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Renoult E, Hubert J, Ladrière M, Billaut N, Mourey E, Feuillu B, Kessler M. Robot-assisted laparoscopic and open live-donor nephrectomy: a comparison of donor morbidity and early renal allograft outcomes. Nephrol Dial Transplant 2005; 21:472-7. [PMID: 16204289 DOI: 10.1093/ndt/gfi150] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Robot-assisted laparoscopic donor (RALD) nephrectomy, a new procedure for the removal of a kidney from a living donor, was performed on 13 subjects at our centre. METHODS The immediate post-operative courses for these donors, and their respective recipients, were compared with those of 13 previous open live-donor nephrectomies (OPEN), performed in our facility. RESULTS We found no significant differences between these two donor groups with respect to age, gender, body mass index or renal vasculature. The average operative times and the warm ischaemia times were greater in the RALD group, 185.5'' vs 113.4'' (P = 0.0001) and 7'15'' vs 1'41'' (P = 0.0001), respectively. There was no conversion to the open procedure in the RALD group. The estimated blood loss was slight in both groups. Following nephrectomy, deep venous thrombosis occurred in one RALD patient and acute pyelonephritis in one OPEN patient. The average duration of hospitalization was shorter after the RALD procedure (5.84+/-1.8 days vs 9.69+/-2.2 days, P = 0.0001). The estimated creatinine clearance rate (eClcreat) was equivalent for all donors, at 5 days and 1 month after nephrectomy. All kidneys started functioning immediately after the transplantation. The mean recipient eClcreat (ml/min) was 58.16+/-26.7 for OPEN group kidneys and 62.23+/-17.59 for RALD group kidneys (P = 0.65), 5 days after transplantation. CONCLUSIONS RALD nephrectomies were associated with very low morbidity among donors, in which both the operative and warm ischaemia times were of longer duration, but had no observable adverse effects upon short-term graft function.
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Affiliation(s)
- Edith Renoult
- Department of Nephrology, University Hospital of Nancy, Rue du Morvan, 54511- Vandoeuvre-les-Nancy, France.
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Sharma A, Meier S, Larmeu L, Florman S, Slakey D. Hand-assisted laparoscopic donor nephrectomy: a low rate of complications. Prog Transplant 2005. [DOI: 10.7182/prtr.15.3.58787u8687264740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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53
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Sharma AK, Meier S, Larmeu L, Florman S, Slakey DP. Hand-Assisted Laparoscopic Donor Nephrectomy: A Low Rate of Complications. Prog Transplant 2005; 15:271-5. [PMID: 16252634 DOI: 10.1177/152692480501500311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Laparoscopic donor nephrectomy is associated with a higher incidence of ureteral complications. Hand-assisted dissection minimizes the use of instruments for intraoperative retraction and handling of periureteric tissue, and may reduce posttransplant complications. Objective To assess the outcome of hand-assisted laparoscopic donor nephrectomy, in particular ureteral complications. Methods Records of 143 kidney transplant recipients who received allografts removed using the hand-assisted laparoscopic technique were retrospectively studied. Results Total operating time was 2.0±0.55 (range 1.08–4) hours. Warm ischemia time was 1.45±0.60 (range 0.58–3.00) minutes. Length of artery, vein, and ureter was 2.4±0.5 cm, 3.0±0.5 cm, and 10.3±2.1 cm, respectively. Estimated blood loss averaged 86.3±55.6 mL. Intraoperative suction was not needed in 65% of patients. Two donors developed incisional hernias and 1 had a postoperative ileus. Four of 143 (2.8%) recipients developed ureteral complications: reoperations for ureteral necrosis (1), stenting for ureteral stenosis (2), and urethral catheterization for ureterovesical leak (1). Graft loss in the first year after transplantation occurred because of renal vein thrombosis, thrombosis of revised arterial anastomosis, arterial thrombosis due to myocardial infarction, vasculitis, focal segmental glomerulosclerosis, and chronic rejection. Delayed graft function developed in 3 recipients. The acute rejection rate was 14.6%. Mean serum creatinine levels at 1 and 3 years were 134±61 μmol/L (1.52±0.69 mg/dL) and 121±35 μmol/L (1.37±0.40 mg/dL), respectively. Conclusions Hand-assisted laparoscopic donor nephrectomy is associated with a low incidence of ureteral complications; may reduce the technical difficulty of the operation and minimize retraction with instruments, resulting in fewer complications for donors and recipients; and minimizes donor blood loss.
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Affiliation(s)
- Ajay K Sharma
- Tulane University Health Sciences Center, New Orleans, LA, USA
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Affiliation(s)
- Rajeev Kumar
- Urology, All India Institute of Medical Sciences, New Delhi, India
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Tan M, Kandaswamy R, Sutherland DER, Gruessner RWG. Laparoscopic donor distal pancreatectomy for living donor pancreas and pancreas-kidney transplantation. Am J Transplant 2005; 5:1966-70. [PMID: 15996246 DOI: 10.1111/j.1600-6143.2005.00950.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
With the proliferation and expanding applications of laparoscopic techniques, we determined the applicability of the laparoscopic approach to living pancreas donation. We performed the first laparoscopic donor distal pancreatectomy in 1999. We herein present our initial experience with five hand-assisted laparoscopic donor pancreatectomies. Three donors underwent distal pancreatectomy alone; two underwent a simultaneous left nephrectomy. The mean donor age was 48.4+/-8.7 years with a body mass index of 23.7 kg/m2. The donor and recipient survival rate was 100% at up to 3 years of follow-up. There were no episodes of pancreatitis, leaks, or pseudocysts. All donors returned to their preoperative state of health and to work. None of the donors have required oral anti-diabetic medications or insulin. We conclude that laparoscopic donor distal pancreatectomy is a safe and efficient procedure; hand-assisted laparoscopic distal pancreatectomy appears to be preferable, because of the added margin of safety from increased tactile feedback and ease of pancreatic dissection. The procedure can be accomplished with a single 6-cm periumbilical incision and only two 12-mm ports, resulting in excellent cosmesis and high donor satisfaction.
