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Fong KY, Foo JCH, Chan YH, Aslim EJ, Ng LG, Gan VHL, Lim EJ. Graft retrieval incisions in minimally invasive donor nephrectomy: Systematic review and network meta-analysis. Transplant Rev (Orlando) 2024; 38:100813. [PMID: 37979238 DOI: 10.1016/j.trre.2023.100813] [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: 10/06/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Various incisions are employed for graft extraction during minimally invasive donor nephrectomy, but an overarching synthesis of associated short-term donor outcomes is lacking. METHODS An electronic literature search was conducted on PubMed, EMBASE and Scopus for studies comparing ≥2 graft extraction incisions in laparoscopic or robotic donor nephrectomy with ≥10 patients per arm. Eligible study designs included randomized trials, case-control, and cohort studies. Primary outcomes were donor length of stay (LOS); in-hospital analgesic requirement; and postoperative complications. Secondary outcomes were warm ischemia time (WIT), total operation time (TOT), and estimated blood loss (EBL). Random-effects Frequentist network meta-analyses were conducted for all outcomes. RESULTS Twenty-nine studies (4702 patients) were shortlisted. Six incisions were analyzed: iliac, Pfannenstiel, midline hand-assisted laparoscopic (HAL), midline umbilical, flank and transvaginal natural orifice transluminal endoscopic surgery (NOTES). The flank incision had significantly longer LOS than all other incisions. LOS was significantly longer in Pfannenstiel than iliac incision (mean difference [MD] = 0.29, 95%CI = 0.002-0.58 days). Midline HAL had significantly shorter TOT than most other incisions. Midline umbilical incisions had significantly higher WIT than midline HAL and Pfannenstiel incisions. Midline HAL had shorter WIT than transvaginal NOTES (MD = 0.80, 95%CI = 0.05-1.56 min). No major differences were seen in analgesia requirement, postoperative complications and EBL. CONCLUSION Six different incisions for graft retrieval are broadly comparable across most short-term outcomes although long-term outcomes remain to be elucidated. Iliac and Pfannenstiel incisions yielded similar outcomes besides marginally lower LOS for the former. Midline incision for HAL may be associated with shorter TOT, and transvaginal NOTES is an effective technique for selected female donors. TRIAL REGISTRATION PROSPERO CRD42023445407.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Lay Guat Ng
- Department of Urology, Singapore General Hospital, Singapore
| | - Valerie Huei Li Gan
- Department of Urology, Singapore General Hospital, Singapore; SingHealth Duke-NUS Transplant Centre, Singapore
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore.
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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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3
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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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4
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Outcomes after 20 years of experience in minimally invasive living-donor nephrectomy. World J Urol 2022; 40:807-813. [DOI: 10.1007/s00345-021-03912-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022] Open
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5
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Abdessater M, Champy CM, da Costa JB, Courcier J, Yiou R, Hoznek A, Vordos D, Grimbert P, Matignon M, Londero T, le Corvoisier P, Salomon L, De la Taille A, Ingels A. Comparison of the iliac, vaginal and umbilical graft extraction in robot-assisted laparoscopic living donor nephrectomy. World J Urol 2021; 39:2783-2788. [PMID: 33015741 DOI: 10.1007/s00345-020-03462-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To compare different extractions routes for robot-assisted living donor nephrectomy in terms of post-operative pain and renal function recovery. METHODS Live donor kidney transplantation data from our institution were reviewed from November 2011 to March 2017. Postoperative pain was estimated using cumulative painkillers consumption. Variables were compared between the 3 groups with ANOVA for continuous data, χ2 test for categorial data. A survival analysis with Kaplan-Meier curve assessing time to transplant recipient nadir was performed to compare the renal function recovery. RESULTS Sixty-three RLDN were performed (23 iliac, 23 vaginal and 17 umbilical extractions). There was no significant difference between the three groups in terms of operative time, blood lost, warm ischemia time, cumulative painkiller consumption and renal function recovery time. Postoperative complications for Umbilical, Vaginal and Iliac were, respectively, of 0, 3 and 1. No major difference was found between the 3 groups beside a slightly longer hospital stay in the iliac group. CONCLUSION Iliac incision might impact post-operative pain with a moderate but significant longer hospital stay. Vaginal extraction is an option when cosmetic outcomes present a real demand. The three options appeared to be safe and should be discussed with the patient in regard of the surgeon experience.
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Affiliation(s)
- Maher Abdessater
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Cécile M Champy
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - José Batista da Costa
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Jean Courcier
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - René Yiou
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Andras Hoznek
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Dimitri Vordos
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Philippe Grimbert
- Department of Nephrology, APHP, Henri Mondor University Hospital, UPEC, Créteil, France
| | - Marie Matignon
- Department of Nephrology, APHP, Henri Mondor University Hospital, UPEC, Créteil, France
| | - Tiphanie Londero
- Department of Nephrology, APHP, Henri Mondor University Hospital, UPEC, Créteil, France
| | - Philippe le Corvoisier
- Department of Clinical Investigations, APHP, Henri Mondor University Hospital, UPEC, Créteil, France
- INSERM, CIC 1430, Créteil, France
| | - Laurent Salomon
- Department of Urology, Hôpital Mont-de-Marsan, Mont-de-Marsan, France
| | - Alexandre De la Taille
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Alexandre Ingels
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
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Zhang H, Tong JJ, Zhang ZN, Wang HB, Zhang YH. Laparoscopic left hemihepatectomy combined with right lateral hepatic lobectomy in pigs: surgical approach and comparative study of the inflammatory response versus open surgery. VETERINARY RESEARCH FORUM : AN INTERNATIONAL QUARTERLY JOURNAL 2021; 12:1-6. [PMID: 33953867 PMCID: PMC8094135 DOI: 10.30466/vrf.2019.105865.2518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 08/06/2019] [Indexed: 11/25/2022]
Abstract
This study describes a left hemihepatectomy combined with a right lateral hepatic lobectomy. It compares the inflammatory response associated with laparoscopic hepatectomy (LH group, n = 7) with conventional open hepatectomy (OH group, n = 7). Blood was collected before surgery as well as 1, 2, 3, 5, and 7 days after surgery to determine the white blood cell count and levels of serum cortisol (COR), interleukin-6 (IL-6), and C-reactive protein (CRP). The left hemi-hepatectomy combined with a right lateral hepatic lobectomy was completed in miniature pigs. The average operative time was 139.00 ± 9.07 min, which was longer than that in the OH group (121.67 ± 3.02 min). The length of surgical incision associated with the OH group was 17.93 ± 1.09 cm, significantly longer than that related to the LH group (5.10 ± 0.17 cm). The estimated mean blood loss in the LH group was 136.43 ± 63.24 mL, which was significantly lower than that in the OH group. No severe complications (e.g., massive bleeding, bile leakage, and air embolism) were reported. The CRP levels, COR, and IL-6, increased significantly in the OH group and then slowly returned to their preoperative levels. A postoperative laparoscopic exploration revealed that the incised portion of the liver adhered to the omentum, but no additional abnormalities were observed. These findings indicate that a 4-trocar method for laparoscopic left hemihepatectomy combined with a right lateral hepatic lobectomy is safe and feasible. The inflammatory response for those receiving LH are lower than that for those receiving OH. This porcine model can be used as a research analog for liver disease and regeneration.
