Title: MINI-FLANK DONOR NEPHRECTOMY INCISION:A SINGLE CENTRE EXPERIENCE FROM NIGERIA

Biography:

Dr. Igbokwe Martin is a Consultant Urologist/ Kidney Transplant Surgeon at Zenith Medical and Kidney Centre, Abuja. His research interests are surgery, transplantation, urology, and many more. He has also attended several transplantation conferences.

Abstract

Background 
Donor nephrectomy (DN) is an important aspect of  kidney transplantation. It entails safe retrieval of a healthy renal allograft from a donor for this purpose. Over the last 2 decades, open DN has given way to minimal invasive techniques like laparoscopic and robotic DN. However, DN via a mini-incision has gained popularity in many parts of the world as a suitable alternative to LDN especially were there are lack of facilities or expertise for LDN or robotic DN. Mini-incision donor nephrectomy (MIDN) is a modification of the ODN with incisions of<12cm in length and has been found to offer an acceptable scar, duration of hospital stay, pain assessment and generally less mobidity than with the traditional ODN. This study aims to describe our experience with mini-flank incision DN among Nigerian patients.
Patients and Methods
A prospective review of all donor nephrectomy patients performed in a single Nigerian kidney transplantation centre over a 30-months duration was made. Information obtained from these patients were classified as pre-, intra- and post-operative. Data include socio-demographic characteristics, pre-operative preparation, details of intra-operative techniques like side of donor nephrectomy, length of incision, duration of surgery, intra-operative complications,1st  warm ischemic time and post-operative findings eg  post-operative pain, days on admission, analgesic requirements, duration of ileus, commencement of oral intake and and cosmetic outlook  of the scar. These were entered into a proforma and analyzed using SPSS version 21.
Results
A total of 304 patients underwent ODN during the study period, of which 230 (75.6%) had MIDN. Mean duration of  the surgery was 130±28 minutes .MIDN  was mostly performed on patients with BMI of <30kg/msq  and these patients had better post-operative pain control. Oral intake and ambulation was commenced on 1st day post-op and the cosmetic outcome was acceptable in over 90% of kidney donors.
Conclusion
Mini-incision for Donor Nephrectomy through the flank approach is a suitable alternative to laparoscopic donor nephrectomy in the developing world were facilities and skills for laparoscopic or robotic nephrectomies are unavailable. It offers shorter operating time and 1st warm ischemic time with comparable morbidity rate.