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Zemla P, Hartmann I, Hruska F, Kral M, Janeckova J, Utikal P, Vidlar A, Krejci K, Bachleda P. Robotic assisted living donor nephrectomy - the first in the Czech Republic. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2024; 168:177-180. [PMID: 37614196 DOI: 10.5507/bp.2023.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/19/2023] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION A kidney transplant is the best method for treating terminal kidney failure. Long-term results of kidney transplants from living donors are significantly better than transplants from dead donors. Living kidney donors are healthy people who undergo a major operation in order to improve the health of another person. Therefore, major emphasis is on safety, low level of invasiveness and a desirable cosmetic effect of the donor nephrectomy. Since 2012, the Department of Urology at the University Hospital in Olomouc has performed 12 kidney harvestings from living donors. The kidney harvesting was conducted using various techniques. CASE REPORT The first robotic assisted kidney harvesting in the Czech Republic was performed in June 2022. The donor was a 57-year-old man who donated his kidney to his 32-year-old daughter. The left kidney was evaluated as suitable for kidney harvesting. The operation took 174 min. The kidney's warm ischemia was 145 s. Based on the Clavien Dindo classification, no 2nd degree or high post-operative complications were recorded. The donor's pre-operative glomerular filtration was 1.63 mL/s. Six months post-operation, it went down to 1.19 mL/s. This represents a 27% decrease. The kidney recipient did not require early dialysis. Six months post-operation, the recipient's glomerular filtration was 2.03 mL/s. CONCLUSION In the hands of experienced professionals and transplantation centres, robotic assisted donor nephrectomy is a feasible and safe option for this operation. It not only provides all the advantages of a laparoscopic operation but it also adds other technical improvements and minimizes intraoperative stress on the surgeon. Currently, the global trend is moving towards increasing the ratio of robotic assisted donor nephrectomies.
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Affiliation(s)
- Pavel Zemla
- Department of Urology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Igor Hartmann
- Department of Urology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Frantisek Hruska
- Department of Urology, University Hospital Olomouc, Olomouc, Czech Republic
| | | | - Jana Janeckova
- Department of Surgery II - Vascular and Transplantation Surgery, University Hospital Olomouc, Olomouc, Czech Republic
| | - Petr Utikal
- Department of Surgery II - Vascular and Transplantation Surgery, University Hospital Olomouc, Olomouc, Czech Republic
| | - Ales Vidlar
- Department of Urology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Karel Krejci
- Department of Internal Medicine III - Nephrology, Rheumatology and Endocrinology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Petr Bachleda
- Department of Surgery II - Vascular and Transplantation Surgery, University Hospital Olomouc, Olomouc, Czech Republic
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Huang H, Qiu Y, Liu G, Liu X, Lin X, Wu X, Xie W, Yang X, Kong W, Chen J. Robot-assisted laparoscopic retroperitoneal donor nephrectomy: a safe and efficient improvement. World J Urol 2024; 42:243. [PMID: 38639784 DOI: 10.1007/s00345-024-04939-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
PURPOSE Reducing operative injuries is important in living donor nephrectomy. The robot-assisted transperitoneal approach has some advantages than traditional laparoscopic techniques. However, longer operation time and risks of abdominal complications indicate the need for improved techniques. The aim of this study is to present the robot-assisted laparoscopic retroperitoneal donor nephrectomy and evaluate its safety and feasibility. METHODS This was a retrospective study. From June 2016 to December 2020, 218 living donors underwent robot-assisted laparoscopic retroperitoneal donor nephrectomy. Perioperative data such as operation time, warm ischemia time, length of stay and complications were collected and analyzed. To evaluate the feasibility of this surgical technique, the cumulative summation method was used to construct a learning curve. RESULTS There were 60 male and 158 female donors aged 36-72 years, with an average age of 53.1 ± 6.8 years. Three patients (1.4%) were converted to open surgery. The mean operation time was 115.4 ± 41.9 min, the warm ischemia time was 206.6 ± 146.7 s, and the length of stay was 4.1 ± 1.4 days. Complications were reported in 22 patients (10.1%), three of whom (1.4%) had Clavien‒Dindo IIIa complications. No ileus occurred. No donors were readmitted. Four patients had delayed graft function. The cumulative summation curve showed that the number needed to reach proficiency was 33. The operation time and warm ischemia time after technical proficiency were 100.4 ± 21.6 min and 142.5 ± 50.7 s, respectively. CONCLUSION Robot-assisted laparoscopic retroperitoneal donor nephrectomy is a safe and efficient technique that offers advantages of shorter operation time and no abdominal organ interference.
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Affiliation(s)
- Hongfeng Huang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, Zhejiang, China
- National Key Clinical Department of Kidney Diseases, Zhejiang University, Hangzhou, Zhejiang, China
- Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yingyin Qiu
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, Zhejiang, China
- National Key Clinical Department of Kidney Diseases, Zhejiang University, Hangzhou, Zhejiang, China
- Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang University, Hangzhou, Zhejiang, China
| | - Guangjun Liu
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, Zhejiang, China
- National Key Clinical Department of Kidney Diseases, Zhejiang University, Hangzhou, Zhejiang, China
- Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xinyu Liu
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, Zhejiang, China
- National Key Clinical Department of Kidney Diseases, Zhejiang University, Hangzhou, Zhejiang, China
- Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaoli Lin
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, Zhejiang, China
- National Key Clinical Department of Kidney Diseases, Zhejiang University, Hangzhou, Zhejiang, China
- Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaoying Wu
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, Zhejiang, China
- National Key Clinical Department of Kidney Diseases, Zhejiang University, Hangzhou, Zhejiang, China
- Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wenqing Xie
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, Zhejiang, China
- National Key Clinical Department of Kidney Diseases, Zhejiang University, Hangzhou, Zhejiang, China
- Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiuyan Yang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, Zhejiang, China
- National Key Clinical Department of Kidney Diseases, Zhejiang University, Hangzhou, Zhejiang, China
- Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang University, Hangzhou, Zhejiang, China
| | - Weiwei Kong
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, Zhejiang, China
- National Key Clinical Department of Kidney Diseases, Zhejiang University, Hangzhou, Zhejiang, China
- Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China.
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, Zhejiang, China.
- National Key Clinical Department of Kidney Diseases, Zhejiang University, Hangzhou, Zhejiang, China.
- Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China.
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang University, Hangzhou, Zhejiang, China.
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Papa S, Popovic A, Loerzel S, Iskhagi S, Gallay B, Leggat J, Saidi R, Hod Dvorai R, Shahbazov R. Laparoscopic to robotic living donor nephrectomy: Is it time to change surgical technique? Int J Med Robot 2023; 19:e2550. [PMID: 37452584 DOI: 10.1002/rcs.2550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/09/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND We aimed to explore differences in outcomes of robotic and laparoscopic donor nephrectomies (LDN). METHODS This study compared robotic and laparoscopic surgical techniques for live donor nephrectomies in 153 patients at a single centre. RESULTS Left nephrectomies were more common in both groups, but with no significant difference between the groups (76.6% vs. 77.6%, p = 0.88). The robotic donor nephrectomies (RDN) group experienced significantly less blood loss (60 vs. 134 mL, p < 0.01), but warm ischaemia time was similar between groups (3.2 vs. 3.7 min, p = 0.54).The RDN group had decreased subjective pain scores (3.54 vs. 4.21, p = 0.04) and shorter length of hospitalisation (2.22 vs. 3.04 days, p < 0.01).There were also fewer complications in the RDN than the LDN group (4 vs. 8, p = 0.186). CONCLUSION This study demonstrated that RDN is a safe and alternative to LDN. Decreased blood loss and hospital stays and fewer complications may reflect decreased tissue manipulation with robotic assistance.
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Affiliation(s)
- Sarah Papa
- Department of Surgery, Division of Transplantation, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Aleksandar Popovic
- Department of Surgery, Division of Urology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Sharon Loerzel
- Department of Surgery, Division of Transplantation, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Samir Iskhagi
- Department of Surgery, Division of Transplantation, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Brian Gallay
- Department of Medicine, Division of Nephrology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - John Leggat
- Department of Medicine, Division of Nephrology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Reza Saidi
- Department of Surgery, Division of Transplantation, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Reut Hod Dvorai
- Department of Pathology and Laboratory Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Rauf Shahbazov
- Department of Surgery, Division of Transplantation, SUNY Upstate Medical University, Syracuse, New York, USA
- Department of Surgery, Albany Medical Center, Albany, New York, USA
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Centonze L, Di Bella C, Giacomoni A, Silvestre C, De Carlis R, Frassoni S, Franchin B, Angrisani M, Tuci F, Di Bello M, Bagnardi V, Lauterio A, Furian L, De Carlis L. Robotic Versus Laparoscopic Donor Nephrectomy: A Retrospective Bicentric Comparison of Learning Curves and Surgical Outcomes From 2 High-volume European Centers. Transplantation 2023; 107:2009-2017. [PMID: 37195281 DOI: 10.1097/tp.0000000000004618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Although laparoscopic donor nephrectomy (LDN) represents the gold-standard technique for kidney living donation, robotic donor nephrectomy (RDN) settled as another appealing minimally invasive technique over the past decades. A comparison between LDN and RDN outcomes was performed. METHODS RDN and LDN outcomes were compared, focusing on operative time and perioperative risk factors affecting surgery duration. Learning curves for both techniques were compared through spline regression and cumulative sum models. RESULTS The study analyzed 512 procedures (154 RDN and 358 LDN procedures) performed between 2010 and 2021 in 2 different high-volume transplant centers. The RDN group presented a higher prevalence of arterial variations (36.2 versus 22.4%; P = 0.001) compared with the LDN cohort. No open conversions occurred; operative time (210 versus 195 min; P = 0.011) and warm ischemia time (WIT; 230 versus 180 s; P < 0.001) were longer in RDN. Postoperative complication rate was similar (8.4% versus 11.5%; P = 0.49); the RDN group showed shorter hospital stay (4 versus 5 d; P < 0.001). Spline regression models depicted a faster learning curve in the RDN group ( P = 0.0002). Accordingly, cumulative sum analysis highlighted a turning point after about 50 procedures among the RDN cohort and after about 100 procedures among the LDN group.Higher body mass index resulted as an independent risk factor for longer operative time for both techniques; multiple arteries significantly prolonged operative time in LDN, whereas RDN was longer in right kidney procurements; both procedures were equally shortened by growing surgical experience. CONCLUSIONS RDN grants a faster learning curve and improves multiple vessel handling. Incidence of postoperative complications was low for both techniques.