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Affiliation(s)
- Hua Zhang
- Department of Animal Science, College of Animal Science and Technology, Beijing University of Agriculture, Beijing, China
| | - Jin-Jin Tong
- Department of Animal Science, College of Animal Science and Technology, Beijing University of Agriculture, Beijing, China
| | - Zhao-Nan Zhang
- Department of Animal Science, College of Animal Science and Technology, Beijing University of Agriculture, Beijing, China
| | - Hong-Bin Wang
- Department of Veterinary Surgery, College of Veterinary Medicine, Northeast Agricultural University, Harbin, China
| | - Yong-Hong Zhang
- Department of Animal Science, College of Animal Science and Technology, Beijing University of Agriculture, Beijing, China
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Karayagiz AH, Ozdemir E, Besli S, Polatkan SAV, Yilmaz G, Erturk T, Cakir U, Berber I. Comparison of Long-Term Outcomes of Standard and Transvaginal Kidney Extraction in Laparoscopic Living Donor Nephrectomy. J Laparoendosc Adv Surg Tech A 2021; 31:1309-1314. [PMID: 33471592 DOI: 10.1089/lap.2020.0949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: A limited number of publications are available in the literature regarding laparoscopic living donor nephrectomy with vaginal extraction (LLDN-VE) for kidney transplantation. The aim of this study was to compare long-term recipient outcomes of standard laparoscopic living donor nephrectomy (S-LLDN) and LLDN-VE. Methods: A total of 652 patients [119 LLDN-VE (18.3%) and 533 S-LLDN (81.7%)] were included in this retrospective cross-sectional study. The data related to donor and recipient demographics, surgical and anatomical characteristics, and recipient and graft status were retrieved and compared using nonparametric statistical methods. Kaplan-Meier and Cox proportional hazards regression analyses were applied to compute survival according to the surgical technique. Results: The mean follow-up duration was 73.0 ± 25.4 months for S-LLDN and 69.8 ± 20.4 months for LLDN-VE recipients. The main determinants of long-term outcomes were the serum creatinine (SCr) levels, death-censored graft survival, and recipient survival at the end of the post-op 5th year. LLDN-VE recipients' discharge SCr was found to be statistically lower (P = .049) than S-LLDN patients. Graft survival rates censored for death were 93.8% for the S-LLDN and 93.3% for the LLDN-VE recipients. Cox regression analysis showed significance for younger donor age (P = .010) with the application of 17 parameters, indicating better graft survival outcomes for kidney recipients with younger donors. Conclusions: Compared with the standard method, the long-term results of LLDN-VE are in accordance with or could even be more advantageous than S-LLDN in certain aspects. LLDN-VE appears to be a feasible, safe, and cosmetically superior approach with no negative postoperative sexual or morbid effects on the donor.
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Affiliation(s)
- Abdulhak Hamit Karayagiz
- Department of General Surgery, Kidney Transplantation Center, Acibadem International Hospital, Istanbul, Turkey
| | - Ebru Ozdemir
- Department of General Surgery, Kidney Transplantation Center, Acibadem International Hospital, Istanbul, Turkey
| | - Sevval Besli
- Department of Nephrology, Haskoy Hemodialysis Center, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Seyit Ali Volkan Polatkan
- Department of General Surgery, Kidney Transplantation Center, Acibadem International Hospital, Istanbul, Turkey
| | - Gulay Yilmaz
- Department of Nephrology, Kidney Transplantation Center, Acibadem International Hospital, Istanbul, Turkey
| | - Turker Erturk
- Department of General Surgery, Kidney Transplantation Center, Acibadem International Hospital, Istanbul, Turkey
| | - Ulkem Cakir
- Department of Nephrology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Ibrahim Berber
- Department of General Surgery, Acibadem University School of Medicine, Istanbul, Turkey
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Musquera Felip M, Ajami Fardoun T, Peri Cusi L, Alcaraz Asensio A. Technique Description and Outcomes of Robotic Transvaginal-Assisted Living Donor Kidney Transplantation. Urol Int 2020; 105:148-154. [PMID: 33260186 DOI: 10.1159/000511756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/19/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the study was to describe the surgical technique of totally robotic kidney transplantation with transvaginal insertion and to assess its safety and feasibility. METHODS It is a prospective analysis of the first 5 cases of robotic kidney transplantation with transvaginal insertion. Robotic-assisted kidney transplantation was performed after transvaginal insertion of a living donor kidney graft. Donor's and recipient's characteristics, intraoperative variables, postoperative complications, and surgical outcomes were assessed. RESULTS The median operative time was 220 min. Mean rewarming ischemia time of 53 min, with immediate diuresis. No intraoperative complications were observed. Mean hospitalization period was 9 days, with mean Cr of 1.5 mg/dL at discharge. CONCLUSIONS Robotic kidney transplantation with transvaginal insertion is feasible and safe. A greater number of procedures are required to confirm the results of this new technique.
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Affiliation(s)
| | | | - Lluis Peri Cusi
- Urology Department, Hospital Clinic of Barcelona, Barcelona, Spain
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Musquera M, Peri L, Ajami T, Revuelta I, Izquierdo L, Mercader C, Sierra A, Diekmann F, D'Anna M, Monsalve C, Alcaraz A. Results and Lessons Learned on Robotic Assisted Kidney Transplantation. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8687907. [PMID: 32934965 PMCID: PMC7484686 DOI: 10.1155/2020/8687907] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/28/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Nowadays, minimally invasive surgery in kidney transplantation is a reality thanks to robotic assistance. In this paper, we describe our experience, how we developed the robotic assisted Kidney transplantation (RAKT) technique, and analyze our results. Material and Methods. This is a retrospective study of all RAKTs performed at our center between July 2015 and March 2020. We describe the donor selection, surgical technique, and analyze the surgical results and complications. A comparison between the first 20 cases and the following ones is performed. RESULTS During the aforementioned period, 82 living donor RAKTs were performed. The mean age was 47.4 ± 13.4 and 50 (61%) were male. Mean body mass index was 25 ± 4.7 and preemptive in 63.7% of cases. Right kidneys and multiple arteries were seen in 14.6% and 12.2%, respectively. Mean operative and rewarming time was 197 ± 42 and 47 ± 9.6 minutes, respectively. Five cases required conversion to open surgery because of abnormal kidney vascularization. Two patients required embolization for subcapsular and hypogastric artery bleeding without repercussion. Three kidneys were lost, two of them due to acute rejection and one because venous thrombosis. Late complications requiring surgery included one kidney artery stenosis, one ureteral stenosis, two lymphoceles, and three hernia repairs. We noticed a significant reduction in time between the first 20 cases and the following ones from 248.25 ± 38.1 to 189.75 ± 25.3 (p < 0.05). With a mean follow-up time of 1.8 years (SD 1.3), the mean creatinine was 1.52 (SD 0.7) and RAKT graft survival was 98%. CONCLUSIONS The robotic approach is an attractive, minimally invasive method for kidney transplantation, yielding good results. Further studies are needed to consider it a standard approach.