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Affiliation(s)
- Miguel Tan
- Department of Surgery, Division of Transplantation, University of Minnesota, MN, USA
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Furuya Y, Araki I, Zakoji H, Takihana Y, Tanabe N, Takeda M. Modified endoscopic live donor nephrectomy: retroperitoneoscopy followed by hand-assistance. Int J Urol 2005; 12:603-6. [PMID: 15985090 DOI: 10.1111/j.1442-2042.2005.01099.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We have developed a novel modification of previous approaches to donor nephrectomy and herein review our original operative procedure. First, the posterior aspect of the kidney was dissected retroperitoneoscopically and dissection of the renal artery, ureter and gonadal vein was almost completed. Second, the anterior aspect of the kidney was dissected with transperitoneal hand-assistance, and dissection of the renal pedicle from the anterior surface was accomplished easily and safely. This operative procedure was successfully performed for two donors with no intraoperative or postoperative complications. Our modified endoscopic donor nephrectomy is feasible as a minimally invasive procedure because of its safety, and its ability to preserve renal function and establish an excellent operative field for both posterior and anterior aspects of the kidney.
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Affiliation(s)
- Yasuhisa Furuya
- Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi 409-3898, Japan.
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Heimbach JK, Taler SJ, Prieto M, Cosio FG, Textor SC, Kudva YC, Chow GK, Ishitani MB, Larson TS, Stegall MD. Obesity in living kidney donors: clinical characteristics and outcomes in the era of laparoscopic donor nephrectomy. Am J Transplant 2005; 5:1057-64. [PMID: 15816886 DOI: 10.1111/j.1600-6143.2005.00791.x] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Acceptance of obese individuals as living kidney donors is controversial related to possible increased risk for surgical complications and concern that obesity may contribute to long-term renal disease. We retrospectively examined 553 consecutive hand-assisted laparoscopic living kidney donations between October 1, 1999 and April 1, 2003. We stratified donors into quartiles by baseline body mass index (BMI) assessing perioperative complications and 6-12 months post-donation metabolic and renal function. Compared to BMI <25 kg/m(2), high BMI donors (> or =35 kg/m(2)) had slightly longer operative times (mean increase 19 min), more overall perioperative complications (mostly minor wound complications), yet the same low rate of major surgical complications (conversion to open and re-operation) and similar length-of-stay (2.3 vs. 2.4 days). At 6-12 months after donation (mean 11 months), renal function and microalbuminuria did not differ with BMI. These results suggest that laparoscopic donor nephrectomy is generally safe in selected obese donors and does not result in a high rate of major perioperative complications. Obese donors have higher baseline cardiovascular risk and warrant risk reduction for long-term health. While early results are encouraging, we advocate careful study of obese donors and do not support their widespread use until longer follow-up is available.
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Affiliation(s)
- Julie K Heimbach
- Mayo Clinic College of Medicine, Department of Transplant Surgery, Rochester, Minnesota, USA
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Vats HS, Rayhill SC, Thomas CP. Early Postnephrectomy Donor Renal Function: Laparoscopic versus Open Procedure. Transplantation 2005; 79:609-12. [PMID: 15753853 DOI: 10.1097/01.tp.0000151662.84962.4e] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Laparoscopic donor nephrectomy (LDN) is becoming the method of choice to procure kidneys from living donors. Despite the benefits to the donor, there have been concerns over the transient deterioration of renal function in the recipient of LDN compared with standard nephrectomy. We carried out a retrospective review of all living donors at our institution between January 2000 and December 2002. On the first postoperative day, the fall in renal function in laparoscopic donors is significantly greater than the fall seen in open donors. This difference could not be explained by relative hypotension, excessive blood loss, or inadequate fluid replacement in the laparoscopic group. Importantly, this difference is no longer evident by the third postoperative day. We speculate that this may be secondary to the pneumoperitoneum or the prolonged anesthesia on glomerular filtration rate. Furthermore, this finding could explain the slower recovery of graft function in recipients of laparoscopically procured kidney transplants.
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Affiliation(s)
- Hemender S Vats
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA 52242-1081, USA
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Carlier M. Quel bénéfice peut-on attendre de l'hyperhydratation et de l'optimisation hémodynamique per- et postopératoire des patients ? ACTA ACUST UNITED AC 2005; 24:194-8. [PMID: 15737506 DOI: 10.1016/j.annfar.2004.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M Carlier
- Université Catholique de Louvain Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200 Bruxelles, Belgique.
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Branco Filho AJ, Branco AW, Kondo W, Maciel RF, Carvalho RMD, Garcia MJ. Controle dos vasos renais usando clips vasculares e fio cirúrgico em nefrectomias vídeo-assistidas de doadores vivos. Rev Col Bras Cir 2005. [DOI: 10.1590/s0100-69912005000100009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: A nefrectomia laparoscópica em doadores vivos para transplante renal vem assumindo um papel importante na era das cirurgias minimamente invasivas, acarretando menor morbidade aos doadores, e resultados semelhantes à técnica aberta no que se refere ao enxerto renal. O objetivo do presente artigo é relatar a experiência do nosso serviço utilizando a técnica de controle dos vasos renais usando fio cirúrgico e clips vasculares. MÉTODO: Foram realizadas 45 nefrectomias utilizando a técnica vídeo-assistida, com ligadura dos vasos renais com clips de titânio (LT-300) e fio cirúrgico. As variáveis analisadas foram tempo cirúrgico, perda sangüínea, tempo de isquemia quente, permanência hospitalar, necessidade de conversão e complicações. RESULTADOS: O procedimento foi realizado com sucesso em todos os casos. O tempo cirúrgico médio foi de 118 minutos, com perda sangüínea estimada em 84ml e tempo de isquemia quente de 4,3 minutos. Dois casos de íleo prolongado, uma lesão de veia gonadal, um escape de artéria renal e uma necrose de ureter foram observados. A permanência hospitalar média foi de 3,7 dias. O uso de clips vasculares e fio cirúrgico reduziu a perda de tecido venoso comparado à técnica com staplers e gerou redução de custos. CONCLUSÕES: A nefrectomia vídeo-assistida com a técnica descrita é factível e mostrou ser efetiva na contenção de gastos e na redução de tecido venoso perdido.
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Affiliation(s)
| | | | - William Kondo
- Hospital Universitário Cajuru; Irmandade Santa Casa de Misericórdia de Curitiba (Aliança Saúde - PUC-PR)
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Constant DL, Florman SS, Mendez F, Thomas R, Slakey DP. Use of the LigaSure Vessel Sealing Device in Laparoscopic Living-Donor Nephrectomy. Transplantation 2004; 78:1661-4. [PMID: 15591956 DOI: 10.1097/01.tp.0000144379.29943.ed] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Laparoscopic living-donor nephrectomy has gained acceptance within the transplant community. The technique requires advanced laparoscopic techniques, and great care must be taken to ensure safety of the operation for the donor and transplantability of the donor kidney. Minimizing the risk of bleeding and trauma to the kidney are important features of a successful living-donor nephrectomy. Improved laparoscopic instrumentation has afforded greater safety and efficacy through technical advances. METHODS The LigaSure device was used in 124 consecutive living-donor nephrectomies beginning in 1999. A transplant database was reviewed for operative statistics including intraoperative blood loss and operating time. RESULTS The LigaSure device was used to dissect and seal all venous and arterial branches. Estimated blood loss was 90 +/- 53 mL. A suction device was required in only 40 (32%) of the cases. No patient experienced postoperative bleeding. There were two donor complications: one incisional hernia and one ileus. All kidneys functioned immediately upon reperfusion. CONCLUSIONS The LigaSure device is an extremely effective tool for obtaining hemostasis by sealing both venous and arterial branches of the major renal vessels. This is also effective in sealing lymphatic tissues and thereby facilitating dissection. Avoiding the use of metallic clips simplified final division of the renal artery and vein. As with any laparoscopic instrument, the anatomic geometry of the operative field may limit use based upon port placement.