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Affiliation(s)
- Leonardo Centonze
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Caterina Di Bella
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padua, Padua, Italy
| | - Alessandro Giacomoni
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Cristina Silvestre
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padua, Padua, Italy
| | - Riccardo De Carlis
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
- PhD Course in Clinical and Experimental Sciences, University of Padua, Padua, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Barbara Franchin
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padua, Padua, Italy
| | - Marco Angrisani
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Francesco Tuci
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padua, Padua, Italy
| | - Marianna Di Bello
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padua, Padua, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Andrea Lauterio
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Lucrezia Furian
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padua, Padua, Italy
| | - Luciano De Carlis
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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The Non-Muscle-Splitting Mini-Incision Donor Nephrectomy Remains a Feasible Technique in the Laparoscopic Era of Living Kidney Donation. TRANSPLANTOLOGY 2022. [DOI: 10.3390/transplantology4010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Laparoscopic donor nephrectomy (LDN) is the current gold standard in kidney donation. Mini-incision open donor nephrectomy (MINI) techniques have been used extensively but have become less popular. The aim of the present study was to compare the results and safety of a non-muscle-splitting MINI technique with the current gold standard of LDN. A single center retrospective cohort study of all living donor nephrectomies between 2011 and 2019 was used for the study. The primary outcome of this study was short term (<30 days) with Clavien–Dindo grade complications. Secondary outcomes included multivariable regression analysis of perioperative data. No differences in complication rates were observed between MINI and LDN and also after correction for known confounders. As expected, the operative time and first warm ischemia were significantly shorter in the MINI group and less blood loss was observed in the LDN group. Complications and conversion rate (LDN to open) among the LDN patients were in line with recent published meta-analyses. This study confirms the perioperative safety of living kidney donation in modern practice. Complication rates of both MINI and LDN procedures are limited and not different between procedures. In specific circumstances, the MINI procedure can still be considered a safe and feasible alternative for living kidney donation.
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Frutos MÁ, Crespo M, Valentín MDLO, Alonso-Melgar Á, Alonso J, Fernández C, García-Erauzkin G, González E, González-Rinne AM, Guirado L, Gutiérrez-Dalmau A, Huguet J, Moral JLLD, Musquera M, Paredes D, Redondo D, Revuelta I, Hofstadt CJVD, Alcaraz A, Alonso-Hernández Á, Alonso M, Bernabeu P, Bernal G, Breda A, Cabello M, Caro-Oleas JL, Cid J, Diekmann F, Espinosa L, Facundo C, García M, Gil-Vernet S, Lozano M, Mahillo B, Martínez MJ, Miranda B, Oppenheimer F, Palou E, Pérez-Saez MJ, Peri L, Rodríguez O, Santiago C, Tabernero G, Hernández D, Domínguez-Gil B, Pascual J. Recommendations for living donor kidney transplantation. Nefrologia 2022; 42 Suppl 2:5-132. [PMID: 36503720 DOI: 10.1016/j.nefroe.2022.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/26/2021] [Indexed: 06/17/2023] Open
Abstract
This Guide for Living Donor Kidney Transplantation (LDKT) has been prepared with the sponsorship of the Spanish Society of Nephrology (SEN), the Spanish Transplant Society (SET), and the Spanish National Transplant Organization (ONT). It updates evidence to offer the best chronic renal failure treatment when a potential living donor is available. The core aim of this Guide is to supply clinicians who evaluate living donors and transplant recipients with the best decision-making tools, to optimise their outcomes. Moreover, the role of living donors in the current KT context should recover the level of importance it had until recently. To this end the new forms of incompatible HLA and/or ABO donation, as well as the paired donation which is possible in several hospitals with experience in LDKT, offer additional ways to treat renal patients with an incompatible donor. Good results in terms of patient and graft survival have expanded the range of circumstances under which living renal donors are accepted. Older donors are now accepted, as are others with factors that affect the decision, such as a borderline clinical history or alterations, which when evaluated may lead to an additional number of transplantations. This Guide does not forget that LDKT may lead to risk for the donor. Pre-donation evaluation has to centre on the problems which may arise over the short or long-term, and these have to be described to the potential donor so that they are able take them into account. Experience over recent years has led to progress in risk analysis, to protect donors' health. This aspect always has to be taken into account by LDKT programmes when evaluating potential donors. Finally, this Guide has been designed to aid decision-making, with recommendations and suggestions when uncertainties arise in pre-donation studies. Its overarching aim is to ensure that informed consent is based on high quality studies and information supplied to donors and recipients, offering the strongest possible guarantees.
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Affiliation(s)
| | - Marta Crespo
- Nephrology Department, Hospital del Mar, Barcelona, Spain
| | | | | | - Juana Alonso
- Nephrology Department, Hospital Regional Universitario de Málaga, Spain
| | | | | | - Esther González
- Nephrology Department, Hospital Universitario 12 Octubre, Spain
| | | | - Lluis Guirado
- Nephrology Department, Fundacio Puigvert, Barcelona, Spain
| | | | - Jorge Huguet
- RT Surgical Team, Fundació Puigvert, Barcelona, Spain
| | | | - Mireia Musquera
- Urology Department, Hospital Clinic Universitari, Barcelona, Spain
| | - David Paredes
- Donation and Transplantation Coordination Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | - Ignacio Revuelta
- Nephrology and RT Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | - Antonio Alcaraz
- Urology Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | - Manuel Alonso
- Regional Transplantation Coordination, Seville, Spain
| | | | - Gabriel Bernal
- Nephrology Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Alberto Breda
- RT Surgical Team, Fundació Puigvert, Barcelona, Spain
| | - Mercedes Cabello
- Nephrology Department, Hospital Regional Universitario de Málaga, Spain
| | | | - Joan Cid
- Apheresis and Cell Therapy Unit, Haemotherapy and Haemostasis Department, Hospital Clinic Universitari, Barcelona, Spain
| | - Fritz Diekmann
- Nephrology and RT Department, Hospital Clinic Universitari, Barcelona, Spain
| | - Laura Espinosa
- Paediatric Nephrology Department, Hospital La Paz, Madrid, Spain
| | - Carme Facundo
- Nephrology Department, Fundacio Puigvert, Barcelona, Spain
| | | | | | - Miquel Lozano
- Apheresis and Cell Therapy Unit, Haemotherapy and Haemostasis Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | | | | | | | - Eduard Palou
- Immunology Department, Hospital Clinic i Universitari, Barcelona, Spain
| | | | - Lluis Peri
- Urology Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | | | | | - Domingo Hernández
- Nephrology Department, Hospital Regional Universitario de Málaga, Spain
| | | | - Julio Pascual
- Nephrology Department, Hospital del Mar, Barcelona, Spain.
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Park JW, Lee HH, Lee HS, Kim YS. Reproducibility and Step-By-Step Learning Curve of Retroperitoneal Video-Assisted Mini-Laparotomy Surgery for Living Donor Nephrectomy: A Single-Center Experience. EXP CLIN TRANSPLANT 2022; 20:657-662. [DOI: 10.6002/ect.2022.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Recomendaciones para el trasplante renal de donante vivo. Nefrologia 2022. [DOI: 10.1016/j.nefro.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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9
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Minimally Invasive and Open Donor Nephrectomy: Lessons Learned From a French Multicenter Experience. Transplant Proc 2022; 54:696-701. [DOI: 10.1016/j.transproceed.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/01/2022] [Indexed: 11/21/2022]
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10
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El Hennawy H, Al Hashemy A, Al Faifi A, Safar O, Obeid M, Gomaa M, Alkhalaqi A, Babiker M, Abdelaziz A, Al Humaid R, Zaitoun M, AlAlsheikh K. Pediatric renal transplantation in Southern Saudi Arabia: A single-center retrospective study. INDIAN JOURNAL OF TRANSPLANTATION 2022. [DOI: 10.4103/ijot.ijot_118_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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de la Oliva Valentín M, Hernández D, Crespo M, Mahillo B, Beneyto I, Martínez I, Kanter J, Calderari E, Gil-Vernet S, Sánchez S, Agüera ML, Bernal G, de Santiago C, Díaz-Corte C, Díaz C, Espinosa L, Facundo C, Fernández-Lucas M, Ferreiro T, García-Erauzkin G, García-Alvarez T, Fraile P, González-Rinne A, González-Soriano MJ, González E, Gutiérrez-Dalmau A, Jiménez C, Lauzurica R, Lorenzo I, Martín-Moreno PL, Moreso F, de Gracia MC, Pérez-Flores I, Ramos-Verde A, Revuelta I, Rodríguez-Ferrero ML, Ruiz JC, Sánchez-Sobrino B, Domínguez-Gil B. Live donor kidney transplantation. Situation analysis and roadmap. Nefrologia 2022; 42:85-93. [PMID: 36153903 DOI: 10.1016/j.nefroe.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/17/2021] [Indexed: 06/16/2023] Open
Abstract