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Affiliation(s)
- Mireia Musquera
- Department of Urology, Hospital Clínic, Barcelona 08036, Spain
| | - Lluis Peri
- Department of Urology, Hospital Clínic, Barcelona 08036, Spain
| | - Tarek Ajami
- Department of Urology, Hospital Clínic, Barcelona 08036, Spain
| | - Ignacio Revuelta
- Department of Nephrology and Kidney Transplant, Hospital Clínic, Barcelona 08036, Spain
| | - Laura Izquierdo
- Department of Urology, Hospital Clínic, Barcelona 08036, Spain
| | | | - Alba Sierra
- Department of Urology, Hospital Clínic, Barcelona 08036, Spain
| | - Fritz Diekmann
- Department of Nephrology and Kidney Transplant, Hospital Clínic, Barcelona 08036, Spain
| | - Maurizio D'Anna
- Department of Urology, Hospital Clínic, Barcelona 08036, Spain
| | | | - Antonio Alcaraz
- Department of Urology, Hospital Clínic, Barcelona 08036, Spain
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Sener TE, Sahin B, Fichera M, Panella MM, Tanidir Y, Lucan CV, Netsch C, Lunelli L. Does Vaginal Wall Surgical Trauma During Hybrid Transvaginal NOTES Nephrectomy Have Traumatic Effects On Sexual Functions? A Prospective Study. J INVEST SURG 2020; 34:914-921. [DOI: 10.1080/08941939.2019.1710627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Tarik Emre Sener
- Department of Urology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Bahadir Sahin
- Department of Urology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Michele Fichera
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Marco Marzio Panella
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Yiloren Tanidir
- Department of Urology, School of Medicine, Marmara University, Istanbul, Turkey
| | | | | | - Luca Lunelli
- Department of Urology, Tenon University Hospital, Pierre and Marie Curie University, Paris, France
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Laparoscopic nephrectomy with transvaginal extraction of the kidney. The first case performed in Romania – national premiere. GINECOLOGIA.RO 2020. [DOI: 10.26416/gine.28.2.2020.3184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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12
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Baez-Suarez Y, Amaya-Nieto J, Garcia-Lopez A, Giron-Luque F. Hand-assisted Laparoscopic Nephrectomy: Evaluation of the Learning Curve. Transplant Proc 2020; 52:67-72. [PMID: 31889541 DOI: 10.1016/j.transproceed.2019.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/25/2019] [Accepted: 10/18/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hand-assisted laparoscopic donor nephrectomy (HALDN) has rapidly become the best alternative to open nephrectomy for living kidney donation. As more centers continue to adopt the laparoscopic technique, the safety of the initial transplants must be ensured while ascending the learning curve (LC). This study looks to determine the safety of HALDN and to describe the results of the LC in our center. METHODS We conducted a retrospective review of 500 HALDNs performed in our center from July 2003 to July 2017. We analyzed demographic and perioperative characteristics and complications during the first postoperative month. We divided HALDNs into 2 groups: before and after completing the LC (50 nephrectomies). For each group, we assessed operating room time, estimated blood loss, length of stay, and complication and conversion rates. RESULTS A total of 500 HALDNs were performed in the study period. Of those, 454 were analyzed in the 2 groups. The median operating room time was 2 hours, length of stay was 2 days, and blood loss was 50 cc. The overall rate of complication was 6.8%. There were significant differences between the 2 groups in operating time, blood loss, and length of stay (P < .05). No differences were found in terms of complication (P = .42) and conversion (P = .28) rates. CONCLUSION There was a significant decrease in operating time, blood loss, and length of stay in patients who underwent laparoscopic donor nephrectomy by an experienced laparoscopist. However, no differences were found in complication and conversion rates, which suggests that improvement in surgical training can be accomplished without altering the donor safety.
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Affiliation(s)
- Yenny Baez-Suarez
- Department of Surgery, Division of Transplant, Colombiana de Trasplantes, Bogota, Colombia.
| | | | | | - Fernando Giron-Luque
- Department of Surgery, Division of Transplant, Colombiana de Trasplantes, Bogota, Colombia
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Zou X, Zhang G, Xie T, Yuan Y, Xiao R, Wu G, Wang X, Xu H, Liu F, Wu Y, Liao Y, Liu Q, Sun Y, Yang B, Wang L, Xu C, Gao X. Natural orifice transluminal endoscopic surgery in urology: The Chinese experience. Asian J Urol 2019; 7:1-9. [PMID: 31970065 PMCID: PMC6962750 DOI: 10.1016/j.ajur.2019.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/21/2018] [Accepted: 12/26/2018] [Indexed: 12/21/2022] Open
Abstract
Objective To describe the Chinese experience of natural orifice transluminal endoscopic surgery (NOTES) in urology. Methods From December 2008 to May 2017, 35 animal experiments and 305 clinical surgeries of NOTES or natural orifices specimen extractions (NOSE) were performed in China. The animal experiments included five kidney biopsies, 24 nephrectomies and six partial nephrectomies. The clinical surgeries included 12 transvaginal NOSE (TV-NOSE), 266 hybrid transvaginal NOTES (TV-NOTES) and 27 pure TV-NOTES. The TV-NOSE procedure was performed in five transumbilical laparoendoscopic single-site (U-LESS) nephrectomies, four suprapubic-assisted laparoendoscopic single-site surgery (SA-LESS) nephroureterectomies, and three laparoscopic radical cystectomies. The hybrid TV-NOTES procedure included 210 nephrectomies, 31 adrenalectomies, eight nephroureterectomies, 13 partial nephrectomies, and four heminephrectomies. The pure TV-NOTES procedure included five renal cyst decortications and 22 nephrectomies. Results A total of 29 animal experiments were successfully performed. One partial nephrectomy was converted to standard laparoscopic surgery. Two kidney biopsies and two nephrectomies were unsuccessful. A total of 297 clinical surgeries were successfully performed. Six patients who underwent hybrid TV-NOTES were converted to open surgery. Two patients who underwent pure TV-NOTES were converted to SA-LESS. There were 22 major complications, 16 occurred intraoperatively and six postoperatively. The mean visual analog score (VAS) of 48 h after the operation was 2.5 points in TV-NOSE, 2.3 points in hybrid TV-NOTES and 1.7 points in pure TV-NOTES. The mean follow-up of 50.6 (3.0–87.0) months showed that all patients were in good condition. The umbilicus scars were nearly invisible in TV-NOSE and hybrid TV-NOTES. The vaginal incision healed well. Conclusions TV-NOSE and TV-NOTES are feasible, safe, and effective with little injury, low pain, fast recovery, and good cosmetic outcomes in properly selected patients. They are worth consideration for urological clinical practice.
