Minimally invasive living donor operation for simultaneous pancreas and kidney transplantation: HALS-nephrectomy and distal pancreatectomy

N. Akutsu, M. Maruyama, K. Saigo, C. Iwashita, K. Otsuki, T. Ito, T. Asano, T. Kenmochi
Chiba-East National Hospital, Surgery, Chiba, Japan

Objective: It is seriously important for living donations to make safer and to reduce operating stress. Laparoscopic surgery is though to be a useful operating procedure for solving these problems. We have performed 15 cases of LD-SPKTx. With the last 7 cases, we did hand-assisted laparoscopic (HALS) living donor nephrectomy and distal pancreatectomy (LDNP) for donor benefits. In this presentation, we report the summary of 7 cases of successfully completed HALS-LDNP.

Methods: Placements of working ports were as follows (one hand port (7 cm); above umbilicus, two 12 mm ports; (left lateral abdomen and left lower abdomen)). First, we performed left nephrectomy after dividing ureter with double clipping and finally dividing renal artery and vein by ENDO GIA . Next, distal pancreatectomy was performed. Pancreatic tail and spleen was dissected from retroperitoneal tissue until found celiac artery and portal vein. Then we cut the pancreatic body above the left side edge of portal vein with LCS and harvested pancreas and spleen.

Results: Five of donors were women and two were men. Average of age is 47.1 ± 14.2 years old. Total operation time was 472 ± 42 minutes. An estimated blood loss was 423 ± 216 ml. A warm ischemia time (WIT) of kidney was 127 ± 30 seconds and that of pancreas was 296 ± 82 seconds. As compared with open approach, HALS approach took more operation time and WIT of pancreas, but less WIT of kidney and blood loss. Graft functions of kidney were so good that urine was recognized immediately and all recipients obtained withdrawal of hemodialysis. As pancreas function, five recipients got normalizing of blood sugar without insulin. They discharged the hospital without remarkable complications.

Conclusions: We demonstrated that HALS-LDNP would have advantages of safeness for donor and of transplant organ function in SPKTx.