephrectomy is now the preferred technique for living donor renal transplantation. To our knowledge we provide the first published multi-institutional consensus describing practice patterns, technical considerations and interesting controversies involved in laparoscopic living donor nephrectomy. Materials and Methods: We designed a survey with 33 multiple choice questions looking at demographics, patient selection, technical considerations, postoperative care and followup involved in laparoscopic living donor nephrectomy. Surveys were sent to the 58 fellowship training programs in the United States accredited by the American Society of Transplant Surgeons. Results: The 32 responding programs performed approximately 40% of laparoscopic living donor nephrectomies in the United States in 2005. We found that almost all centers used a donor committee to screen candidates, enforce a body mass index cutoff, and use right kidneys when necessary and left kidneys in women of childbearing age. Regarding laparoscopic access, pure laparoscopy was favored 2 to 1 over the hand assisted technique and most of those who use nonbladed trocars do not close the fascia. Most surgeons divide the adrenal vein in left cases, use a vascular stapler on the renal artery and vein, and keep the ureter with the gonadal vein in the specimen. At most centers heparin is given before controlling the vessels. Extraction in pure laparoscopic cases is usually performed using a preplaced entrapment bag through a modified Pfannenstiel incision. Conclusions: Our survey describes how most renal transplant centers with accredited fellowship programs in the United States approach laparoscopic living donor nephrectomy. Specifically trends are revealed regarding patient selection, laparoscopic access and surgical technique.

AB - Purpose: Laparoscopic living donor nephrectomy is now the preferred technique for living donor renal transplantation. To our knowledge we provide the first published multi-institutional consensus describing practice patterns, technical considerations and interesting controversies involved in laparoscopic living donor nephrectomy. Materials and Methods: We designed a survey with 33 multiple choice questions looking at demographics, patient selection, technical considerations, postoperative care and followup involved in laparoscopic living donor nephrectomy. Surveys were sent to the 58 fellowship training programs in the United States accredited by the American Society of Transplant Surgeons. Results: The 32 responding programs performed approximately 40% of laparoscopic living donor nephrectomies in the United States in 2005. We found that almost all centers used a donor committee to screen candidates, enforce a body mass index cutoff, and use right kidneys when necessary and left kidneys in women of childbearing age. Regarding laparoscopic access, pure laparoscopy was favored 2 to 1 over the hand assisted technique and most of those who use nonbladed trocars do not close the fascia. Most surgeons divide the adrenal vein in left cases, use a vascular stapler on the renal artery and vein, and keep the ureter with the gonadal vein in the specimen. At most centers heparin is given before controlling the vessels. Extraction in pure laparoscopic cases is usually performed using a preplaced entrapment bag through a modified Pfannenstiel incision. Conclusions: Our survey describes how most renal transplant centers with accredited fellowship programs in the United States approach laparoscopic living donor nephrectomy. Specifically trends are revealed regarding patient selection, laparoscopic access and surgical technique.

KW - kidney

KW - laparoscopy

KW - nephrectomy

KW - tissue donors

KW - trends

UR - http://www.scopus.com/inward/record.url?scp=40849123728&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=40849123728&partnerID=8YFLogxK

U2 - 10.1016/j.juro.2007.11.066

DO - 10.1016/j.juro.2007.11.066

M3 - Article

C2 - 18295274

AN - SCOPUS:40849123728

VL - 179

SP - 1488

EP - 1492

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 4

ER -