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Affiliation(s)
- Xiaofeng Zou
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Research Center of Jiangxi Province for Engineering Technology of Calculus Prevention and Control, Ganzhou, China
| | - Guoxi Zhang
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Research Center of Jiangxi Province for Engineering Technology of Calculus Prevention and Control, Ganzhou, China
| | - Tianpeng Xie
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Research Center of Jiangxi Province for Engineering Technology of Calculus Prevention and Control, Ganzhou, China
| | - Yuanhu Yuan
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Research Center of Jiangxi Province for Engineering Technology of Calculus Prevention and Control, Ganzhou, China
| | - Rihai Xiao
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Research Center of Jiangxi Province for Engineering Technology of Calculus Prevention and Control, Ganzhou, China
| | - Gengqing Wu
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Research Center of Jiangxi Province for Engineering Technology of Calculus Prevention and Control, Ganzhou, China
| | - Xiaoning Wang
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Research Center of Jiangxi Province for Engineering Technology of Calculus Prevention and Control, Ganzhou, China
| | - Hui Xu
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Research Center of Jiangxi Province for Engineering Technology of Calculus Prevention and Control, Ganzhou, China
| | - Folin Liu
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Research Center of Jiangxi Province for Engineering Technology of Calculus Prevention and Control, Ganzhou, China
| | - Yuting Wu
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Research Center of Jiangxi Province for Engineering Technology of Calculus Prevention and Control, Ganzhou, China
| | - Yunfeng Liao
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Research Center of Jiangxi Province for Engineering Technology of Calculus Prevention and Control, Ganzhou, China
| | - Quanliang Liu
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Research Center of Jiangxi Province for Engineering Technology of Calculus Prevention and Control, Ganzhou, China
| | - Yinghao Sun
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Bo Yang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Linhui Wang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Chuanliang Xu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xiaofeng Gao
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
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Luke PP, Aquil S, Alharbi B, Sharma H, Sener A. First Canadian experience with robotic laparoendoscopic single-site vs. standard laparoscopic living-donor nephrectomy: A prospective comparative study. Can Urol Assoc J 2018; 12:E440-E446. [PMID: 29989887 PMCID: PMC6217949 DOI: 10.5489/cuaj.5275] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to compare the outcomes of robotic laparoendoscopic single-site living donor nephrectomy (R-LESS LDN) vs. standard laparoscopic living donor nephrectomy (LLDN). METHODS Between October 2013 and November 2015, 39 patients were allocated to either standard LLDN (n=25) or R-LESS LDN (n=14). Patient demographics, perioperative outcomes, analgesic requirement, visual analogue scale of pain at postoperative days 1, 3, 7, and 30, and a health-related quality of life and body image questionnaire were prospectively collected. RESULTS There were no significant differences in demographics and intraoperative outcomes between the two cohorts. The R-LESS LDN cohort had lower analgesic requirement (p=0.002) and lower visual pain scores on days 1 and 3 (p=0.001). Additionally, body image and satisfaction scores in the R-LESS group were also superior compared to the LLDN cohort (p=0.008). There was no significant difference in the postoperative complications according to the Clavien-Dindo system. Recipient graft functional outcomes were equivalent. CONCLUSIONS This is the first evidence that R-LESS LDN is safe and associated with comparable surgical and early functional outcomes compared to LLDN, while pain, donor body image, and satisfaction scores were improved compared to LLDN.
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Affiliation(s)
- Patrick P Luke
- Department of Surgery, Division of Urology, Western University, London, ON, Canada
- Multi-Organ Transplant Program, London Health Sciences Centre, London, ON, Canada
- Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Centre, London, ON, Canada
| | - Shahid Aquil
- Department of Surgery, Division of Urology, Western University, London, ON, Canada
- Western University Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Multi-Organ Transplant Program, London Health Sciences Centre, London, ON, Canada
| | - Bijad Alharbi
- Department of Surgery, Division of Urology, Western University, London, ON, Canada
- Western University Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Multi-Organ Transplant Program, London Health Sciences Centre, London, ON, Canada
| | - Hemant Sharma
- Department of Surgery, Division of Urology, Western University, London, ON, Canada
- Western University Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Multi-Organ Transplant Program, London Health Sciences Centre, London, ON, Canada
| | - Alp Sener
- Department of Surgery, Division of Urology, Western University, London, ON, Canada
- Multi-Organ Transplant Program, London Health Sciences Centre, London, ON, Canada
- Matthew Mailing Centre for Translational Transplant Studies, London Health Sciences Centre, London, ON, Canada
- Department of Microbiology and Immunology, Western University, London, ON, Canada
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15
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Abdel-Karim AM, El Tayeb MM, Yahia E, Elmissiry M, Hassouna M, Elsalmy S. Evaluation of the Role of Laparoendoscopic Single-Site Surgery vs Minilaparoscopy for Treatment of Upper Urinary Tract Pathologies: Prospective Randomized Comparative Study. J Endourol 2018; 31:1237-1242. [PMID: 29020831 DOI: 10.1089/end.2017.0363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES To present the first prospective randomized comparison between laparoendoscopic single-site surgery (LESS) and minilaparoscopy (ML) for treatment of upper urinary tract pathologies. PATIENTS AND METHODS Between January 2013 and June 2015, patients with different upper urinary pathologies were blindly randomized to both LESS and ML. All procedures were done by single experienced surgeon. Both cohorts were compared regarding demographic data, peri and postoperative characteristics, and visual analog pain scale (VAS). Cosmetic outcome was assessed after 12 months using patient scar assessment scale (PSAS) and observer scar assessment scale (OSAS). RESULTS Sixty patients were randomized into two equal groups with comparable demographic and preoperative characteristics. Indications included nephrectomy, pyeloplasty, cyst marsupialization, adrenalectomy, and repair of retrocaval ureter. Operative time was 167 ± 24 and 145 ± 39 minutes in LESS and ML groups, respectively (p = 0.09). Estimated blood loss was 59 ± 34 and 43 ± 42 mL in both groups, respectively (p = 0.2). VAS was 1.7 ± 0.6 and 2.8 ± 0.5 in both groups, respectively (p = 0.02). PSAS and OSAS were 5.9 ± 0.85 and 10.6 ± 1.98 vs 8.9 ± 0.9 and 13.5 ± 6.3 in both groups, respectively (p > 0.05). There were no intraoperative complications, conversions to open surgery, or conventional laparoscopy in both groups. Mean postoperative Diclofenac Na was 151.7 ± 35.6 and 169.7 ± 47.3 mg in both groups, respectively (p = 0.04). Postoperative complications rate and hospital stay were comparable between both groups. CONCLUSION Both LESS and ML have comparable operative time, blood loss, complication rate, and hospital stay in treatment of upper urinary tract pathologies. However, LESS is associated with less analgesic requirement and better cosmetic outcome.