Living donor kidney transplantation (LDKT) is the best treatment option for end stage renal disease in terms of both patient and graft survival. However, figures on LDKT in Spain that had been continuously growing from 2005 to 2014, have experienced a continuous decrease in the last five years. One possible explanation for this decrease is that the significant increase in the number of deceased donors in Spain during the last years, both brain death and controlled circulatory death donors, might have generated the false idea that we have coped with the transplant needs. Moreover, a greater number of deceased donor kidney transplants have caused a heavy workload for the transplant teams. Furthermore, the transplant teams could have moved on to a more conservative approach to the information and assessment of patients and families considering the potential long-term risks for donors in recent papers. However, there is a significant variability in the LDKT rate among transplant centers and regions in Spain independent of their deceased donor rates. This fact and the fact that LDKT is usually a preemptive option for patients with advanced chronic renal failure, as time on dialysis is a negative independent factor for transplant outcomes, lead us to conclude that the decrease in LDKT depends on other factors. Thus, in the kidney transplant annual meeting held at ONT site in 2018, a working group was created to identify other causes for the decrease of LDKT in Spain and its relationship with the different steps of the process. The group was formed by transplant teams, a representative of the transplant group of the Spanish Society of Nephrology (SENTRA), a representative of the Spanish Society of Transplants (SET) and representatives of the Spanish National Transplant Organization (ONT). A self-evaluation survey that contains requests about the phases of the LDKT processes (information, donor work out, informed consent, surgeries, follow-up and human resources) were developed and sent to 33 LDKT teams. All the centers answered the questionnaire. The analysis of the answers has resulted in the creation of a national analysis of strengths, weaknesses, opportunities, threats (SWOT) of the LDKT program in Spain and the development of recommendations targeted to improve every step of the donation process. The work performed, the conclusions and recommendations provided, have been reflected in the following report: Spanish living donor kidney transplant program assessment: recommendations for optimization. This document has also been reviewed by a panel of experts, representatives of the scientific societies (Spanish Society of Urology (AEU), Spanish Society of Nephrology Nursery (SEDEN), Spanish Society of Immunology (SEI/GETH)) and the patient association ALCER. Finally, the report has been submitted to public consultation, reaching ample consensus. In addition, the transplant competent authorities of the different regions in Spainhave adopted the report at institutional level. The work done and the recommendations to optimize LDKT are summarized in the present manuscript, organized by the different phases of the donation process.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Sara Sánchez
- Organización Nacional de Trasplantes, Madrid, Spain
| | | | | | | | | | - Cándido Díaz
- H. Clínico U. de Santiago, Santiago de Compostela, Spain
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12
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Valentín MDLO, Hernández D, Crespo M, Mahillo B, Beneyto I, Martínez I, Kanter J, Calderari E, Gil-Vernet S, Sánchez S, Agüera ML, Bernal G, de Santiago C, Díaz-Corte C, Díaz C, Espinosa L, Facundo C, Fernández-Lucas M, Ferreiro T, García-Erauzkin G, García-Alvarez T, Fraile P, González-Rinne A, González-Soriano MJ, González E, Gutiérrez-Dalmau A, Jiménez C, Lauzurica R, Lorenzo I, Martín-Moreno PL, Moreso F, de Gracia MC, Pérez-Flores I, Ramos-Verde A, Revuelta I, Rodríguez-Ferrero ML, Ruiz JC, Sánchez-Sobrino B, Domínguez-Gil B. Live donor kidney transplantation. Situation analysis and roadmap. Nefrologia 2021; 42:S0211-6995(21)00113-2. [PMID: 34294484 DOI: 10.1016/j.nefro.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/17/2021] [Indexed: 10/20/2022] Open
Abstract
Living donor kidney transplantation (LDKT) is the best treatment option for end stage renal disease in terms of both patient and graft survival. However, figures on LDKT in Spain that had been continuously growing from 2005 to 2014, have experienced a continuous decrease in the last five years. One possible explanation for this decrease is that the significant increase in the number of deceased donors in Spain during the last years, both brain death and controlled circulatory death donors, might have generated the false idea that we have coped with the transplant needs. Moreover, a greater number of deceased donor kidney transplants have caused a heavy workload for the transplant teams. Furthermore, the transplant teams could have moved on to a more conservative approach to the information and assessment of patients and families considering the potential long-term risks for donors in recent papers. However, there is a significant variability in the LDKT rate among transplant centers and regions in Spain independent of their deceased donor rates. This fact and the fact that LDKT is usually a preemptive option for patients with advanced chronic renal failure, as time on dialysis is a negative independent factor for transplant outcomes, lead us to conclude that the decrease in LDKT depends on other factors. Thus, in the kidney transplant annual meeting held at ONT site in 2018, a working group was created to identify other causes for the decrease of LDKT in Spain and its relationship with the different steps of the process. The group was formed by transplant teams, a representative of the transplant group of the Spanish Society of Nephrology (SENTRA), a representative of the Spanish Society of Transplants (SET) and representatives of the Spanish National Transplant Organization (ONT). A self-evaluation survey that contains requests about the phases of the LDKT processes (information, donor work out, informed consent, surgeries, follow-up and human resources) were developed and sent to 33 LDKT teams. All the centers answered the questionnaire. The analysis of the answers has resulted in the creation of a national analysis of strengths, weaknesses, opportunities, threats (SWOT) of the LDKT program in Spain and the development of recommendations targeted to improve every step of the donation process. The work performed, the conclusions and recommendations provided, have been reflected in the following report: Spanish living donor kidney transplant program assessment: recommendations for optimization. This document has also been reviewed by a panel of experts, representatives of the scientific societies (Spanish Society of Urology (AEU), Spanish Society of Nephrology Nursery (SEDEN), Spanish Society of Immunology (SEI/GETH)) and the patient association ALCER. Finally, the report has been submitted to public consultation, reaching ample consensus. In addition, the transplant competent authorities of the different regions in Spain have adopted the report at institutional level. The work done and the recommendations to optimize LDKT are summarized in the present manuscript, organized by the different phases of the donation process.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Sara Sánchez
- Organización Nacional de Trasplantes, Madrid, España
| | | | | | | | | | - Cándido Díaz
- H. Clínico U. de Santiago, Santiago de Compostela, España
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13
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Garrard L, Hakeem A, Robertson S, Farid S, Hostert L, Baker R, Jameel M, Morris-Stiff G, Ahmad N. The Prevailing Preference for Left Nephrectomy in Living Donor Transplantation Does Not Adversely Affect Long-Term Donor and Recipient Outcomes. Transplant Proc 2021; 53:1897-1904. [PMID: 34247861 DOI: 10.1016/j.transproceed.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/02/2021] [Accepted: 06/01/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND In living donor renal transplantation, surgeons traditionally prefer the left kidney for donation. The aim of this study was to assess the effects of the choice of laterality of donor nephrectomy on donor and recipient outcomes. METHODS The data was obtained from the UK National Health Service Blood and Transplant (NHSBT). During the study period, 7919 donor nephrectomy and transplantation were carried out in 24 transplant centers. Of these procedures, 6407 (80.9%) were left and 1512 (19.1%) were right kidney donors. RESULTS Right kidney donation was associated with higher incidence of surgical site infection in the donor. Recipient outcome was superior for left-sided kidneys in terms of immediate graft function, delayed graft function, graft loss within 30 days, and graft survival at 3 years, but not at 1 and 5 years. Open donor nephrectomy (n = 2396, 30.2%) was associated with higher rates of pneumothorax and hemorrhage, longer hospital stay, and inferior graft survival at 3 and 5 years compared with laparoscopic donor nephrectomy (n = 5523, 69.8%). CONCLUSIONS A right donor nephrectomy is associated with higher rate of wound infection in the donor and similar long-term graft outcomes in the recipients. Laparoscopic donor nephrectomy offers lower rate of major complications in the donor and a better overall graft survival.
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Affiliation(s)
- Lucy Garrard
- Division of Surgery, Department of Transplantation Surgery, St James's University Hospital, Leeds, United Kingdom
| | - Abdul Hakeem
- Division of Surgery, Department of Transplantation Surgery, St James's University Hospital, Leeds, United Kingdom
| | - Scot Robertson
- Division of Surgery, Department of Transplantation Surgery, St James's University Hospital, Leeds, United Kingdom
| | - Shahid Farid
- Division of Surgery, Department of Transplantation Surgery, St James's University Hospital, Leeds, United Kingdom
| | - Lutz Hostert
- Division of Surgery, Department of Transplantation Surgery, St James's University Hospital, Leeds, United Kingdom
| | - Richard Baker
- Department of Renal Medicine, St James's University Hospital, Leeds, United Kingdom
| | - Muhammad Jameel
- Department of Transplantation Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Kingdom of Saudi Arabia
| | - Gareth Morris-Stiff
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Niaz Ahmad
- Division of Surgery, Department of Transplantation Surgery, St James's University Hospital, Leeds, United Kingdom; Department of Transplantation Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Kingdom of Saudi Arabia.
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14
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Serni S, Pecoraro A, Sessa F, Gemma L, Greco I, Barzaghi P, Grosso AA, Corti F, Mormile N, Spatafora P, Caroassai S, Berni A, Gacci M, Giancane S, Tuccio A, Sebastianelli A, Li Marzi V, Vignolini G, Campi R. Robot-Assisted Laparoscopic Living Donor Nephrectomy: The University of Florence Technique. Front Surg 2021; 7:588215. [PMID: 33521044 PMCID: PMC7844329 DOI: 10.3389/fsurg.2020.588215] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022] Open
Abstract
Objective: To provide a step-by-step overview of the University of Florence technique for robotic living donor nephrectomy (LDN), focusing on its technical nuances and perioperative outcomes. Methods: A dedicated robotic LDN program at our Institution was codified in 2012. Data from patients undergoing robotic LDN from 2012 to 2019 were prospectively collected. All robotic LDNs were performed by a highly experienced surgeon, using the da Vinci Si robotic platform in a three-arm configuration. In this report we provide a detailed overview of our surgical technique for robotic LDN. The main objective of the study was to evaluate the technical feasibility and safety of the technique, including perioperative surgical complications rate and mid-term functional outcomes. Results: Overall, 36 patients undergoing robotic LDNs were included in the study. Of these, 28 (78%) were left LDNs. Median (IQR) donor pre-operative eGFR was 88 (75.6–90) ml/min/1.73 m2. In all cases, robotic LDN was completed without need of conversion. The median (IQR) overall operative time was 230 (195–258) min, while the median console time was 133 (IQR 117-166) min. The median (IQR) warm ischemia time was 175 (140–255) s. No intraoperative adverse events or 90-d major surgical complications were recorded. At a median (IQR) follow-up of 24 months (IQR 11-46), median (IQR) eGFR patients undergoing in living donor nephrectomy was 57.4 (47.9; 63.9) ml/min/1.73 m2. Conclusions: In our experience, robotic LDN is technically feasible and safe. The use of robotic surgery for LDN may provide distinct advantages for surgeons while ensuring optimal donors' perioperative and functional outcomes.