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Affiliation(s)
- Douglas L Constant
- Transplant Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, TW-35, New Orleans, LA 70112, USA.
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Kim DY, Stegall MD, Prieto M, Chow GK, Bohorquez HE, Covarrubias MA, Heimbach JK, Morgenstern BZ, Gloor JM, Milliner DS, Weckwerth JA, Weis KD, Ishitani MB. Hand-assisted laparoscopic donor nephrectomy for pediatric kidney allograft recipients. Pediatr Transplant 2004; 8:460-3. [PMID: 15367281 DOI: 10.1111/j.1399-3046.2004.00195.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Laparoscopic donor nephrectomy (LDN) is the method of choice for procuring kidneys from living donors at many transplant centers. The aim of this study was to assess the feasibility as well as outcome of LDN in pediatric recipients. Twenty-two pediatric patients, 18-yr old or younger received kidneys procured by a hand-assisted LDN technique. The mean operative time was no different (p = 0.9) and the mean length of stay was more than 1 day shorter in the LDN group (p = 0.0001) compared with the 13 pediatric patients who received kidneys by standard open nephrectomy. Body mass index (BMI), number of donor kidney vessels, or laterality of the kidney did not impact the donor operation or outcome. Actuarial 1-yr patient survival was 100% and allograft survival was 95%, which are equivalent to registry data. There were no donor mortalities and there were five morbidities. None required hospitalization. There were no conversions from LDN to open nephrectomy. One kidney was lost because of overwhelming infection necessitating withdrawal of immunosuppression. In conclusion, hand-assisted LDN is a safe method of procuring kidneys from potential donors with no significant negative outcomes to the pediatric recipients.
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Affiliation(s)
- Dean Y Kim
- Department of Surgery, Division of Transplantation Surgery, William J. von Liebig Transplant Center, Mayo Medical School, Foundation and Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Kawamoto S, Montgomery RA, Lawler LP, Horton KM, Fishman EK. Multi-detector row CT evaluation of living renal donors prior to laparoscopic nephrectomy. Radiographics 2004; 24:453-66. [PMID: 15026593 DOI: 10.1148/rg.242035104] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Since its introduction in 1995, laparoscopic nephrectomy has become the preferred technique at many medical centers for the harvesting of kidneys from living donors for transplantation. Because the field of view at laparoscopic surgery is limited, preoperative radiologic evaluation of the donor's anatomy---the renal veins and arteries, collecting system, and parenchyma--is critical. Spiral computed tomographic (CT) angiography is a fast, safe, minimally invasive, and generally accepted method for preoperative evaluation of the renal vessels. Multi-detector row CT scanners offer shorter image acquisition time, narrower collimation, better spatial resolution, and less tube heating than do single-detector row CT scanners. Multi-row scanners also provide more complete anatomic coverage, increased contrast enhancement of the arteries, and greater longitudinal spatial resolution--all of which are important both for accurate imaging of the renal vasculature and for three-dimensional postprocessing of image data. Dual-phase multi-detector row CT angiography combined with three-dimensional postprocessing enables minimally invasive and highly accurate depiction of the preoperative donor anatomy. To make the most effective use of this method, radiologists must be familiar with its technical aspects, advantages, and potential pitfalls. They also must be able to identify variations in vasculature and in renal and extrarenal anatomy that are important for laparoscopic donor nephrectomy.
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Affiliation(s)
- Satomi Kawamoto
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 601 N Caroline St, Room 3254, Baltimore, MD 21287-0801, USA
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Jacobs SC, Ramey JR, Sklar GN, Bartlett ST. Laparoscopic kidney donation from patients older than 60 years1 1No competing interests declared. J Am Coll Surg 2004; 198:892-7. [PMID: 15194070 DOI: 10.1016/j.jamcollsurg.2004.02.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2003] [Revised: 02/16/2004] [Accepted: 02/18/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND The current study seeks to determine if the efficacy and safety of laparoscopic donor nephrectomy holds true when performed in patients older than 60 years of age. STUDY DESIGN Medical records of 42 renal donors older than 60 years were reviewed compared with younger controls carefully matched for gender, race, nephrectomy side, auxiliary recipient procedures, and date of surgery. RESULTS Preoperative baseline serum creatinine was identical in both groups (0.9 +/- 0.2 mg/dL) although controls had a slightly higher (NS) creatinine clearance (106.9 +/- 19.1 versus 100.0 +/- 35.5 mL/m). Operatively, there was no substantial difference between groups in operative time, warm ischemia time, estimated blood loss, number or size of ports used, and length of incision needed for removal of kidney. Intraoperative and postoperative complication rates were also equivalent between old and young donors. Postnephrectomy serum creatinine was identical. There was no increased length of hospitalization for older donors and they tended to require less morphine sulfate patient-controlled anesthesia. Recipient renal function was slightly better in the younger kidneys early and the difference became statistically significant at 6 to 12 months, but the magnitude of the improvement is not clinically important. CONCLUSIONS Laparoscopic donor nephrectomy may be performed safely in patients older than 60 years of age. There was no increase in complication rates or length of hospital stay. Older donors did not have a greater increase in serum creatinine after donation compared with donors younger than 40 years of age, nor did recipients of these older kidneys have clinically significantly higher serum creatinine than recipients of kidneys from donors less than 40 years old.