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Affiliation(s)
- Aly M Abdel-Karim
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Marawan M El Tayeb
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Elsaid Yahia
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Mostafa Elmissiry
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Mohamed Hassouna
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Salah Elsalmy
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
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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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17
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Lentine KL, Kasiske BL, Levey AS, Adams PL, Alberú J, Bakr MA, Gallon L, Garvey CA, Guleria S, Li PKT, Segev DL, Taler SJ, Tanabe K, Wright L, Zeier MG, Cheung M, Garg AX. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation 2017; 101:S1-S109. [PMID: 28742762 PMCID: PMC5540357 DOI: 10.1097/tp.0000000000001769] [Citation(s) in RCA: 198] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 03/20/2017] [Indexed: 12/17/2022]
Abstract
The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a "proof-in-concept" risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided.In citing this document, the following format should be used: Kidney Disease: Improving Global Outcomes (KDIGO) Living Kidney Donor Work Group. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017;101(Suppl 8S):S1-S109.
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Affiliation(s)
| | | | | | | | - Josefina Alberú
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | | | - Dorry L. Segev
- Johns Hopkins University, School of Medicine, Baltimore, MD
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Lafranca JA, Spoon EQW, van de Wetering J, IJzermans JNM, Dor FJMF. Attitudes among transplant professionals regarding shifting paradigms in eligibility criteria for live kidney donation. PLoS One 2017; 12:e0181846. [PMID: 28732093 PMCID: PMC5521829 DOI: 10.1371/journal.pone.0181846] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/26/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The transplant community increasingly accepts extended criteria live kidney donors, however, great (geographical) differences are present in policies regarding the acceptance of these donors, and guidelines do not offer clarity. The aim of this survey was to reveal these differences and to get an insight in both centre policies as well as personal beliefs of transplant professionals. METHODS An online survey was sent to 1128 ESOT-members. Questions were included about several extended donor criteria; overweight/obesity, older age, vascular multiplicity, minors as donors and comorbidities; hypertension, impaired fasting glucose, kidney stones, malignancies and renal cysts. Comparisons were made between transplant centres of three regions in Europe and between Europe and other countries worldwide. RESULTS 331 questionnaires were completed by professionals from 55 countries. Significant differences exist between regions in Europe in acceptance of donors with several extended criteria. Median refusal rate for potential live donors is 15%. Furthermore, differences are seen regarding pre-operative work-up, both in specialists who perform screening as in preoperative imaging. CONCLUSIONS Remarkably, 23.4% of transplant professionals sometimes deviate from their centre policy, resulting in more or less comparable personal beliefs regarding extended criteria. Variety is seen, proving the need for a standardized approach in selection, preferably evidence based.
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Affiliation(s)
- Jeffrey A. Lafranca
- Department of Surgery, division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Emerentia Q. W. Spoon
- Department of Surgery, division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jacqueline van de Wetering
- Department of Internal Medicine, division of Nephrology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan N. M. IJzermans
- Department of Surgery, division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank J. M. F. Dor
- Department of Surgery, division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
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Three-dimensional laparoscopy for living-donor nephrectomy with vaginal extraction: The first case. Int J Surg Case Rep 2017; 34:87-89. [PMID: 28376420 PMCID: PMC5379907 DOI: 10.1016/j.ijscr.2017.03.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 03/12/2017] [Accepted: 03/16/2017] [Indexed: 11/23/2022] Open
Abstract
Introduction Two-dimensional laparoscopy for living donor nephrectomy is the current standard of care. We report the first case of three-dimensional laparoscopy for living-donor nephrectomy with vaginal extraction. Presentation of case The procedure was performed in a 66-year-old woman donating his left kidney to her son with the HD S 3D column (Karl Storz, Tuttlingen, Germany). Preoperative computed tomography showed one left renal artery. The warm ischemic time was 2 min 20 s and the operative time was 200 min. There was no loss of blood and no intraoperative or postoperative complications. Discussion This report demonstrates the feasibility of using 3D laparoscopy which allows for a more in-depth vision, greater overall definition of planes, better accuracy of dissection and reduced operative times, for nephrectomy with vaginal extraction for kidney donation. Conclusion Three-dimensional laparoscopy for living-donor nephrectomy with vaginal extraction is feasible and could become a new standard.
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20
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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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21
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Raveendran V, Adiyat KT, Koduveli RM, John R. Robotic renal transplant recipient surgery with vaginally inserted allograft. J Robot Surg 2017; 11:473-477. [PMID: 28321809 DOI: 10.1007/s11701-017-0691-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 03/10/2017] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | - Roy John
- Aster Medcity, Ernakulam, Kerala, India
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22
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Butticè S, Sener TE, Lucan VC, Lunelli L, Laganà AS, Vitale SG, Netsch C, Tanidir Y, Pappalardo R, Magno C. Hybrid Transvaginal NOTES Nephrectomy: Postoperative Sexual Outcomes. A Three-center Matched Study. Urology 2017; 99:131-135. [DOI: 10.1016/j.urology.2016.09.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/31/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022]
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23
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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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24
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Transvaginal specimen removal in minimally invasive surgery: feasibility and possible complications during the incision of the posterior vaginal wall. World J Urol 2016; 35:1155-1156. [DOI: 10.1007/s00345-016-1955-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 10/12/2016] [Indexed: 01/06/2023] Open
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Barman N, Palese M. Robotic-Assisted Laparoscopic Donor Nephrectomy of Patient With Nutcracker Phenomenon. EXP CLIN TRANSPLANT 2016; 16:212-215. [PMID: 27210521 DOI: 10.6002/ect.2015.0335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report the case of a 30-year-old male patient undergoing a robotic-assisted laparoscopic left donor nephrectomy, where compression of the left renal vein between the superior mesenteric artery and aorta was noted on magnetic resonance angiography before the operation. The patient was diagnosed with nutcracker phenomenon and was noted to be asymptomatic at that time. This is the first reported case to date of a patient with nutcracker phenomenon who underwent a robotic-assisted laparoscopic donor nephrectomy. This article also reviews the current literature on nutcracker phenomenon and nutcracker syndrome.
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Affiliation(s)
- Naman Barman
- From the Icahn School of Medicine at Mount Sinai, NY, USA
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26
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Cabral JF, Braga IC, Branco F, Cavadas V, Ferreira AF, Ramos MS. What about vaginal extraction of the kidney? results of an online survey. Int Braz J Urol 2016; 42:78-82. [PMID: 27136470 PMCID: PMC4811229 DOI: 10.1590/s1677-5538.ibju.2015.0170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/20/2015] [Indexed: 11/22/2022] Open
Abstract
PURPOSE We aimed to characterize surgeons opinion about the vaginal extraction of the kidney after transperitoneal laparoscopic nephrectomy. Matherial and Methods: A 9-item questionnaire was published online (Survey Monkey TM) and publicized via email to a multidisciplinary pool of surgeons in Portugal. Data was collected and statistical analysis was performed using IBM SPSS Statistics, Version 21.0. RESULTS Three hundred and fifty nine inquiries were sent, 154 surgeons completed the questionnaires (response rate of 43.0%). Fifty five point eight percent of the participants would choose the transvaginal approach for themselves or for a close relative. The most stated arguments were a better cosmesis (29.0%) expectancy of lower post operative pain (26.0%) and lower rate of incisional hernias (23.0%). Defenders of the transabdominal procedure justified with an expectancy of lower complication rate (39%), namely impairment of sexual function and fertility (22%). The female gender and the familiarity with transvaginal surgery were the stronger predictors of the option for this approach (70.6% vs 48.5%; p=0,016 and 85.3% vs 46.6%; p <0.001 respectively). CONCLUSIONS Contrasting with similar surveys published on transvaginal NOTES, the vaginal specimen extraction after conventional laparoscopic nephrectomy was fairly accepted by the inquired surgeons.