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Affiliation(s)
- Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Sessa
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Luca Gemma
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Isabella Greco
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Paolo Barzaghi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Antonio Andrea Grosso
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Corti
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Nicola Mormile
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Pietro Spatafora
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Simone Caroassai
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Alessandro Berni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Saverio Giancane
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Agostino Tuccio
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Arcangelo Sebastianelli
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Vincenzo Li Marzi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Graziano Vignolini
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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15
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Abdul-Muhsin HM, McAdams SB, Syal A, Nuñez-Nateras R, Navaratnam A, Moss AA, Hewitt WR, Singer AL, Jadlowiec CC, Harbell JW, Mathur AK, Reddy KS, Castle EP. Robot Assisted Renal Allograft Nephrectomy: Initial Case Series and Description of Technique. Urology 2020; 146:118-124. [PMID: 33091385 DOI: 10.1016/j.urology.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/27/2020] [Accepted: 10/06/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the outcomes and perioperative complication rates following robot- assisted transplant nephrectomy ((RATN). METHODS All patients who underwent RATN at our institution were included. No exclusion criteria were applied. Clinical records were retrospectively reviewed and reported. This included preoperative, intraoperative, and postoperative outcomes. Complications were reported utilizing the Clavien-Dindo classification system. Descriptive statistics were reported using frequencies and percentages for categorical variables, means and standard deviation for continuous variables. RESULTS Between July 2014 and April 2018, 15 patients underwent RATN. Most patients had the transplant in the right iliac fossa (13/15). Ten patients underwent a concomitant procedure. The total operative time for the entire cohort was 336 (±102) minutes (including cases who had concomitant procedures) and 259 (±46 minutes) when cases with concomitant procedures were excluded. Mean estimated blood loss was 383 (±444) mL. Postoperatively, 3 patients required blood transfusion. Average hospital stay was 4 (±2.7) days. Most patients had finding consistent with graft rejection on final pathology. There were 5 complications; 3 of which were minor (grade 2 = 2 and grade 3 = 1); one patient had a wound infection requiring dressing (3A) and one patient died due to pulmonary embolism following discharge. Limitations include small series and retrospective nature of the study. CONCLUSION This case series demonstrate that RATN is technically feasible. With continued experience and larger case series, the robotic approach may provide a minimally invasive alternative to open allograft nephrectomy.
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Affiliation(s)
| | | | - Amit Syal
- Mayo Clinic Arizona, Department of Urology, Phoenix, AZ
| | | | | | - Adyr A Moss
- Mayo Clinic Arizona, Department of Transplantation, Phoenix, AZ
| | | | - Andrew L Singer
- Mayo Clinic Arizona, Department of Transplantation, Phoenix, AZ
| | | | - Jack W Harbell
- Mayo Clinic Arizona, Department of Transplantation, Phoenix, AZ
| | - Amit K Mathur
- Mayo Clinic Arizona, Department of Transplantation, Phoenix, AZ
| | - Kunam S Reddy
- Mayo Clinic Arizona, Department of Transplantation, Phoenix, AZ
| | - Erik P Castle
- Mayo Clinic Arizona, Department of Urology, Phoenix, AZ
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16
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Rysmakhanov M, Yelemessov A, Mussin N, Sultangereyev Y, Kaliyev A, Tezcaner T, Yıldırım S. Pure 3-Dimensional Laparoscopic Living-Donor Nephrectomy: First Case In Kazakhstan. EXP CLIN TRANSPLANT 2020; 18:68-69. [PMID: 32008499 DOI: 10.6002/ect.tond-tdtd2019.p12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The available scientific literature has described the tangible benefits of operations using new 3-dimensional laparoscopic systems. The purpose of this report was to describe the first experience of pure 3-dimensional laparoscopic living-donor nephrectomy for transplant in the Republic of Kazakhstan. A living-donor kidney transplant was performed in a 21-year-old male patient with the father as the donor. The operation was performed with general anesthesia using a 3-dimensional endo-videoscopic stance with flexible camera (Olympus, Tokyo, Japan). The time of warm ischemia was 130 seconds, and the total operation time was 280 minutes. The postoperative period proceeded smoothly, without any complication. The patient was discharged on day 3 after transplant with normal levels of creatinine and urea. The recipient's surgery was typical, and no complications or difficulties in perfor-ming anastomosis were encountered. With further accumulation of experience, 3-dimensional laparoscopic nephrectomy from living donors could become a new criterion standard.
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17
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Néphrectomie laparoscopique assistée par robot dans le cadre du donneur-vivant : étude chez les donneurs et les receveurs à partir de 155 cas. Prog Urol 2019; 29:596-602. [DOI: 10.1016/j.purol.2019.08.263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 05/30/2019] [Accepted: 08/06/2019] [Indexed: 12/23/2022]
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18
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Koch M, Kroencke S, Li J, Wiessner C, Nashan B. Structured introduction of retroperitoneoscopic donor nephrectomy provides a high level of safety and reduces the physical burden for the donor compared to an anterior mini incision: A cohort study. Int J Surg 2019; 69:139-145. [PMID: 31400503 DOI: 10.1016/j.ijsu.2019.07.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 12/29/2022]
Abstract
INTRODUCTION A major goal in living donor kidney transplantation is to reduce the physical burden for the donor. Key-hole surgery for donor nephrectomy is a safe procedure, but concerns regarding donor safety during the learning phase might be the reason for surgeons' reluctance to change to a minimal invasive approach. MATERIAL AND METHODS We analyzed the first 100 retroperitoneoscopic donor nephrectomies (RPDN) performed at our institution and compared the results to the last 50 mini incision donor nephrectomies (MIDN) regarding donor and recipient outcome, and analyzed the learning curves of RPDN. RESULTS The learning phase of RPDN was very short with significantly shorter operative times compared to MIDN (118 vs. 175 min, p < 0.001) and significantly fewer surgical complications (p = 0.03). RPDN patients rated the physical burden (p = 0.01) as lower, and they felt less bothered by the surgical scar (p = 0.03). CONCLUSION Introducing RPDN is safe, even during the learning phase of the surgeons. Changing surgical technique from MIDN to RPDN reduces the surgical burden of the procedure. Our study might encourage more transplant centres to adopt a minimally invasive approach.
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Affiliation(s)
- Martina Koch
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Germany; Department of General, Visceral and Transplant Surgery, Universitätsmedizin Mainz, Germany.
| | - Sylvia Kroencke
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany
| | - Jun Li
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Germany
| | - Christian Wiessner
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Björn Nashan
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Germany; Clinic for HPB Surgery and Transplantation Center, First Affiliated Hospital, University of Science and Technology of China, Anhui, China
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19
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Gautier S, Monakhov A, Miloserdov I, Arzumanov S, Tsirulnikova O, Semash K, Dzhanbekov T. Simultaneous laparoscopic left lateral sectionectomy and nephrectomy in the same living donor: The first case report. Am J Transplant 2019; 19:1847-1851. [PMID: 30768839 DOI: 10.1111/ajt.15318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/20/2019] [Accepted: 02/08/2019] [Indexed: 01/25/2023]
Abstract
With the presence of organ shortage, living donors remain important sources of grafts, especially for pediatric recipients. Laparoscopic nephrectomy has become the gold standard for living donors. Additionally, laparoscopic partial liver procurement in living donors has proven its safety and feasibility in the latest studies. We have combined both approaches to perform a simultaneous liver-kidney transplantation in a pediatric patient from the same living donor. Our experience of laparoscopic left lateral sectionectomy and laparoscopic nephrectomy in living donors was the basis for adapting to this procedure. A 29-year-old mother was an ABO-incompatible (ABOi) donor for the left lateral section (LLS) of the liver and left kidney for her 2-year-old son. The postoperative period was uneventful. Two sessions of plasmapheresis and rituximab induction were necessary to prepare for ABOi transplantation. The donor and recipient were discharged on postoperative days 5 and 28, respectively. Simultaneous laparoscopic left lateral sectionectomy and nephrectomy in the same living donor is feasible for transplantation from the parent to the child with advanced laparoscopic expertise.
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Affiliation(s)
- Sergey Gautier
- Department of Surgery, National Medical Research Center of Transplantology and Artificial Organs named after academician V.I. Shumakov, Moscow, Russia.,Department of Transplantology and Artificial Organs, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Artem Monakhov
- Department of Surgery, National Medical Research Center of Transplantology and Artificial Organs named after academician V.I. Shumakov, Moscow, Russia.,Department of Transplantology and Artificial Organs, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Igor Miloserdov
- Department of Surgery, National Medical Research Center of Transplantology and Artificial Organs named after academician V.I. Shumakov, Moscow, Russia.,Department of Transplantology and Artificial Organs, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Sergey Arzumanov
- Department of Kidney Transplantation and Vascular Surgery in Urology, N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology, Moscow, Russia
| | - Olga Tsirulnikova
- Department of Transplantology and Artificial Organs, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Konstantin Semash
- Department of Surgery, National Medical Research Center of Transplantology and Artificial Organs named after academician V.I. Shumakov, Moscow, Russia
| | - Timur Dzhanbekov
- Department of Surgery, National Medical Research Center of Transplantology and Artificial Organs named after academician V.I. Shumakov, Moscow, Russia
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20
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Zorgdrager M, van Londen M, Westenberg LB, Nieuwenhuijs-Moeke GJ, Lange JFM, de Borst MH, Bakker SJL, Leuvenink HGD, Pol RA. Chronic pain after hand-assisted laparoscopic donor nephrectomy. Br J Surg 2019; 106:711-719. [PMID: 30919435 PMCID: PMC6593841 DOI: 10.1002/bjs.11127] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/18/2018] [Accepted: 01/03/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Data on chronic pain after kidney donation are sparse. The aim of this study was to assess the incidence of chronic pain after hand-assisted laparoscopic nephrectomy. METHODS Living kidney donors who donated between 2011 and 2017 at the University Medical Centre Groningen were included. All patients underwent hand-assisted laparoscopic donor nephrectomy. Postdonation pain and movement disabilities were assessed using the Carolinas Comfort Scale (CCS) and a visual analogue scale (VAS). The prevalence, severity of pain and the need for analgesics were reported. RESULTS Some 333 living kidney donors with a mean age of 56 years were included. At a median of 19 (i.q.r. 10-33) months after donation, 82 donors (24·6 per cent) had a CCS score above 0, of which 58 (71 per cent) had a CCS score of at least 2 and 57 (70 per cent) reported movement limitations. Some 110 donors (33·0 per cent) had a VAS score of more than 0. Complaints mainly occurred during bending over (12·3 per cent) and exercising (12·4 per cent). Thirty-two donors (9·7 per cent) required analgesics during follow-up between donation and the time of measurement, and six of 82 (7 per cent) reported chronic inguinal pain. In multivariable analysis, donor age (odds ratio (OR) 0·97, 95 per cent c.i. 0·95 to 0·99; P = 0·020) and length of hospital stay (OR 1·21, 1·01 to 1·51; P = 0·041) were independently associated with chronic pain. CONCLUSION One-quarter of donors experienced chronic postdonation pain or discomfort, most of which was bothersome. Younger donors and those with a longer postoperative hospital stay had more symptoms.