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Affiliation(s)
- Stephen C Jacobs
- Department of Surgery, Division of Urology, University of Maryland School of Medicine, Baltimore, MD, USA
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Mitre AI, Dénes FT, Piovesan AC, Simões FA, Castilho LN, Arap S. Laparoscopic nephrectomy in live donor. Int Braz J Urol 2004; 30:22-8. [PMID: 15707509 DOI: 10.1590/s1677-55382004000100005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2002] [Accepted: 01/12/2004] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To present the initial experience of videolaparoscopic nephrectomy in live renal donor. MATERIALS AND METHODS In the period from April 2000 to August 2003, 50 left nephrectomies in live donor were performed by videolaparoscopy for transplantation. Twenty-eight patients were male (56%) and 22 female (44%). Mean age was 37.2 years, and the mean body mass index (BMI) was 27.1 kg/m2. RESULTS Mean surgical time was 179.5 minutes, and warm ischemia time of the graft was 3.79 minutes. The mean estimated bleeding was 141 mL. There was no need of blood transfusion or conversion to open surgery. In 42 cases (84%), the vascular portion of the graft was considered good by the recipient's surgical team and in all cases, the ureter was considered of proper size, though in one of them (2%) its vascularization was considered improper. The transplanted kidneys produced urine still in the surgical room in 46 of the 50 transplantations considered. In only 2 cases opioid was required for analgesia. In average, 3.1 doses of dipyrone were used for each patient during hospital stay, and hospital discharge occurred, in average, after 3.2 days post-operatively. Two patients required re-operations and one of them evolved to death. CONCLUSIONS The laparoscopic nephrectomy in live donor for renal transplantation is an alternative to conventional open surgery. In relation to the graft, no alteration, either anatomic or functional, was detected. Though there is already a large documentation in the international literature regarding this procedure, in our setting a prospective randomized study with the usual surgical study is still necessary in order to prove the advantages and disadvantages of the method.
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Affiliation(s)
- Anuar I Mitre
- General Hospital, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
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Basiri A, Ziaee SAM, Hosseini Moghaddam SMM, Maghsoodi R, Shafi MH, Salim NS. Laparoscopic living donor nephrectomy in a center with limited laparoscopic experience. Transplant Proc 2003; 35:2549-50. [PMID: 14612009 DOI: 10.1016/j.transproceed.2003.08.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- A Basiri
- Urology Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Troppmann C, Ormond DB, Perez RV. Laparoscopic (vs open) live donor nephrectomy: a UNOS database analysis of early graft function and survival. Am J Transplant 2003; 3:1295-301. [PMID: 14510704 DOI: 10.1046/j.1600-6143.2003.00216.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The impact of laparoscopic (lap) live donor nephrectomy on early graft function and survival remains controversial. We compared 2734 kidney transplants (tx) from lap donors and 2576 tx from open donors reported to the U.S. United Network for Organ Sharing from 11/1999 to 12/2000. Early function quality (>40 mL urine and/or serum creatinine [creat] decline >25% during the first 24 h post-tx) and delayed function incidence were similar for both groups. Significantly more lap (vs. open) txs, however, had discharge creats greater than 1.4 mg/dL (49.2% vs. 44.9%, p = 0.002) and 2.0 mg/dL (21.8% vs. 19.5%, p = 0.04). But all later creats, early and late rejection, as well as graft survival at 1 year (94.4%, lap tx vs. 94.1%, open tx) were similar for lap and open recipients. Our data suggests that lap nephrectomy is associated with slower early graft function. Rejection rates and short-term graft survival, however, were similar for lap and open graft recipients. Further prospective studies with longer follow up are necessary to assess the potential impact of the laparoscopic procurement mode on early graft function and long-term outcome.
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Affiliation(s)
- Christoph Troppmann
- Department of Surgery, University of California, Davis, Medical Center, Sacramento, CA, USA.
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Abstract
Abstract
Background
Living kidney donation represents an important source of organs for patients with end-stage renal failure. Over the past decade, laparoscopic donor nephrectomy has replaced the conventional open procedure in many transplant centres. Using evidence-based methods, this study examines the current status of laparoscopic donor nephrectomy.
Method
A Medline literature search (PubMed database, 1999–2002) and manual cross-referencing were performed to identify all articles relating to laparoscopic donor nephrectomy. Safety and efficacy criteria were analysed systematically for each study. Studies included were categorized using an evidence-based level grading system.
Results
Of 687 publications, 20 studies with level I–II evidence and 12 with level III evidence were analysed. Only one level I study could be identified. Level I and level II evidence suggests superiority of the laparoscopic approach in regard to postoperative analgesic consumption, hospital stay and return to work. Other safety and efficacy criteria, including donor and recipient outcomes, were similar between the two techniques.
Conclusion
Laparoscopic donor nephrectomy has gained community acceptance by physicians and patients over the past decade. Despite a lack of strong evidence, such as large prospective randomized studies, laparoscopic donor nephrectomy is likely to become the ‘gold standard’ for donor nephrectomy in the near future.
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Affiliation(s)
- A E Handschin
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
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Duchene DA, Johnson DB, Li S, Roden JS, Sagalowsky AI, Cadeddu JA. Laparoscopic donor nephrectomy at a low volume living donor transplant center: successful outcomes can be expected. J Urol 2003; 170:731-3. [PMID: 12913684 DOI: 10.1097/01.ju.0000081648.65198.2d] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Concern has been raised about possible increased morbidity associated with laparoscopic donor nephrectomy (LDN) during the learning curve of the procedure and at centers with a low volume of living donors. We evaluated the safety and success of LDN at a low volume living donor transplant center with a skilled laparoscopic urologist and experienced renal transplant team. MATERIALS AND METHODS We reviewed the records of all patients who underwent LDN at our institution. A single surgeon skilled in laparoscopy (JAC) performed all LDNs. Patient demographics, operative reports, complications and recipient outcomes were evaluated. RESULTS A total of 17 LDNs were performed between January 2000 and September 2002. There was 1 elective conversion to an open procedure for kidney harvest due to complex hilar anatomy. Only 1 minor complication occurred (wound seroma) and 1 donor had creatinine persistently elevated to 1.9 mg/dl (normal 0.6 to 1.2). Mean operating room time, estimated blood loss and hospital stay were 250 minutes, 188 ml and 2.5 days, respectively. Recipient creatinine had a nadir mean of 1.2 mg/dl and a 90-day postoperative mean of 1.6 mg/dl. One recipient eventually lost the graft due to recurrent disease. CONCLUSIONS LDN can be performed safely and efficiently at low volume transplant centers with a skilled laparoscopist and experienced renal transplant team. Laparoscopic skills developed during similar procedures, such as laparoscopic radical and partial nephrectomy, minimize the learning curve and morbidity of LDN to produce results consistent with those in the published literature.
