Low-pressure pneumoperitoneum during laparoscopic donor nephrectomy to optimize live donors' comfort
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Publication year
2013Source
Clinical Transplantation, 27, 4, (2013), pp. E478-83ISSN
Publication type
Article / Letter to editor
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Organization
Surgery
Urology
Nephrology
Anesthesiology
Journal title
Clinical Transplantation
Volume
vol. 27
Issue
iss. 4
Page start
p. E478
Page end
p. 83
Subject
DCN NN - Brain networks and neuronal communication NCEBP 7: Effective primary care and public health; N4i 4: Auto-immunity, transplantation and immunotherapy; NCEBP 14: Cardiovascular diseases; NCEBP 14: Cardiovascular diseases NCMLS 3: Tissue engineering and pathology; NCEBP 2: Evaluation of complex medical interventions; ONCOL 4: Quality of Care; IGMD 9: Renal disorderAbstract
Nowadays, laparoscopic donor nephrectomy (LDN) has become the gold standard to procure live donor kidneys. As the relationship between donor and recipient loosens, it becomes of even greater importance to optimize safety and comfort of the surgical procedure. Low-pressure pneumoperitoneum has been shown to reduce pain scores after laparoscopic cholecystectomy. Live kidney donors may also benefit from the use of low pressure during LDN. To evaluate feasibility and efficacy to reduce post-operative pain, we performed a randomized blinded study. Twenty donors were randomly assigned to standard (14 mmHg) or low (7 mmHg) pressure during LDN. One conversion from low to standard pressure was indicated by protocol due to lack of progression. Intention-to-treat analysis showed that low pressure resulted in a significantly longer skin-to-skin time (149 +/- 86 vs. 111 +/- 19 min), higher urine output during pneumoperitoneum (23 +/- 35 vs. 11 +/- 20 mL/h), lower cumulative overall pain score after 72 h (9.4 +/- 3.2 vs. 13.5 +/- 4.5), lower deep intra-abdominal pain score (11 +/- 3.3 vs. 7.5 +/- 3.1), and a lower cumulative overall referred pain score (1.8 +/- 1.9 vs. 4.2 +/- 3). Donor serum creatinine levels, complications, and quality of life dimensions were not significantly different. Our data show that low-pressure pneumoperitoneum during LDN is feasible and may contribute to increase live donors' comfort during the early post-operative phase.
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- Faculty of Medical Sciences [90373]
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