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Affiliation(s)
- M Zorgdrager
- Department of Radiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - M van Londen
- Department of Internal Medicine, Division of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - L B Westenberg
- Department of Radiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - G J Nieuwenhuijs-Moeke
- Department of Anaesthesiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - J F M Lange
- Department of Surgery, Division of Transplant Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - M H de Borst
- Department of Internal Medicine, Division of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - S J L Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - H G D Leuvenink
- Department of Surgery, Division of Transplant Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - R A Pol
- Department of Surgery, Division of Transplant Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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21
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Silvinato A, Bernardo WM, Santos LS. Living donor nephrectomy. Rev Assoc Med Bras (1992) 2018; 64:1061-1068. [PMID: 30569978 DOI: 10.1590/1806-9282.64.12.1061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. CONCLUSIONS The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.
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Affiliation(s)
| | - Antonio Silvinato
- Author and member of the Guidelines Program of the Brazilian Medical Association, São Paulo, Brasil
| | - Wanderley M Bernardo
- Lecturer Professor of School of Medicine of USP; São Paulo, SP, Brasil.,Coordinator of the Brazilian Medical Association Guidelines Program, São Paulo, SP, Brasil
| | - Luis Sérgio Santos
- Reviewer and member of the Guidelines Program of the Brazilian Medical Association, São Paulo, Brasil
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22
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Hirose T, Hotta K, Iwami D, Harada H, Morita K, Tanabe T, Sasaki H, Fukuzawa N, Seki T, Shinohara N. Safety and Efficacy of Retroperitoneoscopic Living Donor Nephrectomy: Comparison of Early Complication, Donor and Recipient Outcome with Hand-Assisted Laparoscopic Living Donor Nephrectomy. J Endourol 2018; 32:1120-1124. [DOI: 10.1089/end.2018.0669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Takayuki Hirose
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Kiyohiko Hotta
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Daiki Iwami
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroshi Harada
- Department of Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo, Japan
| | - Ken Morita
- Department of Urology, Kushiro City General Hospital, Kushiro, Japan
| | - Tatsu Tanabe
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Hajime Sasaki
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Nobuyuki Fukuzawa
- Department of Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo, Japan
| | - Toshimori Seki
- Department of Urology, Sapporo City General Hospital, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
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23
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Hager B, Herzog SA, Hager B, Sandner-Kiesling A, Zigeuner R, Pummer K. Comparison of early postoperative pain after partial tumour nephrectomy by flank, transabdominal or laparoscopic access. Br J Pain 2018; 13:177-184. [PMID: 31308942 DOI: 10.1177/2049463718808542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim To explore whether the total pain experience differs after (partial) kidney tumour nephrectomies via flank, transabdominal or laparoscopic access. Materials and methods We analyzed retrospectively 107 patients with flank, 12 with transabdominal and 21 with laparoscopic interventions. For pain treatment, conventional analgesics (A) or intravenous patient-controlled analgesia (PCIA) or thoracic peridural analgesia (tPDA) were used. Self-reported pain was measured with a Visual Analogue Scale three times daily. The area under the curve (AUC) at rest (R) and during a standardized body movement (M) were calculated from the intervention till the end of the second T(0-2) and seventh postoperative day T(0-7), respectively. Results The median AUC for T(0-2) at R was more intense for laparoscopy (13) than for flank incision (A, 9) and approximately the same during M. For flank incisions (A), the median AUC at R rises from 9 for T(0-2) to 22 for T(0-7) and at M the median AUC increases from 18 to 37. In contrast, laparoscopy did not cause further pain after the second postoperative day. Furthermore, with flank incision for T(0-2), at R, tPDA was superior to A (median AUC: 5 versus 9, p = 0.02) and at M again tPDA (median AUC: 12) had a better pain-control as A (18) or even as PCIA (19, p = 0.005). Conclusion Laparoscopic nephrectomies cause a relatively intense mean cumulative pain for T(0-2) and a subsequent absence of pain. However, flank incisions went on to increased pain levels until the seventh postoperative day with tPDA as most effective therapy.
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Affiliation(s)
- Boris Hager
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Sereina A Herzog
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Barbara Hager
- Department of Anesthesiology, Medical University of Graz, Graz, Austria
| | | | - Richard Zigeuner
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Karl Pummer
- Department of Urology, Medical University of Graz, Graz, Austria
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24
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Experience and Security of the Hand-Assisted Laparoscopic Nephrectomy of a Living Donor in a Public Health Center. Transplant Proc 2018; 50:433-435. [PMID: 29579821 DOI: 10.1016/j.transproceed.2017.12.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 12/05/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hand-assisted laparoscopic nephrectomy (HALDN) is currently the procedure of choice for obtaining living donor kidneys for transplantation. In our institution, it has been the standard procedure for 5 years. Previous studies have shown the same function of the graft as that obtained by open surgery, with a lower rate of bleeding and no differences in complications. We sought to demonstrate the experience and safety of HALDN compared with open donor nephrectomy in healthy donors for kidney transplantation. METHODS A retrospective analytical observational study was conducted, reviewing the records of the living donors for kidney transplant undergoing open donor nephrectomy or HALDN in our center from March 1, 2009, to March 1, 2016. Renal function was assessed by the estimated glomerular filtration rate by the Modification of Diet in Renal Disease method before and after donation, as well as bleeding (mL), and complications (according to Clavien), performing a comparative analysis between the two techniques using parametric or nonparametric tests. RESULTS A total of 179 living donor nephrectomies were performed during the study period-31 open donor nephrectomy (17.3%) and 148 HALDN (82.7%)-without relevant baseline differences, except for creatinine. HALDN has a shorter surgical time (156,473 ± 87.75 minutes vs 165,484 ± 69.95 minutes) and less bleeding (244.59 ± 416.08 mL vs 324.19 ± 197.986 mL) and a shorter duration of hospital stay (3.74 ± 1.336 days vs 4.75 ± 1.226 days). There were no significant differences in surgical complications at 30 days, or graft loss reported; there were 3 conversions (1.7%) from the HALDN to the open technique. There were no differences in renal function in the donors or recipients at the 5th day or the month after surgery. CONCLUSIONS Laparoscopic nephrectomy has replaced open surgery as the gold standard for living kidney donors. HALDN is a safe and feasible procedure when compared with open donor nephrectomy, achieving a shorter surgical time with less bleeding, and no difference in the number of complications. This procedure lowers costs by decreasing the duration of the hospital stay, making is feasible to perform it at any institution with appropriately trained personnel.
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Tae BS, Balpukov U, Kim HH, Jeong CW. Evaluation of the Learning Curve of Hand-Assisted Laparoscopic Donor Nephrectomy. Ann Transplant 2018; 23:546-553. [PMID: 30082679 PMCID: PMC6248071 DOI: 10.12659/aot.909397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In this study, we analyzed the learning curve of hand-assisted laparoscopic donor nephrectomy (HALDN). MATERIAL AND METHODS The first 198 consecutive donors (110 cases by expert surgeon and 88 cases by newbie surgeon) operated on using HALDN were included in this study. The primary outcome measures were warm ischemic time (WIT), total operation time and estimated blood loss (EBL). The secondary outcome measures included length of hospital stay (LOS), graft outcome, and surgery-related complications. We used the cumulative sum (CUSUM) method to generate learning curves. RESULTS Except for WIT, all operative and convalescence parameters of donors and graft outcomes were similar for the 2 groups, including the total operation time (174.13 minutes vs. 171.75 minutes, P=0.140), EBL (108.27 cc vs. 116.82 cc, P=0.494), LOS (4.80 days vs. 4.92 days, P=0.144), and overall rates of intraoperative and postoperative complications (P>0.05). A significant difference was observed in WIT between the 2 groups (140.59 sec vs. 106.85 sec, P=0.027). Upon visual assessment of the CUSUM plots, a downward inflexion point for decreasing WIT was observed in 4 cases, total operation time in 12 cases, and EBL in 15 cases. CONCLUSIONS HALDN has a relatively short learning curve and similar results may be expected from newbie urologists who are trained in minimally invasive surgery fellowship.
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Affiliation(s)
- Bum Sik Tae
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Ulanbek Balpukov
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
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26
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Kawan F, Theil G, Fornara P. Robotic Donor Nephrectomy: Against. Eur Urol Focus 2018; 4:142-143. [PMID: 30082229 DOI: 10.1016/j.euf.2018.07.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/16/2018] [Indexed: 11/24/2022]
Abstract
The use of robotic techniques in laparoscopic donor nephrectomy currently tends to involve a longer ischemia time without clear advantages, and the cost of robotic surgery is significantly higher. If only one robot is available, then unnecessary prolongation of cold ischemia time also occurs, as the donor must first be undocked to dock the recipient. The combination of laparoscopic donor nephrectomy with parallel initiation of robot-assisted situs preparation and exposure of the renal vessels appears to be the best current approach to safe and cost-effective donor nephrectomy and subsequent robot-assisted kidney transplantation without wasting any time.