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Affiliation(s)
| | - Isaac Campos Braga
- Departamento de Urologia, Hospital de Santo António - C.H.P, Porto, Portugal
- Instituto de Investigação em Ciências da Vida e da Saúde - I.C.V.S, Universidade do Minho; ICVS/3B´s - PT Laboratório Associado ao Governo, Braga, Portugal
| | - Frederico Branco
- Departamento de Urologia, Hospital de Santo António - C.H.P, Porto, Portugal
| | - Vitor Cavadas
- Departamento de Urologia, Hospital de Santo António - C.H.P, Porto, Portugal
| | - Avelino Fraga Ferreira
- Departamento de Urologia, Hospital de Santo António - C.H.P, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar - I.C.B.A.S - Universidade do Porto, Porto, Portugal
| | - Miguel Silva Ramos
- Departamento de Urologia, Hospital de Santo António - C.H.P, Porto, Portugal
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La néphrectomie laparoscopique avec extraction vaginale est-elle délétère sur la sexualité des patientes ? Prog Urol 2015; 25:1153-9. [DOI: 10.1016/j.purol.2015.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 08/12/2015] [Accepted: 09/04/2015] [Indexed: 11/23/2022]
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28
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Modi P, Pal B, Kumar S, Modi J, Saifee Y, Nagraj R, Qadri J, Sharmah A, Agrawal R, Modi M, Shah V, Kute V, Trivedi H. Laparoscopic Transplantation Following Transvaginal Insertion of the Kidney: Description of Technique and Outcome. Am J Transplant 2015; 15:1915-22. [PMID: 25809421 DOI: 10.1111/ajt.13224] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 01/15/2015] [Accepted: 01/16/2015] [Indexed: 01/25/2023]
Abstract
Laparoscopic kidney transplantation (LKT) is well accepted modality of treatment for ESRD patients at our center. Usually, the kidney is inserted through small Pfannenstiel incision. With the permission of the Internal Review Board, we carried out LKT in eight female recipients following insertion of the kidney through the vagina. The kidney was procured by the retroperitoneoscopic approach. Antibiotic prophylaxis was given. All cases were carried out successfully with immediate graft function and 100% graft and patient survival at 1 year of follow-up. Estimated glomerular filtration rate at 1 month and 1 year was similar to eight randomly selected female recipients who underwent open kidney transplantation (OKT). No analgesia was required in seven out of eight patients after the 3rd postoperative day. In summary, vaginal insertion of kidney and LKT is safe and feasible in a selected group of patients. It is associated with better analgesia and has similar allograft function as compare to OKT.
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Affiliation(s)
- P Modi
- Department of Urology and Transplantation Surgery, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - B Pal
- Department of Urology and Transplantation Surgery, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - S Kumar
- Department of Urology and Transplantation Surgery, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - J Modi
- Department of Urology and Transplantation Surgery, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Y Saifee
- Department of Urology and Transplantation Surgery, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - R Nagraj
- Department of Urology and Transplantation Surgery, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - J Qadri
- Department of Urology and Transplantation Surgery, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - A Sharmah
- Department of Urology and Transplantation Surgery, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - R Agrawal
- Department of Obstetrics and Gynecology, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - M Modi
- Department of Anesthesiology, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - V Shah
- Department of Anesthesiology, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - V Kute
- Department of Nephrology, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - H Trivedi
- Department of Nephrology, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
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Perioperative outcome and female sexual function after laparoscopic transvaginal NOTES-assisted nephrectomy. World J Urol 2015; 33:2009-14. [DOI: 10.1007/s00345-015-1573-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022] Open
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Andrés G, García-Mediero J, García-Tello A, Arance I, Cabrera P, Angulo J. The best option: Umbilical LESS radical nephrectomy with vaginal extraction. Actas Urol Esp 2015; 39:188-94. [PMID: 24974779 DOI: 10.1016/j.acuro.2014.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 05/26/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Umbilical laparoendoscopic single-site (LESS) surgery represents an excellent alternative to laparoscopic or robotic multiport surgery. LESS surgery offers faster recovery, less postoperative pain and optimal cosmetic results. The reusable nature of its instruments also has significant economic advantages. PATIENT AND METHOD We present a 34-year-old patient with a solid mesorenal lesion measuring 8 cm in the left kidney treated with pure LESS radical nephrectomy assisted by vaginal extraction of the specimen. The umbilical approach using a single-site multichannel KeyPort (Richard Wolf GmbH, Knittlingen, Germany) with DuoRotate curved instruments allows for minimum crushing and fewer spatial conflicts. Its perfect umbilical adaptation provides a hermetic system. The instrument's double rotation provides considerable movement precision. Vaginal extraction avoids damage to the abdominal wall and the need for widening the umbilical incision. RESULTS After the placement of the device and triangulation of the clips, we proceeded to operate on posterior parietal peritoneum. The descending colon was mobilized to access the retroperitoneum and dissect the renal hilum. Hem-o-lok clips were placed on the artery and vein, which were subsequently sectioned. The specimen was inserted into a laparoscopic bag. Under direct vision, we placed a 15-mm trocar through the bottom of the vaginal posterior fornix to facilitate the extraction of the bag's thread. The incision was widened with the fingers, and the specimen was extracted, closing the vagina from the perineum with visualization from the navel. Abdominal drainage was not employed. The surgical time was 180 min. The patient was discharged the following day without needing analgesia. A year later, the patient was disease-free and had no complications. CONCLUSIONS Umbilical LESS radical nephrectomy with vaginal extraction is feasible in selected cases. The procedure is oncologically safe, avoids scars and facilitates early recovery. From a practical point of view, this approach greatly simplifies natural orifice transluminal endoscopic surgery (NOTES) and enables a minimally invasive equivalent result.