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Affiliation(s)
- David A Duchene
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9110, USA
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70
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Hsu THS, Su LM, Ratner LE, Jarrett TW, Kavoussi LR. Demographics of 353 laparoscopic renal donor and recipient pairs at the Johns Hopkins Medical Institutions. J Endourol 2003; 17:393-6. [PMID: 12965065 DOI: 10.1089/089277903767923173] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE The demographics of laparoscopic donor nephrectomy (LDN) have not been characterized in detail. The aim of this study was to review our LDN experience with respect to donor and recipient demographic characteristics and trends. PATIENTS AND METHODS Over a 6-year period, 353 patients underwent LDN. A retrospective chart review was performed to identify the donor and recipient demographic characteristics and trends associated with the procedure. RESULTS Among the donors, the mean age was 41 years, with a predominance of females (59.2%), whites (76.2%), and blood relations (72%). Siblings were the most common related-donor-to-recipient relationship, and spouses were the most common unrelated relationships. Among the recipients, the mean age was 43 years, with a predominance of males (58.4%), whites (73.7%), and dialysis-dependent patients (55%). Diabetes mellitus and hypertension were the most common causes of end-stage renal failure. With the introduction of laparoscopy, there was a nearly twofold increase in the total number of live renal donations, and there was a significant expansion in the unrelated-donor pool. CONCLUSIONS Laparoscopic harvest of donated kidneys is associated with new trends that may help alleviate the current organ shortage.
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Affiliation(s)
- Thomas H S Hsu
- Brady Urological Institute and the Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
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71
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Kawamoto S, Montgomery RA, Lawler LP, Horton KM, Fishman EK. Multidetector CT angiography for preoperative evaluation of living laparoscopic kidney donors. AJR Am J Roentgenol 2003; 180:1633-8. [PMID: 12760934 DOI: 10.2214/ajr.180.6.1801633] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the accuracy of multidetector CT (MDCT) angiography as the primary imaging technique in the evaluation of living kidney donors. SUBJECTS AND METHODS Seventy-four consecutive living kidney donors (30 men, 44 women; mean age, 41.7 years) who underwent MDCT were evaluated. CT examination was performed with 120 mL of IV contrast material at an injection rate of 3 mL/sec and a pitch of 6. In every case, arterial and venous phase volumetric data sets were acquired at 25 and 55 sec, respectively. Scans were reconstructed at 1-mm intervals for three-dimensional (3D) imaging using a volume-rendering technique. Axial CT images and 3D CT angiography were evaluated prospectively by one reviewer and retrospectively by two reviewers who had no knowledge of surgical results. Surgical correlation for the location of primary and accessory renal arteries, early branching of the renal arteries, and renal vein anomalies was made. RESULTS Seventy-two subjects underwent left nephrectomy, and two subjects underwent right nephrectomy because supernumerary left renal arteries were detected on preoperative CT angiography. Eighteen supernumerary renal arteries (two arteries to 16 kidneys and three arteries to one kidney) to 74 kidneys underwent nephrectomy. CT and surgical findings agreed in 93% of subjects (the average of three reviewers; range, 89-97%). Two small accessory renal arteries were missed by all three reviewers. Those arteries were diminutive and were thought to be insignificant by the surgeons. Early branching of the renal arteries was shown in 14 arteries, and CT and surgical findings agreed in 96% (the average of three reviewers; range, 93-97%). Renal vein anomalies were present in eight subjects, and CT and surgical findings agreed in 99% of the cases (range, 96-100%). CONCLUSION MDCT angiography is highly accurate for detecting vascular anomalies and providing anatomic information for laparoscopic living donor nephrectomy.
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Affiliation(s)
- Satomi Kawamoto
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 601 N. Caroline St., Rm. 3254, Baltimore, MD 21287-0801, USA
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72
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Ascher NL. What's new in general surgery: transplantation. J Am Coll Surg 2003; 196:778-83. [PMID: 12742212 DOI: 10.1016/s1072-7515(03)00152-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nancy L Ascher
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
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73
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Pradel FG, Limcangco MR, Mullins CD, Bartlett ST. Patients' attitudes about living donor transplantation and living donor nephrectomy. Am J Kidney Dis 2003; 41:849-58. [PMID: 12666072 DOI: 10.1016/s0272-6386(03)00033-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The growing shortage of organs available for transplantation has resulted in an increased use of living donors for kidney transplantation. The laparoscopic nephrectomy is a new procedure used to remove kidneys from donors. The study objective was to explore the attitudes of recipients and donors toward living donor kidney transplantation and the impact of the laparoscopic donor nephrectomy on donors' and recipients' acceptance of living donor kidney transplantation. METHODS Tailored self-administered questionnaires were mailed to kidney donors, potential donors, recipients and potential recipients who visited the University of Maryland School of Medicine Division of Transplantation between January 1998 and May 2001. RESULTS The laparoscopic donor nephrectomy helped recipients and potential recipients with their decision to accept a kidney from a living donor (recipients: 53% strongly agreed, 36% agreed; potential recipients: 42% strongly agreed, 46% agreed). To a lesser extent, the laparoscopic donor nephrectomy assisted donors and potential donors with their decision to donate (donors: 19% strongly agreed, 20% agreed; potential donors: 20% strongly agreed, 20% agreed). Potential recipients and recipients identified 2 barriers to accepting living donor kidney transplantation: they were unwilling to accept a kidney if it meant this would financially burden their donors, and they worried that their donors might succumb to a future kidney problem. CONCLUSION Overall, the study found a positive attitude toward living donor kidney transplantation and laparoscopic donor nephrectomy. This new surgical procedure seemed to positively influence recipients and potential recipients to accept a kidney. In contrast, it had less impact on donors' and potential donors' willingness to give their kidney.
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Affiliation(s)
- Françoise G Pradel
- Center on Drugs and Public Policy, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA.
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74
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Hsu THS, Su LIM, Ratner LE, Trock BJ, Kavoussi LR. Impact of renal artery multiplicity on outcomes of renal donors and recipients in laparoscopic donor nephrectomy. Urology 2003; 61:323-7. [PMID: 12597939 DOI: 10.1016/s0090-4295(02)02124-6] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To review our laparoscopic donor nephrectomy experience to determine the impact of multiple renal arteries on renal donor and recipient outcomes. Multiple renal arteries can present a challenge during live laparoscopic donor nephrectomy. METHODS During a 6-year period, 353 patients underwent laparoscopic donor nephrectomy and an equal number of patients underwent living-related renal transplantation. A retrospective chart review was performed to evaluate the renal donors and recipients associated with the laparoscopic procedure. RESULTS Laparoscopic donor nephrectomies were associated with one renal artery in 277 cases (78.5%), two renal arteries in 71 cases (20.1%), and three renal arteries in 5 cases (1.4%). A left-sided procedure was most commonly performed in all three groups. The operative and renal allograft warm ischemia times increased with the number of renal arteries, but the differences were not statistically significant. The renal artery anatomy did not have a significant association with intraoperative blood loss, postoperative hospital stay, or complication rate in the donor group. Regarding the transplant recipients, renal artery multiplicity had no significant association with the complication rate, 1-year graft survival, or creatinine clearance levels at 1, 2, or 3 days or at 3, 6, or 12 months postoperatively. CONCLUSIONS With meticulous procurement and reconstructive transplantation techniques, the presence of multiple renal arteries in laparoscopic donor nephrectomy does not have a significant impact on the outcomes of the renal donors or recipients.