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Affiliation(s)
- Felix Kawan
- Clinic of Urology and Transplantation, Medical Faculty of Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Gerit Theil
- Clinic of Urology and Transplantation, Medical Faculty of Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Paolo Fornara
- Clinic of Urology and Transplantation, Medical Faculty of Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
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Margreiter C, Gummerer M, Gallotta V, Scheidl S, Öfner D, Kienzl-Wagner K, Maier HT, Oberhuber R, Margreiter R, Schneeberger S. Open Management of the Renal Vein Is a Safe Modification in Right-Sided Laparoscopic Living Donor Nephrectomy to Maximize Graft Vein Length. Transplant Proc 2018; 50:3199-3203. [PMID: 30577185 DOI: 10.1016/j.transproceed.2018.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 06/19/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The primary objective in living donor kidney transplantation is donor safety. In laparoscopic living donor nephrectomy, most centers prefer the left kidney for donation given the shorter renal vein, higher rate of thromboses, and more difficult surgical procedure for right kidney retrieval. The goal of this study was to demonstrate the feasibility of a hybrid technique using a Satinsky clamp in right-sided living donor nephrectomy to obtain maximal renal vein and to compare the outcome with standard left-sided laparoscopic donor nephrectomies. MATERIAL AND METHODS Between 2005 and 2013, 77 patients underwent a left (group L) and 54 a right (group R) living donor nephrectomy. In group R, after laparoscopic dissection and mobilization of the right kidney, two 12-mm trocar incisions in the right upper quadrant were connected in a 5-7 cm subcostal incision. The caval vein was partially clamped under direct vision prior to dissection of the renal vein. The venotomy was then closed with a running 4-0 Prolene suture. The two groups were compared with regard to surgical complications, graft function, and graft survival. RESULTS Using this technique, no significant difference with regard to complications or graft function was observed. Serum creatinine at discharge in donor group L was 1.23 (±0.43) mg/dL and in donor group R 1.21 (±0.37) mg/dL (P = .71). Graft survival at one year was 100% in both groups. CONCLUSION Open management of the renal vein is a safe alternative in laparoscopic right-sided donor nephrectomy and ensures maximal length of the vein.
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Affiliation(s)
- C Margreiter
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria.
| | - M Gummerer
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria; Department of Vascular Surgery, Medical University of Innsbruck, Austria
| | - V Gallotta
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria; Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - S Scheidl
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - D Öfner
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - K Kienzl-Wagner
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - H T Maier
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - R Oberhuber
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - R Margreiter
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - S Schneeberger
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Minilaparoscopy in urology: Systematic review. Actas Urol Esp 2018; 42:299-308. [PMID: 28865709 DOI: 10.1016/j.acuro.2017.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 11/21/2022]
Abstract
CONTEXT There has been a boom in recent years in urological procedures using minilaparoscopy (ML). OBJECTIVE To conduct a systematic review of the published evidence on ML and its current role in urology. ACQUISITION OF EVIDENCE We performed a search on MedLine spanning October 1983 to December 2016 according to PRISMA criteria. A total of 6 comparative articles and 13 series were selected for this manuscript. SUMMARY OF THE EVIDENCE Only 1 study was randomised, 4 studies were prospective and comparative, and most were case series in which the operations were performed with 3-mm instruments. The most common procedures were adrenalectomy, followed by nephrectomy, living donor and pyeloplasty. Other minor conditions were also operated on, including cyst decortications, pyelolithotomies, lymphadenectomies, varicocelectomies and orchiectomies. DISCUSSION There have been significant technical improvements in recent years in the materials of ML. Most procedures were for reconstructive surgery and by transperitoneal approach, with a gradually increasing number of cases of oncologic surgery. Only 36.8% of the series assessed the cosmetic results with validated questionnaires, and 68.4% of the studies used the visual analogue scale to measure pain during the postoperative period. CONCLUSIONS The level of evidence of most published studies is low. ML is a reproducible technique for urological surgery and is safe even for operations on large surgical masses. The procedure's cosmetic and pain results after surgery are superior to those of conventional laparoscopy, although these conclusions should be taken with caution given the limitations of the current studies.
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Luk ACO, Pandian RMK, Heer R. Laparoscopic renal surgery is here to stay. Arab J Urol 2018; 16:314-320. [PMID: 30140467 PMCID: PMC6104665 DOI: 10.1016/j.aju.2018.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/23/2018] [Indexed: 01/20/2023] Open
Abstract
Objectives To review the current literature comparing the outcomes of renal surgery via open, laparoscopic and robotic approaches. Materials and methods A comprehensive literature search was performed on PubMed, MEDLINE and Ovid, to look for studies comparing outcomes of renal surgery via open, laparoscopic, and robotic approaches. Results Limited good-quality evidence suggests that all three approaches result in largely comparable functional and oncological outcomes. Both laparoscopic and robotic approaches result in less blood loss, analgesia requirement, with a shorter hospital stay and recovery time, with similar complication rates when compared with the open approach. Robotic renal surgeries have not shown any significant clinical benefit over a laparoscopic approach, whilst the associated cost is significantly higher. Conclusion With the high cost and lack of overt clinical benefit of the robotic approach, laparoscopic renal surgery will likely continue to remain relevant in treating various urological pathologies.
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Key Words
- (L)(LESS-)DN, (laparoscopic) (laparoendoscopic single-site-) donor nephrectomy
- (L)(O)(RA)PN, (laparoscopic) (open) (robot-assisted) partial nephrectomy
- (L)(O)(RA)PY, (laparoscopic) (open) (robot-assisted) pyeloplasty
- (L)(O)(RA)RN, (laparoscopic) (open) (robot-assisted) radical nephrectomy
- BMI, body mass index
- Donor nephrectomy
- LOS, length of hospital stay
- Laparoscopic/open/robotic renal surgery
- NOTES, natural orifice transluminal endoscopic surgery
- PUJO, PUJ obstruction
- Partial nephrectomy
- Pyeloplasty
- RCT, randomised controlled trial
- Radical nephrectomy
- WIT, warm ischaemia time
- eGFR, estimated GFR
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Affiliation(s)
- Angus Chin On Luk
- Department of Urology, Freeman Hospital, High Heaton, Newcastle upon Tyne, UK
| | | | - Rakesh Heer
- Department of Urology, Freeman Hospital, High Heaton, Newcastle upon Tyne, UK
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Stiegler P, Schemmer P. Robot-Assisted Transplant Surgery - Vision or Reality? A Comprehensive Review. Visc Med 2018; 34:24-30. [PMID: 29594166 DOI: 10.1159/000485686] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Minimally invasive surgery is standard procedure for many operations. Further refinements include the introduction of robotic surgery which is still an emerging field especially in laparoscopic surgery. Since the successful introduction of the da Vinci Robotic Surgical System, the robotic approach in organ transplantation has become of great interest in both the live donor organ retrieval and the recipient operation. Robotic surgery for kidney, liver, and pancreas transplantation is feasible. Over 700 donor nephrectomies and 100 kidney transplantations have been performed already, and robotic surgery is standard in a small number of pioneer centers; however, larger series and most importantly randomized controlled trials for the highest evidence are needed. Longer warm ischemia time and higher costs limit these procedures at the moment.
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Affiliation(s)
- Philipp Stiegler
- Division of Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,Transplant Center Graz, Medical University of Graz, Graz, Austria
| | - Peter Schemmer
- Division of Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,Transplant Center Graz, Medical University of Graz, Graz, Austria
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Lee KW, Choi SW, Park YH, Bae WJ, Choi YS, Ha US, Hong SH, Lee JY, Kim SW, Cho HJ. A randomized, prospective study of laparoendoscopic single-site plus one-port versus mini laparoscopic technique for live donor nephrectomy. World J Urol 2018; 36:585-593. [PMID: 29396785 DOI: 10.1007/s00345-018-2207-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 01/23/2018] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To compare the clinical outcomes of laparoendoscopic single-site plus one-port donor nephrectomy (LESSOP-DN) and mini laparoscopic donor nephrectomy (MLDN). METHODS A prospective randomized controlled trial was conducted from December 2014 to February 2016 in donors scheduled for left donor nephrectomy. Donor and recipient demographics and clinical outcomes including pain scores and questionnaires (BIQ: body image questionnaire, SF-36, patient-reported overall convalescence) were also compared. RESULTS A total of 121 eligible donors were recruited, of which 99 donors who were scheduled to undergo an operation on their left side were randomized into LESSOP-DN (n = 50) and MLDN (n = 49) groups. There were no significant demographic differences between the two groups. The renal extraction time in the LESS-DN group was shorter than that in the MLDN group (75.89 ± 13.01 vs. 87.31 ± 11.38 min, p < 0.001). Other perioperative parameters and complication rates were comparable between the two groups. The LESSOP-DN group had a smaller incision length than the MLDN group (4.89 ± 0.68 vs. 6.21 ± 1.11 cm, p < 0.001), but cosmetic scores and body image scores were similar in the two groups (p = 0.905, 0.217). Donor quality of life (SF-36) and recovery and satisfaction data were comparable between the two groups. Delayed graft function (DGF) occurred in one recipient undergoing MLDN procedure (2.1%) and progressed to graft failure. CONCLUSIONS There were no differences in cosmetic satisfaction between groups despite the smaller incision size of LESSOP-DN. Safety parameters and subjective measures of postoperative morbidity were similar between the two groups.
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Affiliation(s)
- Kyu Won Lee
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sae Woong Choi
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yong Hyun Park
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Woong Jin Bae
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yong Sun Choi
- Department of Urology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - U-Syn Ha
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sung-Hoo Hong
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sae Woong Kim
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Hyuk Jin Cho
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Araújo AM, Guimarães J, Nunes CS, Couto PS, Amadeu E. Dor no período pós‐operatório de nefrectomia laparoscópica com bloqueio do plano transverso abdominal guiado por ultrassom versus infiltração do sítio do trocarte: um estudo prospectivo. Rev Bras Anestesiol 2017; 67:487-492. [DOI: 10.1016/j.bjan.2016.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 08/10/2016] [Indexed: 11/29/2022] Open
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Patil AB, Javali TD, Nagaraj HK, Babu SMLP, Nayak A. Laparoscopic donor nephrectomy in unusual venous anatomy - donor and recepient implications. Int Braz J Urol 2017; 43:671-678. [PMID: 28379667 PMCID: PMC5557443 DOI: 10.1590/s1677-5538.ibju.2016.0309] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 10/01/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Laparoscopic donor nephrectomy is now a commonly performed procedure in most of renal transplantation centers. However, the suitability of laparoscopy for donors with abnormal venous anatomy is still a subject of debate. MATERIALS AND METHODS Between August 2007 and August 2014, 243 laparoscopic donor nephrectomies were performed in our institution. All donors were evaluated with preoperative three-dimensional spiral computed tomography (CT) angiography Thirteen (5.35%) donors had a left renal vein anomaly. A retrospective analysis was performed to collect donor and recipient demographics and perioperative data. RESULTS Four donors had a type I retroaortic vein, seven had type II retroaortic vein and a circumaortic vein was seen in three donors. The mean operative time was 114±11 minutes and mean warm ischemia time was 202±12 seconds. The mean blood loss was 52.7±18.4mL and no donor required blood transfusion. Mean recipient creatinine at the time of discharge was 1.15±0.18mg/dL, and creatinine at six months and one year follow-up was 1.12±0.13mg/dL and 1.2±0.14mg/dL, respectively. There were no significant differences in operative time, blood loss, warm ischemia time, donor hospital stay or recipient creatinine at 6 months follow-up, following laparoscopic donor nephrectomy in patients with or without left renal vein anomalies. CONCLUSION Preoperative delineation of venous anatomy using CT angiography is as important as arterial anatomy. Laparoscopic donor nephrectomy is safe and feasible in patients with retroaortic or circumaortic renal vein with good recipient outcome.
