NOTES Effective in Living Kidney Transplant Donors

A new study confirms the feasibility of Natural Orifice Transluminal Endoscopy Surgery (NOTES) surgical techniques in the extraction of a living donor kidney for transplantation.

Researchers at IDIBAPS - Hospital Clínic of Barcelona (Spain) applied modified transvaginal NOTES extraction techniques in 20 women who underwent living donor nephrectomy (LDN) between July 2009 and October 2010. The researchers compared the prospectively collected clinical data of each donor with those of a contemporaneous matched pair of conventional LDNs. Variables evaluated for donors were procedure length, blood loss, warm ischemia time (WIT), complications, hospital stay, and first-month creatinine nadir. Sexual function was assessed using a questionnaire before and after surgery. Variables evaluated for recipients were complications, graft function, and creatinine evolution.

The results showed that operative variables were similar for both groups except for WIT, which was longer in the transvaginal LDN group, without consequences for graft functioning. One transvaginal LDN case had postoperative bleeding requiring immediate open surgery. All transvaginal LDN donors reported unaltered sexual function after surgery and satisfaction with the results. All recipients had immediate urine output, and all had a functioning graft at last follow-up, except for one recipient of the transvaginal LDN group who required transplantectomy. The study was published in the June 2011 issue of European Urology.

“The minimally invasive surgical techniques for removal of living donor kidneys have many advantages; better quality of life for the donor, minimal scarring, shorter hospital stay and less pain,” said lead author Antonio Alcaraz, MD, head of the department of Urology. “The surgical technique is completely reproducible and can be considered a good alternative procedure that could increase the rate of living donors among women.”

NOTES is an experimental surgical technique whereby abdominal operations can be performed with a trocar passed through a natural orifice (mouth, urethra, anus, etc.) and then through an internal incision in the stomach, vagina, bladder, or colon, thus avoiding any external incisions or scars.

Related Links:
IDIBAPS - Hospital Clínic of Barcelona