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Affiliation(s)
- Thomas H S Hsu
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21224, USA
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75
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Giessing M, Deger S, Ebeling V, Roigas J, Türk I, Loening SA. [Laparoscopic transperitoneal donor nephrectomy. Technique and results]. Urologe A 2003; 42:218-24. [PMID: 12607090 DOI: 10.1007/s00120-002-0281-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Living donor kidney transplantation is one possibility to meet the growing demand for organs in patients with chronic renal failure. In 1995 the first laparoscopic living donor nephrectomy (LDN) was performed in the United States. More than 100 transplant centers worldwide perform LDN. The expectations of a larger number of willing organ donors were fulfilled due to the less traumatic operation. Meanwhile, several techniques exist to retrieve a kidney laparoscopically, including the trans- or retroperitoneal, strictly laparoscopic, or hand-assisted approach. From February 1999 to September 2002, 63 strictly laparoscopic, transperitoneal LDNs were performed at the Department of Urology of the Charité University Hospital, Berlin. Warm ischemic time was 148 s (105-360) and operating time was 203 min (110-305). Intraoperative complications were due to insufficient closure of the vessels in four patients. Mean postoperative hospital stay was 5.7 days (3-9). One year after LDN, renal function as well as creatinine levels of the recipient showed no difference compared to the organs harvested via the approach at our department prior to implementation of LDN. Strictly laparoscopic transperitoneal donor nephrectomy is a safe method for kidney retrieval and ensures excellent graft function.
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Affiliation(s)
- M Giessing
- Universitätsklinik für Urologie, Charité, Berlin.
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76
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Burgos FJ, Alcaraz A, Castillón I, González Martín M, Lledó E, Matesanz R, Marcén R, Montañés P, Pascual J. [Present and future of kidney transplantation]. Actas Urol Esp 2002; 26:731-58. [PMID: 12645371 DOI: 10.1016/s0210-4806(02)72853-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Renal transplant is the treatment of choice for the patient with end stage renal disease. Spain is the country with the highest donation rate (33 ppm). However, at present this figure is stabilized. The development of non-beating heart programmes, living-donor nephrectomy (specially laparoscopic nephrectomy) programmes, and may be xenotransplantation in a non-immediate future could increase the transplantation activity. The knowledge of preservation mechanisms, specially with the use of perfusion machines allows to rescue for transplantation kidneys with a long warm-ischemia time. Furthermore, these machines are useful for analyzing viability markers. The new immunosuppressive drugs: Tacrolimus, Mycophenolate-Mophetil, Rapamycin and monoclonal antibodies against alpha chain of the interleukine-2 receptor (Basoliximab and Dazcizumab) have reduced the incidence of acute rejection in the immediate renal transplant period. However, its effect in the long-term follow-up period is still a matter of controversy. The incidence of tumour in the renal transplant recipient is increased, specially those of lymphoma, skin cancer and Kaposi sarcoma. Periodical exams for detecting the development of tumours are mandatory in this population. Finally, xenotransplantation is an attractive alternative, although immunological, infective and ethical barriers should previously be resolved.
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Affiliation(s)
- F J Burgos
- Servicio de Urología, Hospital Ramón y Cajal, Universidad Alcalá, Madrid
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77
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Hsu THS, Su LM, Ratner LE, Kavoussi LR. Renovascular complications of laparoscopic donor nephrectomy. Urology 2002; 60:811-5; discussion 815. [PMID: 12429304 DOI: 10.1016/s0090-4295(02)01916-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To review the operative renovascular injuries related to our laparoscopic donor nephrectomy experience, since management of intraoperative renovascular complications during laparoscopic nephrectomy can present a serious challenge. METHODS During a 6-year period, 353 patients underwent laparoscopic donor nephrectomy. A retrospective chart review was performed to identify and evaluate the renovascular complications associated with the procedure. RESULTS Eight cases (2.3%) of renovascular complications were identified. Vascular injury involved the renal artery in 6 cases and the renal vein in 2 cases. The etiologies included endovascular GIA stapling failure (n = 2), surgical clip dislodgment (n = 2), and vessel laceration during dissection or stapling (n = 4). Open conversion was necessary in 6 cases (75%). No patient mortality or allograft loss occurred. CONCLUSIONS Laparoscopic donor nephrectomy is associated with a low incidence of renovascular complications. Laparoscopic or open surgical management may be required when problems arise to optimize donor safety and allograft survival.
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Affiliation(s)
- Thomas H S Hsu
- Brady Urological Institute and Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland 21224, USA
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78
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Siqueira TM, Gardner TA, Kuo RL, Paterson RF, Stevens LH, Lingeman JE, Shalhav AL. One versus two proficient laparoscopic surgeons for laparoscopic live donor nephrectomy. Urology 2002; 60:406-9; discussion 409-10. [PMID: 12350472 DOI: 10.1016/s0090-4295(02)01848-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the laparoscopic donor nephrectomy (LDN) results obtained by two different surgical teams, one consisting of a proficient laparoscopic surgeon assisted by an inexperienced laparoscopic surgeon and another consisting of two proficient laparoscopic surgeons. With more centers embarking on LDN programs, it is important to identify the factors that can improve overall outcomes during the initial learning curve. METHODS A retrospective review was performed of the initial 70 sequential LDNs performed between October 1998 and March 2001 at our institutions. The procedures were stratified into two groups. Group 1 consisted of LDN cases performed by one proficient laparoscopic surgeon and an inexperienced laparoscopic surgeon (resident, fellow, or faculty) as the first assistant; group 2 consisted of cases performed by two proficient laparoscopic surgeons. RESULTS Twenty-six LDNs were performed by group 1 and 44 by group 2. The total operative time and estimated blood loss showed a statistically significant decrease in group 2 compared with group 1, 143 +/- 32 minutes versus 218 +/- 38 minutes (P <0.001) and 92 +/- 115 mL versus 158 +/- 148 mL (P = 0.044), respectively. Two major complications occurred in group 1 (7.7%) and two major complications occurred in group 2 (4.5%). The 3-month postoperative recipient creatinine levels were similar for both groups, 1.6 +/- 1.3 versus 1.4 +/- 0.4 (P = 0.408). CONCLUSIONS A surgical team composed of two proficient laparoscopic surgeons during the early learning curve of LDN may allow safe and efficient development of a laparoscopic live donor renal transplantation program.
