Why potential live renal donors prefer laparoscopic nephrectomy: a survey of live donor attitudes.

OBJECTIVES: To address donor attitudes and reasons for selecting either laparoscopic or open donor nephrectomy (LDN, ODN), as despite the increased interest in laparoscopic procedures, organ donation continues to lag behind the demand for organs, and many new initiatives have failed to reduce the gap. PATIENTS AND METHODS: This case series comprised a 10-year review of medical records and a transplant database on donor demographics, analgesic requirements, postoperative complications and length of hospital stay. A structured telephone interview was conducted for all live donors to evaluate donor awareness, reasons for selecting LDN and the psychosocial impact of DN on donors' rehabilitation. RESULTS: Between 1995 and 2004, 38 LDN and 38 ODN were carried out; 70% were women in both groups, with a respective mean age of 44.4 and 47.1 years. Three LDNs were converted to ODN due to technical difficulties. The mean operative duration for LDN (194.8 min) was 78 min longer than for ODN (116.8 min). As expected, the mean analgesia requirement and length of hospital stay was less for LDN than ODN, by 55.4 mg of morphine equivalent and 2.3 days. Although all renal donors were aware of the option of LDN, one patient chose ODN due to safety concerns. The primary source of donor information was derived predominantly from the donor assessment process. The main reason for choosing LDN was the earlier return to work (54%), followed by less postoperative pain (33%). In general, there was minimal psychosocial impact after renal transplantation and the overall donor experience was very positive (85%). CONCLUSION: LDN has remained a safe, less-invasive but effective technique for allograft procurement, with minimal morbidity. Overall, there is less postoperative pain and fewer surgical complications, and an earlier return to normal functioning. The level of satisfaction with the whole renal donation process was very positive, with minimal psychosocial impact.

The determination of short-term breast volume changes and the rate of synthesis of human milk using computerized breast measurement.

The feasibility of using sequential breast volume measurements as a method of studying short-term rates of milk synthesis in women has been established. We have developed a rapid Computerized Breast Measurement system for the determination of breast volume, based upon the Shape Measurement System. A circle encompassing all the breast tissue is drawn in black face paint on the subject's skin. Six patterns of sixty-four horizontal light stripes are projected onto the breast and chest wall surface. A CCD camera relays video images to a computer, which produces a model of the chest by active triangulation. The volume of the breast and the chest wall segment enclosed by the circle is then calculated. The precision of the method was dependent upon the subject repositioning carefully. The coefficient of variation of replicate measurements was 1.6%. The accuracy of the method was established by comparing the change in breast volume before and after a breast-feed with the amount of milk removed by the infant as determined by test weighing. There was a close relationship between the removal of milk by the infant (x) and the change in breast volume (y), (r = 0.93, n = 73, y = 1.10x - 3.25). The rates of milk synthesis between breast-feeds, for six women determined on one to eight occasions, varied from 11 to 58 ml/h. The results show that the amount of milk available in the breast is not necessarily an important determinant of the amount of milk removed by the infant at a breast-feed.