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Affiliation(s)
| | | | | | | | - Arvind Nayak
- Department of Urology, M.S. Ramaiah Hospital, Bangalore
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34
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Comparison of Two Different Laparoscopic Donor Nephrectomy With Vaginal Extraction Techniques—A Single-Center Experience. Transplant Proc 2017; 49:411-414. [DOI: 10.1016/j.transproceed.2017.01.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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35
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Tuğcu V, Şahin S, Yiğitbaşı İ, Şener NC, Akbay FG, Taşçı Aİ. Laparoscopic donor nephrectomy, complications and management: a single center experience. Turk J Urol 2017; 43:93-97. [PMID: 28270958 DOI: 10.5152/tud.2016.44711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/12/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To present our experience with laparoscopic donor nephrectomy (LDN), our complications and management modalities. Material and methods: Fifty-one transperitoneal LDNs performed in our clinic between the years 2011, and 2015, were evaluated retrospectively. Demographic characteristics of the patients, operative and postoperative data and complications were evaluated. RESULTS Nineteen female and 32 male patients with ages ranging from 24 to 65 years underwent left- (n=44), and right-sided (n=7) LDNs. Six patients had two, and one patient three renal arteries. Mean operation time was 115±11 (min-max: 90-150) minutes, and mean warm ischemia time 111±9 (min-max: 90-140 sec) seconds. Mean hospital stay was found to be 2.5±0.5 days. No patient needed to switch to open surgery. In one patient, lumbar vein was ruptured, and hemostatic control was achieved laparoscopically. Postoperative paralytic ileus developed in two patients. Three patients had postoperative atelectasis, and a febrile (38.1°C) episode. CONCLUSION LDN is a minimally invasive method with advantages of short hospital stay, less analgesic requirement, and better cosmetic results. However it should be performed by surgeons with advanced laparoscopic experience.
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Affiliation(s)
- Volkan Tuğcu
- Clinic of Urology, İstanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Selçuk Şahin
- Clinic of Urology, İstanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - İsmail Yiğitbaşı
- Clinic of Urology, İstanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Nevzat Can Şener
- Clinic of Urology, İstanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Fatih Gökhan Akbay
- Clinic of Nephrology, İstanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Ali İhsan Taşçı
- Department of Urology, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey
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Wagenaar S, Nederhoed JH, Hoksbergen AWJ, Bonjer HJ, Wisselink W, van Ramshorst GH. Minimally Invasive, Laparoscopic, and Robotic-assisted Techniques Versus Open Techniques for Kidney Transplant Recipients: A Systematic Review. Eur Urol 2017; 72:205-217. [PMID: 28262412 DOI: 10.1016/j.eururo.2017.02.020] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 02/09/2017] [Indexed: 12/14/2022]
Abstract
CONTEXT Literature on conventional and minimally invasive operative techniques has not been systematically reviewed for kidney transplant recipients. OBJECTIVE To systematically evaluate, summarize, and review evidence supporting operating technique and postoperative outcome for kidney transplant recipients. EVIDENCE ACQUISITION A systematic review was conducted in PubMed-Medline, Embase, and Cochrane Library between 1966 up to September 1, 2016, according to Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Articles were included and scored by two independent reviewers using Group Reading Assessment and Diagnostic Evaluation (GRADE), Newcastle-Ottawa Quality Assessment Scale (NOS), and Oxford guidelines for level of evidence. Main outcomes were graft survival, surgical site infection, incisional hernia, and cosmetic result. In total, 18 out of 1954 identified publications were included in this analysis. EVIDENCE SYNTHESIS Included reports described conventional open, minimally invasive open, laparoscopic, and robotic-assisted techniques. General level of evidence of included studies was low (GRADE: 1-3; NOS: 0-4; and Oxford level of evidence: 4-2). No differences in graft or patient survival were found. For open techniques, Gibson incision showed better results than the hockey-stick incision for incisional hernia (4% vs 16%), abdominal wall relaxation (8% vs 24%), and cosmesis. Minimally invasive operative recipient techniques showed lowest surgical site infection (range 0-8%) and incisional hernia rates (range 0-6%) with improved cosmetic result and postoperative recovery. Disadvantages included prolonged cold ischemia time, warm ischemia time, and total operation time. CONCLUSIONS Although the level of evidence was generally low, minimally invasive techniques showed promising results with regard to complications and recovery, and could be considered for use. For open surgery, the smallest possible Gibson incision appeared to yield favorable results. PATIENT SUMMARY In this paper, the available evidence for minimally invasive operation techniques for kidney transplantation was reviewed. The quality of the reviewed research was generally low but suggested possible advantages for minimally invasive, laparoscopic, and robot-assisted techniques.
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Affiliation(s)
- Sven Wagenaar
- Department of Surgery, VU Medical Center, Amsterdam, The Netherlands; Department of Urology, Meander Medical Centre, Amersfoort, The Netherlands.
| | | | | | - H Jaap Bonjer
- Department of Surgery, VU Medical Center, Amsterdam, The Netherlands
| | - Willem Wisselink
- Department of Surgery, VU Medical Center, Amsterdam, The Netherlands
| | - Gabrielle H van Ramshorst
- Department of Surgery, VU Medical Center, Amsterdam, The Netherlands; Department of Surgery, Dutch Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Timsit MO, Kleinclauss F, Mamzer Bruneel M, Thuret R. Le donneur vivant de rein. Prog Urol 2016; 26:940-963. [DOI: 10.1016/j.purol.2016.09.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 01/10/2023]
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Cienfuegos-Belmonte I, León-Dueñas E, Román-Martín A, Olmo-Ruíz M, González-Roncero F, Medina-López R. Evaluation of the Spanish Urological Association quality care indicators in a kidney transplantation programme. Actas Urol Esp 2016; 40:523-8. [PMID: 26992850 DOI: 10.1016/j.acuro.2016.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/10/2016] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Indicators show the presence of a phenomenon and its intensity. They assess the level of quality care and identify potential situations for improvement. Our objective is to assess the 2013 and 2014 quality care indicators of our department's kidney transplantation area. MATERIAL AND METHOD For 2013 and 2014, we reviewed 88 and 106 kidney transplants and 47 and 66 extractions. We evaluated the quality care indicators developed by the Spanish Urological Association, analysing the results with the SPSS v 21.0 programme. RESULTS The mean cold ischaemia time (CIT) was 14.96hours in 2013 and 18.07hours in 2014. The CIT was ≤18h in 53% and 56% of cadaveric donor kidneys in 2013 and 2014, respectively. The rate of relevant early onset urinary fistulae was 1.14% and 2.83% for each year. The rate of early transplantectomy due to a vascular complication was 3.41% and 2.83% for 2013 and 2014, respectively. Overall patient survival at 1 year was 100% for both periods, and graft survival at 1 year was 95% and 94.34% for 2013 and 2014, respectively. The rate of living-donor transplantation was 14.77% and 17.92%, and 92.31% and 68.42% of the living-donor extractions were laparoscopic for 2013 and 2014, respectively. Resident medical interns were the first surgeon in 6.67% and 12.64% of the transplantations and in 55.88% and 19.14% of the cadaveric extractions during 2013 and 2014, respectively. CONCLUSIONS During the evaluated period, all quality care standards in kidney transplantation were met, except for CIT in both years and resident medical intern participation in kidney implantation in 2013. This analysis promotes improvements in quality care, highlighting weak spots that need work.
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Rampersad C, Patel P, Koulack J, McGregor T. Back-to-back comparison of mini-open vs. laparoscopic technique for living kidney donation. Can Urol Assoc J 2016; 10:253-257. [PMID: 27878046 DOI: 10.5489/cuaj.3725] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Laparoscopic living donor nephrectomy is the standard of care at high-volume renal transplant centres, with benefits over the open approach well-documented in the literature. Herein, we present a retrospective analysis of our single-institution donor nephrectomy series comparing the mini-open donor nephrectomy (mini-ODN) to the laparoscopic donor nephrectomy (LDN) with regards to operative, donor, and recipient outcomes. METHODS From 2007-2011, there were 89 cases of mini-ODN, at which point our centre transitioned to LDN; 94 cases were performed from 2011-2014. In total, 366 patients were reviewed, including donor and recipient pairs. Donor and recipient demographics, intraoperative data, postoperative donor recovery, recipient graft outcomes, and financial cost were assessed comparing the surgical approaches. RESULTS We demonstrate a reduced estimated blood loss (347.83 vs. 90.3 cc), lower intraoperative complication rate (4 vs. 11) and shorter length of hospital stay (2.4 vs. 3.3 days) for patients in the LDN group. Operative time was significantly longer for the LDN group (108.4 vs. 165.9 minutes), although this did not translate to a longer warm ischemia time (mean 2.0 minutes for each group). The rate of delayed graft function and recipient 12-month creatinine were comparable for ODN and LND. Overall cost of LDN was $684 higher for an uncomplicated admission. CONCLUSIONS Despite a longer surgical time and higher upfront cost, our study supports that LDN yields several advantages over the mini-ODN, with a lower estimated blood loss, fewer intraoperative complications, and shorter length of hospital stay, all while maintaining excellent renal allograft outcomes.