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Affiliation(s)
- Tibério M Siqueira
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
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79
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Velidedeoglu E, Williams N, Brayman KL, Desai NM, Campos L, Palanjian M, Wocjik M, Bloom R, Grossman RA, Mange K, Barker CF, Naji A, Markmann JF. Comparison of open, laparoscopic, and hand-assisted approaches to live-donor nephrectomy. Transplantation 2002; 74:169-72. [PMID: 12151727 DOI: 10.1097/00007890-200207270-00005] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Minimally invasive donor nephrectomy has become a favored procedure for the procurement of kidneys from live donors. The optimal minimally invasive surgical approach has not been determined. In the current work, we compared the outcome of kidneys procured using the traditional open approach with two minimally invasive techniques: the standard laparoscopic procedure and a hand-assist procedure. METHODS The function of live-donor kidneys procured by open versus minimally invasive procedures was compared (procedures compared were the traditional open donor nephrectomy [ODN], the standard laparoscopic [LAP] approach, and the hand-assisted [HA] laparoscopic technique). The length of donor operation, donor length of stay in the hospital, surgical complications, and cost of hospitalization for three groups of patients were assessed in a series of 150 live-donor nephrectomies. RESULTS We found that both minimally invasive procedures yielded kidney allografts with excellent early function and a minimum of complications in the donor. The open procedure was associated with a reduced operative time but increased donor length of stay in the hospital. Resource utilization analysis revealed that both minimally invasive techniques were associated with a slight increase in costs compared with the open procedure, despite a shorter hospital stay. CONCLUSIONS Minimally invasive donor nephrectomy is safe and effective for procuring normally functioning organs for live-donor transplantation. Of the two minimally invasive approaches examined, the hand-assisted technique was found to afford a number of important advantages, including facilitating teaching of residents and students, that it is more readily mastered by transplant surgeons, and that it may provide an additional margin of safety for the donor.
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Affiliation(s)
- Ergun Velidedeoglu
- Departments of Surgery and Nephrology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, 19104, USA
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80
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Hazebroek EJ, Gommers D, Schreve MA, van Gelder T, Roodnat JI, Weimar W, Bonjer HJ, IJzermans JNM. Impact of intraoperative donor management on short-term renal function after laparoscopic donor nephrectomy. Ann Surg 2002; 236:127-32. [PMID: 12131095 PMCID: PMC1422558 DOI: 10.1097/00000658-200207000-00019] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether intraoperative diuresis, postoperative recovery, and early graft function differ between laparoscopic open nephrectomy (LDN) and open donor nephrectomy (ODN). SUMMARY BACKGROUND DATA Laparoscopic donor nephrectomy can reduce donor complications in terms of decreased pain and shorter convalescence. Although its technical feasibility has been established, concerns have been raised about the impaired renal function resulting from pneumoperitoneum and short- and long-term function of kidneys removed by LDN. METHODS Between December 1997 and December 2000, 89 LDNs were performed at the authors' institution. These were compared with 83 conventional ODNs performed between January 1994 and December 1997. Graft function, intraoperative variables, and clinical outcome were compared. RESULTS Laparoscopic donor nephrectomy was attempted in 89 patients and completed in 91% (81/89). Length of hospital stay was significantly shorter in the laparoscopic group. During kidney dissection, the amount of fluids administered and intraoperative diuresis were significantly lower for LDN. In recipients, mean serum creatinine was higher after LDN compared with ODN 1 day after surgery. From postoperative days 2 until 28, there were no differences in serum creatinine. Graft survival rates were similar for LDN and ODN. CONCLUSIONS Donors can benefit from an improvement in postoperative recovery after LDN. Assessment of an adequate perioperative hydration protocol is mandatory to ensure optimal kidney quality during laparoscopic procurement. The initial graft survival and function rates justify continued development and adoption of LDN.
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Affiliation(s)
- Eric J Hazebroek
- Department of Surgery, University Hospital Rotterdam-Dijkzigt, The Netherlands
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81
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Improving donor nephrectomy: laparoscopic and open advances. Curr Opin Organ Transplant 2002. [DOI: 10.1097/00075200-200206000-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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82
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Horgan S, Vanuno D, Sileri P, Cicalese L, Benedetti E. Robotic-assisted laparoscopic donor nephrectomy for kidney transplantation. Transplantation 2002; 73:1474-9. [PMID: 12023627 DOI: 10.1097/00007890-200205150-00018] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Minimally invasive laparoscopic nephrectomy is a well-established alternative to open surgery in living donors for kidney transplantation. Donor mortality and morbidity rates as well as recipient outcome are comparable to the open approach. Furthermore, the procedure is associated with reduced donor discomfort, faster recovery, and improved cosmetic results. Recently, an advanced robotic system for laparoscopic surgery was approved for use in the United States. This system allows a greater freedom of movement and recreates the hand-eye coordination and three-dimensional vision that is lost in standard laparoscopic procedures. METHODS We report the first 12 successful cases of robotic-assisted laparoscopic living donor nephrectomy performed using the da Vinci Surgical System (Intuitive Surgical, Mountain View, CA). RESULTS Our initial experience has shown that the system allows the performance of donor nephrectomy in a safe and accurate fashion. CONCLUSIONS As technology continues to evolve, robotic-assisted surgery has the potential to become a widely used attractive alternative to standard laparoscopic donor nephrectomy.
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Affiliation(s)
- Santiago Horgan
- Minimally Invasive Surgery Center and Division of Transplantation, University of Illinois at Chicago Medical Center, Chicago, Illinois 60612, USA
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83
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Boulware LE, Ratner LE, Sosa JA, Tu AH, Nagula S, Simpkins CE, Durant RW, Powe NR. The general public's concerns about clinical risk in live kidney donation. Am J Transplant 2002; 2:186-93. [PMID: 12099522 DOI: 10.1034/j.1600-6143.2002.020211.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Difficulty in attracting live kidney donors may be related to fears regarding both the surgical procedure for kidney harvesting and future failure of the remaining kidney. We conducted a cross-sectional study of households in Maryland to identify public disincentives to living related kidney donation. In multivariate analyses, we assessed the independent effects of several factors on willingness to donate a kidney to a sibling. We also assessed thresholds for factors above which persons would not donate a kidney. Of 385 participants, 66% were extremely willing to donate to a sibling. After adjustment, those who considered the length of a hospital stay, out-of-pocket expenses, size and appearance of a scar, the time it takes to get to the transplant center, and the donor risk of developing kidney failure very important had 50-60% less odds of being extremely willing to donate. Median acceptable levels for risk of complications, hospital stay, compensated and uncompensated time from work, time requiring pain medications, and out-of-pocket expenses were greater than levels from clinical evidence regarding both laparoscopic and open nephrectomy. Unrealistic concerns among the general public regarding live donation may serve as potential disincentives to donation. Efforts to educate the public regarding live donation might help assuage fears and attract those who may not otherwise donate.
