A team of Filipino doctors has successfully performed the first surgical procedure in the Philippines for live kidney donation that is safe, minimally invasive, and relatively pain-free.
The novel surgical procedure is called Retroperitoneoscopic Live Donor Nephrectomy (RPLDN) and was performed at the Providence Hospital in Quezon City by Dr. Juvido P. Agatep, Jr., proponent of Retroperitoneoscopic Surgery in the Philippines. He was assisted by Drs. Christopher Perez, Jayson Dequina, and Carlo Andutan.
The surgical approach to live kidney donation has recently undergone significant changes since the introduction of laparoscopic nephrectomy. Kidney donation is a surgical procedure that is less complicated compared with diseased kidney, yet the surgical challenge is to minimize risks associated with donor morbidity and mortality—the safety of the kidney donor is an absolute priority.
Minimally invasive surgery is a procedure that uses small (less than 1 cm) incisions to retrieve an organ with the aid of a camera and a monitor. Several studies comparing conventional open live donor nephrectomy and minimally invasive donor nephrectomy resulted in less post-operative pain, a shorter hospital stay, a faster return to work.
However, in most cases of laparoscopic live donor nephrectomy, the transperitoneal approach is a procedure that enters the abdominal cavity and involves the mobilization of the bowels and other intraperitoneal organs. This approach always carries a potential risk of bowel injury and of late-onset bowel obstruction due to adhesion of the intestines, causing a higher risk of vascular injury.
On the other hand, RPLDN is another option of a minimally invasive procedure that does not enter the abdominal cavity. Instead, it enters the posterior of the patients, “back door style” so to speak, without the involvement of the intraperitoneal organs. Therefore, it does not cause any bowel complications such as bowel injury, prolonged paralysis of the intestines or bowel obstruction due to adhesions, or risk of vascular, spleen, and liver injury. This procedure is already being performed in some parts of Europe and Asia.
Dr. Juvido Agatep, Jr. who led the team of medical specialists who carried out the first Retroperitoneoscopic Surgery in the Philippines, is the head of the urology section of Providence Hospital and of the minimally invasive section of East Avenue Medical Center. He took up Retroperitoneoscopic and Laparoscopic urology and tumor surgery at the University of Heidelberg-Klinikum in Heilbronn, Germany, and is presently on a two-month fellowship training in Endourology-Ultrasound Guided PCNL at the Beijing Tsinghua Changgung Hospital in Beijing, China.
