Endoscopic surgery in organ transplantation

Only recently the advantages of laparoscopic techniques have been utilised for patients following solid organ transplantation and transplant related p rocedures. Laparoscopy assisted live donor nephrectomy was introduced in 19 95 and has been evaluated in a few large and several small studies includin g our series of 15 patients. All published data indicate feasibility, effec tiveness, and to some extent safety of this procedure, which seem to increa se with experience. In comparisons with historic controls postoperative pai n and incision related morbidity are lower and recovery seems to be faster by about 3 weeks. Although obvious advantages have been promoted, there is, in the absence of controlled trials comparing relevant endpoints, so far n o clear scientific evidence for overall superiority of laparoscopic live do nor nephrectomy when compared with the conventional approach. Endoscopic procedures such as laparoscopic cholecystectomy or nephrectomy a re nowadays safely performed in patients after successful solid organ trans plantation (1, 2). Only recently, endoscopic techniques have been utilised for evaluation and treatment of specific transplant related aspects before and after liver, pancreas, kidney and lung transplantation. Procedures such as pretransplant diagnostic laparoscopy for liver tumours (3), videothorac oscopic wedge resection of the transplanted lung for diagnosis of acute rej ection (4), or diagnostic biopsy after renal and pancreaticoduodenal transp lantation (5) have been described as valuable tools. Intraperitoneal fenest ration of lymphoceles with intraoperativ ultrasonographic guidance after re nal transplantation is in our experience and in that of others (6, 7, 8) st raightforward, safe, effective, and can be of significant advantage for the patient. Ratner introduced laparoscopy assisted nephrectomy for procuring kidneys fr om live donors in 1995 (9). Suzuki (10) and Yang (11) successfully performe d extraperitoneal (by retroperitoneoscopy) and Wolf (12) hand-assisted lapa roscopic live donor nephrectomies in 1998. Since then, mainly laparoscopic live donor nephrectomy is increasingly adopted by transplant surgeons in se veral countries. The so far published results of prospective series includi ng our preliminary experience with this technique will be discussed.