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Essential Urologic Laparoscopy - part 8

bệnh nhân thận giai đoạn cuối, những người vẫn còn trong danh sách chờ đợi, với một thêm 1.543 bệnh nhân chết trong khi chờ đợi cấy ghép thận vào cuối năm nay. Mặc dù tổng số allografts thận vào năm 1995 đã tăng 17% so với năm 1990, số lượng cá nhân trong danh sách chờ tăng không cân đối | 212 Su patients with ESRD who remained on the waiting list with an additional 1 543 patients dying while awaiting renal transplantation by the end of the year. Although the total number of renal allografts in 1995 had increased by 17 from 1990 the number of individuals on the waiting list increased disproportionately by 74 and the number of patients who died increased by 61 . The second observation was that live renal allografts had significant advantages over those of cadaveric allografts including superior allograft and patient survival rates shorter waiting periods for transplantation closer human leukocyte antigen HLA matching shorter cold ischemic times and overall reduced immunosuppression requirements 2 . Despite these advantages the number of live renal transplants performed in 1995 i.e. 3 359 accounted for less than one-third of the total number of transplants performed 1 . Taken together live donor kidneys remained a very valuable but underutilized source of allografts limited only by the willingness of family members and friends to donate a kidney to a loved one. In 1995 Ratner and Kavoussi performed the first laparoscopic live donor nephrectomy an operation that was devised to reduce the disincentives to live kidney donation in hopes of increasing the pool of live donor candidates 3 . Since its inception laparoscopic live donor nephrectomy has made a substantial impact on the treatment and outcome of the donor patient by providing a less invasive alternative to renal donation. This technique has resulted in significantly less postoperative pain shorter hospital stays reduced postoperative convalescence and improved cosmesis without jeopardizing either donor safety or the quality of allograft provided to the recipient 4-11 . Herein we describe our current step-by-step technique for laparoscopic live donor nephrectomy. PREOPERATIVE ASSESSMENT Patient Selection All donor candidates require extensive medical and psychological evaluation in accordance with .