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Affiliation(s)
- L Ebony Boulware
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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84
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Abstract
Laparoscopic donor nephrectomy was developed primarily to increase the number of kidneys available for donation. Further evidence of the safety and efficacy of laparoscopic donor nephrectomy has been reported in the literature, as have studies on the cost-effectiveness of this procedure and its role in removing disincentives for renal donation. Specific technical modifications have been developed and refined that improve outcomes when performing laparoscopic harvesting of right kidneys. Other technical modifications have been developed for use in obese patients. With the adoption of these modified techniques, equivalent results to open donor nephrectomy have been reported. Recently, a wide range of alternative approaches (hand-assisted, retroperitoneal, and gasless laparoscopy) have been utilized for laparoscopic donor nephrectomy.
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Affiliation(s)
- W W Roberts
- The Brady Urological Institute of the Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
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85
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Velidedeoglu E, Williams N, Brayman KL, Desai NM, Campos L, Palanjian M, Wocjik M, Bloom R, Grossman R, Mange K, Buyske J, Barker CF, Naji A, Markmann JF. Surgical options for live-donor nephrectomy. Transplant Proc 2001; 33:3789-90. [PMID: 11750613 DOI: 10.1016/s0041-1345(01)02603-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- E Velidedeoglu
- Department of Surgery, Hospital of the University of Pennsylvania, Pavilion, Philadelphia, Pennsylvania 19104, USA
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Rydberg J, Kopecky KK, Tann M, Persohn SA, Leapman SB, Filo RS, Shalhav AL. Evaluation of prospective living renal donors for laparoscopic nephrectomy with multisection CT: the marriage of minimally invasive imaging with minimally invasive surgery. Radiographics 2001; 21 Spec No:S223-36. [PMID: 11598259 DOI: 10.1148/radiographics.21.suppl_1.g01oc10s223] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Laparoscopic technique for excision of a kidney from a living donor has advantages over conventional open surgery, but operative visibility and surgical exposure are limited. Preoperative multisection computed tomography (CT) can provide necessary anatomic information in a minimally invasive procedure. A three-phase examination is suggested: (a) imaging from the top of the kidneys to the pubic symphysis with a section width of 2.5 mm and no contrast medium, (b) scanning of the kidneys and upper pelvis during the arterial phase of enhancement with a section width of 1.0 mm, and (c) scanning of the kidneys and upper retroperitoneum during the nephrographic phase of enhancement with a section width of 1.0 mm. Emphasis in this article is placed on analysis of the venous anatomy because most radiologists are unfamiliar with the anatomic variations. Conventional radiography of the abdomen and pelvis is performed after CT to evaluate the collecting system and ureters and to provide a lower total radiation dose than if CT were used. Of several postprocessing techniques that may be used, the authors prefer maximum intensity projection for arterial evaluation and multiplanar reformatting for venous evaluation.
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Affiliation(s)
- J Rydberg
- Department of Radiology, Indiana University Hospital, 550 N University Blvd, Rm 0279, Indianapolis, IN 46202-5253, USA.
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87
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Gruessner RW, Kandaswamy R, Denny R. Laparoscopic simultaneous nephrectomy and distal pancreatectomy from a live donor. J Am Coll Surg 2001; 193:333-7. [PMID: 11548807 DOI: 10.1016/s1072-7515(01)01010-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- R W Gruessner
- Department of Surgery, University of Minnesota, Minneapolis 55455, USA
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König P. [Living kidney donation--selection criteria, preparation and follow-up]. ACTA MEDICA AUSTRIACA 2001; 28:70-3. [PMID: 11475104 DOI: 10.1046/j.1563-2571.2001.01016.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Since a dialysis patient in Austria still waits on average more than two years for a renal transplant, the question of a transplant from a living donor is very interesting. We differentiate between related and non-related living donors, who are chosen on the basis of medical criteria and emotional ties. Austria's first three kidney transplants from related donors were performed in 1967. Since then a total of 317 kidneys from genetically related donors have been transplanted until December 31, 2000. Transplants from non-related living donors were performed once in 1982, once in 1990 and since 1995 in a steadily increasing number each year, until they reached 47 by December 31, 2000. The United Network for Organ Sharing calculated the ten-year survival rate for functional grafts for a four-year period (1995-1998) in more than 30,000 renal transplant recipients from HLA-identical twins, non-related living donors, parent and cadaver donors. As anticipated, this study demonstrates that HLA-identical twins (n = 1,581) have the most functional grafts (81%), followed by non-related donor-recipients (n = 1,704) at 67% despite their often poor HLA match, parent-child transplants (n = 2,428) at 62% and cadaver renal grafts (n = 26,178) at 50%. Therefore, medical aspects as well as influences from the psychosocial environment would appear to be decisive for transplantation success. Thus, when choosing from several possible living donors it is absolutely justifiable to choose a donor with a poorer HLA match but good emotional ties. Such a choice requires strict selection criteria, and surgical preparation and follow-up demand the greatest care. While the criteria given in this paper are meant to be guidelines to help in deciding for a liver donor, they certainly do not rule out a different approach following critical reflection and participation by the affected parties, namely donor and recipient, as well as their advisors, nephrologist, transplant surgeon and psychotherapist. At the same time we need to make every effort to further intensify the use of cadaver kidneys. Only in this way can we ensure optimal implementation of all the resources available to us for supplying renal grafts to dialysis patients.
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Affiliation(s)
- P König
- Klinische Abteilung für Nephrologie, Universitätsklinik für Innere Medizin, Leopold-Franzens-Universität, Anichstrasse 35, A-6020 Innsbruck.
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Literature watch. J Endourol 2001; 15:325-30. [PMID: 11339402 DOI: 10.1089/089277901750161971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Michael Cecka J, Shoskes DA, Gjertson DW. Clinical impact of delayed graft function for kidney transplantation. Transplant Rev (Orlando) 2001. [DOI: 10.1016/s0955-470x(05)80001-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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