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Xue Y, Zou X, Zhang G, Yuan Y, Xiao R, Liao Y, Zhong X, Jiang B, Xu R, Zou Y, Xu G, Xie K, Zhang X. Transvaginal Natural Orifice Transluminal Endoscopic Nephrectomy in a Series of 63 Cases: Stepwise Transition From Hybrid to Pure NOTES. Eur Urol 2015; 68:302-10. [PMID: 25837534 DOI: 10.1016/j.eururo.2015.03.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/14/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND The feasibility of hybrid transvaginal NOTES (natural orifice transluminal endoscopic surgery) nephrectomy (HTNN) has already been demonstrated. However, pure transvaginal NOTES nephrectomy (PTNN) has been limited to animal experiments with only one report of its use in humans. OBJECTIVE To describe our initial experience with HTNN and a stepwise transition towards PTNN. DESIGN, SETTING, AND PARTICIPANTS Between May 2010 and September 2011, 63 patients underwent nephrectomy (60 HTNNs and 3 PTNNs) in our institution, including 45 patients with benign renal disease and 18 patients with malignant renal disease. SURGICAL PROCEDURE Of the HTNNs, 33 were performed using two umbilical trocars and one transvaginal trocar, and 27 were performed using one umbilical trocar and a transvaginal multi-instrument access port; 3 PTNNs were performed using a self-developed, three-channel ZOU-port without any transumbilical assistance. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS All data referring to patient demographics, surgery, pathology, and perioperative outcomes were recorded. Sexual function was assessed with the Female Sexual Function Index (FSFI) questionnaire before and after surgery. The cosmetic result was investigated by administering the Patient Scar Assessment Questionnaire and Scoring System (PSAQ). RESULTS AND LIMITATIONS A total of 59 HTNNs and 3 PTNNs were successfully performed. One patient was converted to open surgery because of injury to the inferior vena cava. The mean operative time was 130min (range: 100-260min) for HTNN and 193min (range: 180-210min) for PTNN. The mean estimated blood loss was 150ml. The mean postoperative hospital stay was 7.4 d. Forty-eight patients completed the FSFI questionnaire, and analysis did not show differences in FSFI scores before and after surgery. The better cosmetic results were confirmed by the PSAQ score. CONCLUSIONS HTNN is feasible and safe in appropriate patients. Existing instruments are adequate for HTNN, but significant improvement is still needed. PTNN is technically challenging, but is feasible and may be performed safely. Further improvement of instruments is necessary for PTNN. Clinical investigation in comparison to the established techniques should take place to evaluate the outcome of technique. PATIENT SUMMARY Pure transvaginal natural orifice transluminal endoscopic nephrectomy (PTNN) is technically challenging but feasible and may be performed safely. Further improvements in instruments are necessary for PTNN.
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Affiliation(s)
- Yijun Xue
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, People's Republic of China
| | - Xiaofeng Zou
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, People's Republic of China.
| | - Guoxi Zhang
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, People's Republic of China
| | - Yuanhu Yuan
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, People's Republic of China
| | - Rihai Xiao
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, People's Republic of China
| | - Yunfeng Liao
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, People's Republic of China
| | - Xin Zhong
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, People's Republic of China
| | - Bo Jiang
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, People's Republic of China
| | - Ruiquan Xu
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, People's Republic of China
| | - Yuhua Zou
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, People's Republic of China
| | - Gang Xu
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, People's Republic of China
| | - Kunlin Xie
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, People's Republic of China
| | - Xu Zhang
- Department of Urology, Clinical Division of Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
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Day Case Laparoscopic Nephrectomy With Vaginal Extraction: Initial Experience. Urology 2014; 84:1525-8. [DOI: 10.1016/j.urology.2014.06.084] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/29/2014] [Accepted: 06/18/2014] [Indexed: 11/15/2022]
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Gurluler E, Berber I, Cakir U, Gurkan A. Transvaginal route for kidney extraction in laparoscopic donor nephrectomy. JSLS 2014; 18:JSLS-D-14-00156. [PMID: 25419107 PMCID: PMC4236079 DOI: 10.4293/jsls.2014.00156] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: The aim of this retrospective study was to compare conventional laparoscopic living-donor nephrectomy with transvaginal natural orifice transluminal endoscopic surgery–assisted living-donor nephrectomy in terms of feasibility and reproducibility. Methods: A total of 115 consecutive female patients who underwent laparoscopic living-donor nephrectomy (n = 70) or transvaginal natural orifice transluminal endoscopic surgery–assisted living-donor nephrectomy (n = 45) were included and compared in terms of operative characteristics, as well as donor and recipient outcomes. Results: No significant difference was observed between the laparoscopic living-donor nephrectomy and transvaginal natural orifice transluminal endoscopic surgery–assisted living-donor nephrectomy groups in terms of mean duration of warm and cold ischemia, operation time, length of hospital stay, arterial anastomoses, visual analog scale pain scores, serum creatinine levels, and receiver outcomes, whereas a significantly higher number of venous anastomoses was noted in the laparoscopic living-donor nephrectomy group than in the transvaginal natural orifice transluminal endoscopic surgery–assisted living-donor nephrectomy group (P = .029). Conclusions: Transvaginal natural orifice transluminal endoscopic surgery–assisted living-donor nephrectomy seems to be a feasible and reproducible alternative to conventional laparoscopic living-donor nephrectomy in female donors provided the viability of the vagina as an organ retrieval route.
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Affiliation(s)
- Ercument Gurluler
- International Hospital Organ Transplant Center, Acibadem University, Istanbul, Turkey
| | - Ibrahim Berber
- International Hospital Organ Transplant Center, Acibadem University, Istanbul, Turkey
| | - Ulkem Cakir
- International Hospital Organ Transplant Center, Acibadem University, Istanbul, Turkey
| | - Alihan Gurkan
- International Hospital Organ Transplant Center, Acibadem University, Istanbul, Turkey
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Hu D, Wang X, Hu W. Modified retroperitoneoscopic port sites for surgery of upper urinary tract. JSLS 2014; 18:JSLS-D-13-00206. [PMID: 25392615 PMCID: PMC4154405 DOI: 10.4293/jsls.2014.00206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Our objective was to introduce our experience using modified retroperitoneoscopic port positions for operations of the upper urinary tract. METHODS We designed different trocar positions or incisions according to different surgical procedures and specimen sizes. A total of 116 patients, comprising patients with common adrenal, kidney, and ureter diseases, underwent retroperitoneoscopic operations by use of modified incisions. These patients comprised 23 with adrenal diseases, 84 with kidney diseases, and 9 with ureter diseases. The specimen was retrieved, as much as possible, through a transverse incision to produce a hidden scar after recovery. By contrast, 143 patients underwent the same or similar procedures using classical 3-port incisions. The operative time was defined as the time from skin incision to skin closure. RESULTS There were no significant differences in age, estimated blood loss, oral intake, and hospital stay between groups. A significant difference in favor of the modified group was noted with respect to analgesia use (diclofenac sodium, 50 mg vs 100 mg; P<.05) in all 3 modified methods, as well as in cosmetic outcome in the groups undergoing the first modification (score, 8.9±2.2 VS 7.3±2.8; P<.05) and second modification (score, 8.7±2.5 VS 7.1±2.4; P<.05). In addition, the mean operative time in patients undergoing ureter operations was shorter than that in the conventional group using classical 3-port positions (55±11 minutes vs 70±15 minutes, P<.05). CONCLUSIONS Our modified retroperitoneoscopic incision is a safe, cosmetic alternative procedure for operations of the upper urinary tract. Different diseases and specimen sizes can be treated with the personalized or suitable incisions that we have introduced.
