B. Schönberger

Laparoscopic live donor right nephrectomy: A new technique with preservation of vascular length

Purpose: We report our initial experience with right laparoscopic live donor nephrectomy using a modified vascular clamp for achieving maximal length of the renal vein. Materials and Methods: Since 1999, 34 patients have undergone laparoscopic live donor nephrectomy at ChariteHospital in Berlin, including 30 on the left and 4 on the right side. The right technique involves a 4-port transperitoneal laparoscopic approach with a muscle splitting lumbar incision for kidney extraction. To duplicate completely the comparable open operation a modified Satinsky atraumatic vascular clamp (Aesculap, Inc., Center Valley, Pennsylvania) was introduced throug ha1c m.lateral incision and placed across the vena cava, enabling harvest of the full length of the renal vein flush with the vena cava. The vena cavotomy is closed with a running suture placed in intracorporeal fashion. Results: All procedures were successfully accomplished without technical or surgical compli- cations. Mean operative time was 170 minutes. Mean renal warm ischemia time from endoscopic cross clamping of the renal vessels to cold perfusion on the bench was 2.1 minutes. In all 4 kidneys it was possible to harvest the whole length of the renal vein, so that the recipient operation was performed under optimal vascular conditions. All 4 kidneys were transplanted successfully in the recipients and showed immediate function. Conclusions: Right laparoscopic live donor nephrectomy is technically feasible, safe and a viable option for minimally invasive organ donation when left kidney donation is not desired. The Satinsky atraumatic vascular clamp enabled harvest of the whole right renal vein. We believe that this laparoscopic technique effectively duplicates the open operation with less morbidity.

Laparoscopy for living donor nephrectomy – particularities of the currently applied techniques

Today, laparoscopic donor nephrectomy (LDN) in many centers features the standard approach for kidney retrieval in living donors. More than 60% of the centers in the USA currently perform LDN and numbers are rising in Europe as well. Todays variety of laparoscopic approaches reflects the evolution in the field of LDN. Multiple modifications have been made for the laparoscopic approach, with consequences for intraoperative handling of the kidney, operating and ischemic times and with impact on donor, organ, and recipient. We reviewed the literature from 1995 to 2004 and critically evaluated the different technical modifications, their specific advantages and disadvantages and their impact for the operation. The article aims to help the surgeon choose the technique he feels most safe with for performing laparoscopic kidney retrieval safely and with good results for donor and recipient.

Eugen Rehfisch—Pionier der modernen Urodynamik

ZusammenfassungEugen Rehfisch publizierte 2 bedeutende Arbeiten über die Sphinkterfunktion und die Innervation der Harnblase in Virchows Archiv für pathologische Anatomie, Physiologie und klinische Medizin in den Jahren 1897 und 1900. Die entscheidende Abbildung seiner Publikation von 1897 wurde in dem urodynamischen Schrifttum sehr bekannt. Sie zeigt die erste simultane Aufzeichnung von Blasendruck und Harnvolumen bei einem Menschen. Eugen Rehfischs wegweisende Versuchsanordnung zur Erfassung des Miktionsdruckes bei Miktionsbeginn hat sich in ihren Grundsätzen bis ins Computerzeitalter erhalten. Das war der Grund für den Vorstand des Forum Urodynamicum e.V. dem von der Fa. Pfizer gesponserten Innovationspreis den Namen „Eugen Rehfisch“ zu geben.Am 06. März 1862 wurde Eugen Rehfisch in Kempen/Posen geboren. Er studierte an der Friedrich-Wilhelms-Universität in Berlin und an der Bayerischen Julius-Maximilian-Universität in Würzburg. Etwa seit 1889 arbeitete er als Arzt in Berlin und war geraume Zeit ein Mitarbeiter von Leopold Casper (1859–1959). Seine bedeutsamen urodynamischen Untersuchungen führte er von 1896–1900 am Institut für Physiologie der Friedrich-Wilhelms-Universität in Berlin durch. Danach wandte er sich der Kardiologie zu. Neben seinen urologischen Publikationen fanden wir psychiatrische und kardiologische Studien in der Literatur. Er war aktives Mitglied medizinischer Gesellschaften in Berlin und wurde mit einer Titularprofessur geehrt. Er starb am 07. Oktober 1937 in Berlin und wurde auf dem Jüdischen Friedhof in Berlin-Weißensee beigesetzt. Der Eugen-Rehfisch-Preis ist Ausdruck unserer Verehrung für einen Pionier der modernen Urodynamik.AbstractEugen Rehfisch published two important articles on vesical sphincter function and innervation of the bladder in the Archives of Pathologic Anatomy, Physiology and Clinical Medicine edited by R. Virchow in 1897 and 1900. A figure from his first urodynamic article (1897) became well known in the urodynamic literature. It shows the first simultaneous registration of vesical pressure and urinary volume in a human.Eugen Rehfisch’s ingenious experimental design for examining the process of micturition has remained to this day. For this reason, the board of the Forum Urodynamicum, a registered society in Germany, named its innovation prize donated by the Pfizer company after Eugen Rehfisch. Eugen Rehfisch was born in Kempen/Posen on March 6 1862. He studied at the Friedrich Wilhelms University in Berlin and at the Bavarian Julius Maximilian University in Würzburg. From approximately 1889, he worked as a physician in Berlin and was a co-worker of Leopold Casper (1859–1959) for some time.He performed his important urodynamic studies at the Institute of Physiology of the Friedrich Wilhelms University between 1896 and 1900. After this, he turned to cardiology. Besides articles on urology, he published papers on psychiatry and cardiology. He was an active member of medical societies in Berlin and was awarded the title of a professor. Eugen Rehfisch died on October 7, 1937in Berlin. His grave is in the cemetery of the Jewish congregation in Berlin Weißensee. The Eugen Rehfisch innovation prize is an expression of our admiration.

Laparoscopic donor nephrectomy

Laparoscopic live donor nephrectomy (LDN) has removed disincentives of potential donors and may bear the potential to increase kidney donation. Multiple modifications have been made to abbreviate the learning curve while at the same time guarantee the highest possible level of medical quality for donor and recipient. We reviewed the literature for the evolution of the different LDN techniques and their impact on donor, graft and operating surgeon, including the subtleties of different surgical accesses, vessel handling and organ extraction. We performed a literature search (PubMed, DIMDI, medline) to evaluate the development of the LDN techniques from 1995 to 2003. Today more than 200 centres worldwide perform LDN. Hand‐assistance has led to a spread of LDN. Studies comparing open and hand‐assisted LDN show a reduction of operating and warm ischaemia times for the hand‐assisted LDN. Different surgical access sites (trans‐ or retroperitoneal), different vessel dissection approaches, donor organ delivery techniques, delivery sites and variations of hand‐assistance techniques reflect the evolution of LDN. Proper techniques and their combination for the consecutive surgical steps minimize both warm ischaemia time and operating time while offering the donor a safe minimally invasive laparoscopic procedure. LDN has breathed new life into the moribund field of living kidney donation. Within a few years LDN could become the standard approach in living kidney donation. Surgeons working in this field must be trained thoroughly and well acquainted with the subtleties of the different LDN techniques and their respective advantages and disadvantages.