Optimalisation of the perioperative treatment in kidney donors:
Fast track perioperative care program vs standard perioperative care program in hand-assisted laparoscopic donornephrectomy.

Kidney transplantation has become an established therapy for end stage renal disease. With the advent of laparoscopic living donor nephrectomy a reduction in hospital stay, less postoperative analgesic requirements, improved cosmetics, less postoperative pain and an earlier return to normal daily activities have been reported. Both open and laparoscopic donor nephrectomy have same outcome in morbidity and mortality. The introduction of the fast track perioperative care program has proven its value in many surgical operations. The fast track perioperative care program consists of preoperative counselling, no preoperative fasting but carbohydrate-loaded liquids until 2 h before surgery, tailored anaesthesiology encompassing thoracic epidural anaesthesia and short-acting anaesthetics, short incisions, non-opioid pain management, no routine use of drains and nasogastric tubes, early removal of bladder catheters and early and enhanced postoperative feeding and mobilization. Data of fast track surgery of colon malignancies proved that patients had better outcome with regard to ileus, cardiopulmonary function and muscle function compared to standard perioperative care program. The research question is whether fast track perioperative care program is preferred above standard perioperative care program in hand-assisted laparoscopic donornephrectomy.

Determine whether fast track perioperative care program is preferred above standard perioperative care program in hand-assisted laparoscopic donornephrectomy.

N/A

Fast track program combines various techniques including epidural or regional anaesthesia, minimally invasive techniques, optimal pain control, and aggressive postoperative rehabilitation, including early enteral (oral) nutrition and ambulation. The control group will receive our normal perioperative care including a preoperative enema and postoperative patient-controlled analgesia. The length of the fast track program will be between 48 and 72 hrs.



Specific preoperative donor evaluation included blood and urine examination, angiography, pyelography and renal scintigraphy.


The hand-assisted laparoscopic donor nephrectomy (HALDN) is done transperitoneally.

After open dissection of the distal ureter and gonadal vein through a 7-8 cm Pfannenstiel incision the non dominant operators' hand is introduced through a handport and two 10-12 mm trocars are placed. The insufflation pressure was maximally 12 mmHg. The right or left colon was then mobilized. After transecting the ureter distally, the renal artery is transected with metal clips, while an endoscopic stapler is used to transect the renal vein. The kidney is extracted through the Pfannenstiel incision and cold flushed and preserved with University of Wisconsin solution (UW).