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Affiliation(s)
| | - Premal Patel
- Section of Urology, University of Manitoba, Winnipeg, MB, Canada
| | - Joshua Koulack
- Section of Vascular Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Thomas McGregor
- Section of Urology, University of Manitoba, Winnipeg, MB, Canada
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Jeong WJ, Choi BJ, Hwang JK, Yuk SM, Song MJ, Lee SC. Novel method of laparoendoscopic single-site and natural orifice specimen extraction for live donor nephrectomy: single-port laparoscopic donor nephrectomy and transvaginal graft extraction. Ann Surg Treat Res 2016; 90:111-5. [PMID: 26878020 PMCID: PMC4751145 DOI: 10.4174/astr.2016.90.2.111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 08/13/2015] [Accepted: 09/16/2015] [Indexed: 12/25/2022] Open
Abstract
Laparoscopic live donor nephrectomy (DN) has been established as a useful alternative to the traditional open methods of procuring kidneys. To maximize the advantages of the laparoendoscopic single-site (LESS) method, we applied natural orifice specimen extraction to LESS-DN. A 46-year-old woman with no previous abdominal surgery history volunteered to donate her left kidney to her husband and underwent single-port laparoscopic DN with transvaginal extraction. The procedure was completed without intraoperative complications. The kidney functioned well immediately after transplantation, and the donor and recipient were respectively discharged 2 days and 2 weeks postoperatively. Single-port laparoscopic DN and transvaginal graft extraction is feasible and safe.
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Affiliation(s)
- Won Jun Jeong
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Byung Jo Choi
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Jeong Kye Hwang
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Seung Mo Yuk
- Department of Urology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Min Jong Song
- Department of Gynecology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Sang Chul Lee
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
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You D, Lee C, Jeong IG, Han DJ, Hong B. Transition From Hand-Assisted to Pure Laparoscopic Donor Nephrectomy. JSLS 2016; 19:JSLS.2015.00044. [PMID: 26229420 PMCID: PMC4517067 DOI: 10.4293/jsls.2015.00044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: We compared perioperative donor outcomes and early graft function of hand-assisted laparoscopic donor nephrectomy (HALDN) and pure laparoscopic donor nephrectomy (PLDN) performed by a single surgeon, to define the feasibility of technical transition from HALDN to PLDN. Methods: From October 1, 2012, through June 30, 2014, 60 donor nephrectomies were performed by a single surgeon who lacked experience with laparoscopic renal surgery: the first 30 by HALDN and the last 30 by PLDN. Operative and convalescence parameters were compared, as were intra- and postoperative complications within 90 days according to the Satava and Clavien-Dindo classifications, respectively. Binary logistic regression analysis was used to estimate the association of baseline characteristics with complications. Results: Baseline characteristics were similar in the 2 groups, except for American Society of Anesthesiologists score II (10.0% vs 43.3%; P = .007). All procedures were completed as planned. All operative and convalescence parameters of donors and graft outcomes were similar in the 2 groups, as were overall rates of intraoperative (43.3% vs 36.7%, P = .598) and postoperative (86.7% vs 70.0%; P = .209) complications. No factor was significantly predictive of intraoperative complications, whereas sex (female vs male, odds ratio, 0.183; P = .029) and learning curve (odds ratio, 0.602; P = .036) were significant determinants of postoperative complication. Conclusion: The technical transition from HALDN to PLDN does not involve a steep learning curve for surgeons less experienced with laparoscopic renal surgery and maintains similar perioperative donor and graft outcomes.
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Affiliation(s)
| | | | | | - Duck Jong Han
- Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abstract
BACKGROUND The living kidney donation has become increasingly important in recent years. Because of the decreasing number of postmortem donors, there has been a dramatic increase in morbidity and mortality due to the long waiting times for patients on dialysis. By timely living donation after dialysis entry or even preemptively, this can be avoided. AIM In addition, the living donor has better graft function and better graft survival which is due to the predictability of the donation, the optimal conditioning of donor and recipient, and the short ischemia time. To protect the donor, to provide legal protection, and to avoid abuse, the German legislature reacted with the Transplantation Act and its amendment. The recent recommendations for donor evaluation from the Amsterdam Forum have been used by the Federal Medical Council to revise current guidelines and guidelines for living donation will be drawn up. CONCLUSION The focus of these efforts is standardization of the procedure and protection of the kidney donor. This is also reflected in the recommendations for organ removal technique and the selection of the organ to be used for kidney donation.
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Kroencke S, Schulz KH, Nashan B, Koch M. Anterior vertical mini-incision vs. retroperitoneoscopic nephrectomy in living kidney donation: a prospective study on donors' quality of life and clinical outcome. Clin Transplant 2015; 29:1029-38. [DOI: 10.1111/ctr.12625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Sylvia Kroencke
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
- University Transplant Center; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Karl-Heinz Schulz
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
- University Transplant Center; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Björn Nashan
- University Transplant Center; University Medical Center Hamburg-Eppendorf; Hamburg Germany
- Department of Hepatobiliary and Transplant Surgery; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Martina Koch
- University Transplant Center; University Medical Center Hamburg-Eppendorf; Hamburg Germany
- Department of Hepatobiliary and Transplant Surgery; University Medical Center Hamburg-Eppendorf; Hamburg Germany
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Cho HJ, Choi SW, Kim KS, Park YH, Bae WJ, Hong SH, Lee JY, Kim SW, Hwang TK. Laparoendoscopic Single-Site Plus One-Port Donor Nephrectomy: Analysis of 169 Cases. J Laparoendosc Adv Surg Tech A 2015; 25:636-41. [DOI: 10.1089/lap.2014.0570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Hyuk Jin Cho
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sae Woong Choi
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Kang Sup Kim
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yong Hyun Park
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Woong Jin Bae
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sung-Hoo Hong
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sae Woong Kim
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Tae-Kon Hwang
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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Alessimi A, Adam E, Haber GP, Badet L, Codas R, Fehri HF, Martin X, Crouzet S. LESS living donor nephrectomy: Surgical technique and results. Urol Ann 2015; 7:361-5. [PMID: 26229326 PMCID: PMC4518375 DOI: 10.4103/0974-7796.160321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 10/26/2014] [Indexed: 11/25/2022] Open
Abstract
Purpose: We present the findings of 50 patients undergoing pure trans-umbilical laparo-endoscopic single-site surgery (LESS) living donor nephrectomy (LDN), between February 2010 and May 2014. Materials and Methods: Laparo-endoscopic single-site surgery LDN was performed through an umbilical incision. Different trocars were used, namely Gelpoint (Applied Mιdical, Rancho Santa Margarita, CA) SILS port (Covidien, Hamilton, Bermuda), R-port (Olympus Surgical, Orangeburg, NY) and standard trocars, inserted through the same skin incision but using separate fascial punctures. The standard laparoscopic technique was employed. The kidney was pre-entrapped in a retrieval bag and extracted trans-umbilically. Data were collected prospectively including questionnaires containing patient reported oral pain medication duration and time to recovery. Results: LESS LDN was successful in all patients. Mean warm ischemia time was 6.2 min (3–15), mean procedure time was 233.2 min (172–300), and hospitalization stay was 3.94 days (3–7) with a visual analogue pain score at discharge of 1.32 (0–3). No intraoperative complications occurred. The mean time of oral pain medication was 8.72 days (1–20) and final scar length was 4.06 cm (3–5). Each allograft was functional. Conclusion: Although challenging, trans-umbilical LESS LDN seems to be feasible and safe. Hence, LESS has the potential to improve cosmetic results and decrease morbidity.
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Affiliation(s)
- Abdullah Alessimi
- Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France
| | - Emilie Adam
- Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France
| | - Georges-Pascal Haber
- Center for Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lionel Badet
- Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France
| | - Ricardo Codas
- Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France
| | - Hakim Fassi Fehri
- Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France
| | - Xavier Martin
- Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France
| | - Sébastien Crouzet
- Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France
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Song G, Jeong IG, Kim YH, Han DJ, Kim CS, Ahn H, Ahn TY, Hong B. Kidney Laterality and the Safety of Hand-assisted Live Donor Nephrectomy: Review of 1000 Consecutive Cases at a Single Center. Urology 2015; 85:1360-6. [DOI: 10.1016/j.urology.2014.12.072] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 12/05/2014] [Accepted: 12/12/2014] [Indexed: 10/23/2022]
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From Open to Laparoscopic Living-donor Nephrectomy: Changing the Paradigm in a High-volume Transplant Center. Transplant Proc 2015; 47:903-5. [DOI: 10.1016/j.transproceed.2015.03.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Srivastava A, Prabhakaran S, Sureka SK, Kapoor R, Kumar A, Sharma RK, Prasad N, Ansari MS. The challenges and outcomes of living donor kidney transplantation in pediatric and adolescent age group in a developing country: A critical analysis from a single center of north India. Indian J Urol 2015; 31:33-7. [PMID: 25624573 PMCID: PMC4300569 DOI: 10.4103/0970-1591.145290] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction: Renal transplantation is the treatment of choice for children with end-stage renal disease (ESRD). We evaluated the outcome of renal transplantation in the pediatric and adolescent age groups in the perspective of a developing country as compared with developed nations while highlighting the challenges we have faced in a pediatric transplant programme. Materials and Methods: Seventy live related pediatric and adolescent renal transplantations were reviewed retrospectively. Variables analyzed were etiology of ESRD, pre-transplant renal replacement modality, donor relationship, surgical complications, rejection episodes, immuno-suppression regimens, compliance to immunosuppression, graft survival and overall survival. Results: The cohort consisted of 13 (18%) female and 57 male (82%) recipients. The mean age was 14 ± 1.4 years. The etiology of ESRD was chronic glomerulonephritis (n = 43), chronic interstitial nephritis (n = 26) and Alport's syndrome (n = 1). Fifty-six (80%) children were on hemo-dialysis and 10 (14%) on peritoneal dialysis prior to transplantation. 80.5% and 61% patients were strictly compliant to immunosuppresant medications at 1 and 5 years. The 1, 3 and 5 year graft survival rates were 94.3%, 89.2% and 66.8%, respectively. The overall survival rates were 95.7%, 96.4% and 94.1% for 1, 3 and 5 years, respectively. Conclusions: The spectrum of etiology of ESRD differs in our patients from the west, with chronic glomerulonephritis being the most common etiology. Early graft survival is comparable, but the 5-year graft survival is clearly inferior as compared with developed countries.
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Affiliation(s)
- Aneesh Srivastava
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Sandeep Prabhakaran
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Sanjoy Kumar Sureka
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Rakesh Kapoor
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | | | - R K Sharma
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - M S Ansari
- Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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