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Affiliation(s)
- Dongliang Hu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xinghuan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wanli Hu
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
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Breda A, Schwartzmann I, Emiliani E, Rodriguez-Faba O, Gausa L, Caffaratti J, de León XP, Villavicencio H. Mini-laparoscopic live donor nephrectomy with the use of 3-mm instruments and laparoscope. World J Urol 2014; 33:707-12. [PMID: 25182807 DOI: 10.1007/s00345-014-1360-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 07/01/2014] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To analyze our preliminary outcomes on the use of 3 mm instruments for laparoscopic live donor nephrectomy (LLDN). METHODS Our series includes thirteen patients, who underwent LLDN using 3-mm instruments and laparoscope and 5-mm transumbilical trocar. The patients were followed at 7 and 14 days from discharge and were specifically asked about their cosmetic satisfaction. At follow-up, the recipient graft function was controlled, as well as the donor's cosmetic results. Eight months after surgery, all thirteen patients were asked to fill out the Patient Scar Assessment Questionnaire and Scoring System (PSAQ). RESULTS All patients presented good recovery after surgery. Regarding cosmetic outcomes, the donors expressed their satisfaction toward the minimal incision size and optimal esthetic results at 7 and 14 days from discharge home. The low scores on each section of the PSAQ confirmed the favorable outcomes. Early graft function was satisfactory at 1 and 3 months after the kidney transplantation. Furthermore, there were no major complications in the recipients. CONCLUSIONS Our persistent positive results with the use of 3-mm instruments during LLDN support this technique as a good alternative to the standard laparoscopic approach for minimizing the incision site, while maintaining safety and excellent clinical outcomes. The fact that the general laparoscopic standards are maintained could make this approach a very attractive alternative to the other minimally invasive approaches for live donor nephrectomy. The hope is in that the higher degree of satisfaction in the donor population demonstrated in this study may likely enhance living kidney donation.
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Affiliation(s)
- Alberto Breda
- Urology Department, Fundació Puigvert, Barcelona, Spain,
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Autorino R, Brandao LF, Sankari B, Zargar H, Laydner H, Akça O, De Sio M, Mirone V, Chueh SCJ, Kaouk JH. Laparoendoscopic single-site (LESS) vs laparoscopic living-donor nephrectomy: a systematic review and meta-analysis. BJU Int 2014; 115:206-15. [DOI: 10.1111/bju.12724] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Riccardo Autorino
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
- Urology Unit; Second University of Naples; Naples Italy
| | - Luis Felipe Brandao
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Bashir Sankari
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
- Department of Surgical Subspecialties; Cleveland Clinic Abu Dhabi; Abu Dhabi UAE
| | - Homayoun Zargar
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Humberto Laydner
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Oktay Akça
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Marco De Sio
- Urology Unit; Second University of Naples; Naples Italy
| | | | - Shih-Chieh J. Chueh
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Jihad H. Kaouk
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
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Porpiglia F, Autorino R, Cicione A, Pagliarulo V, Falsaperla M, Volpe A, Gozen AS, Celia A, De Sio M, Saita A, Damiano R, Zacchero M, Fiori C, Terrone C, Bertolo R, Greco F, Breda A, Lima E, Rassweiler J. Contemporary urologic minilaparoscopy: indications, techniques, and surgical outcomes in a multi-institutional European cohort. J Endourol 2014; 28:951-7. [PMID: 24708491 DOI: 10.1089/end.2014.0134] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To provide an analytical overview of contemporary indications, techniques, and outcomes of urologic minilaparoscopy (ML) in multiple European centers. METHODS Data of patients who had undergone a minilaparoscopic urologic procedure at nine European institutions between 2009 and 2012 were retrospectively gathered. Surgical procedures were classified as upper or lower urinary tract and as ablative or extirpative and reconstructive. The main surgical outcome parameters were analyzed and relevant operative data related to the surgical technique were recorded. RESULTS Overall, 192 patients (mean age 45.25±17.8 years) were included in the analysis. Most of them were nonobese (mean body mass index [BMI] 24.7±3.6 kg/m(2)) at low estimated surgical risk (mean American Society of Anesthesiologists [ASA] 1.69±0.68). Indications for surgery were mostly nononcologic (132 cases, 68.8%). Most of the procedures were done in the upper urinary tract (133 cases, 69.2%) and were mostly with a reconstructive intent (109 cases, 56.7%). Overall operative time was 132.7±52.3 minutes with an estimated blood loss of 60.9±47.6 mL while the mean hospital stay was 5±2.1 days. Most of the postoperative complications were low Clavien grade (1 and 2), with only one (0.5%) grade 3 and one (0.5%) grade 4 complications recorded. CONCLUSIONS A broad range of common procedures can be safely and effectively performed with ML techniques. By duplicating the principles of standard laparoscopy, but potentially offering less surgical scar and trauma, ML can be regarded as a viable option when looking for a virtually "scarless" surgery.
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Abstract
Improvements in surgical techniques, and particularly the development and widespread clinical introduction of laparoscopy in the past two decades, have revolutionized the management of urological disease. Natural orifice transluminal endoscopic surgery (NOTES) holds promise in further advancing treatment outcomes in urology. This novel minimally invasive surgical approach can negate the requirement for skin incisions and, therefore, could potentially improve morbidity, convalescence, and cosmesis. After considerable preclinical development, the feasibility of 'hybrid' NOTES-involving concurrent laparoscopy-and 'pure' NOTES nephrectomy and prostatectomy procedures has now been successfully demonstrated in patients with urological conditions, whereas proof-of-concept studies of NOTES partial cystectomy have been performed in animal models. Whether such procedures offer therapeutic and safety benefits compared with traditional laparoscopic techniques remains unknown; indeed, concerns remain over the potential perioperative and postoperative adverse events associated with NOTES, such as incomplete closure of the entry-point incision, infection, and haemorrhage. In particular, however, the requirement for the development of specific rationally designed NOTES instrumentation as well as specially trained, highly skilled personnel to perform the surgery continues to restrict the utility of NOTES. Thus, considerable effort is now needed to shift the focus of research to refining NOTES methodologies to enable translation of these promising proof-of-principle studies into the clinic.
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Komorowski AL, Alba Mesa F, Bała MM, Mituś JW, Wysocki WM. Systematic Review and Meta-analysis of Complications in Transvaginal Approach in Laparoscopic Surgery. Indian J Surg 2014; 77:853-62. [PMID: 27011470 DOI: 10.1007/s12262-014-1038-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 01/20/2014] [Indexed: 10/25/2022] Open
Abstract
Transvaginal access is the most popular natural orifice translumenal technique in the minimally invasive surgery. Reviews on non-gynecological transvaginal approach morbidities reveal that rates vary greatly. A systematic review of transvaginal approach in non-gynecological intraabdominal procedures was carried out to assess the risk of complications. A systematic search was conducted using MEDLINE, EMBASE, PubMed, and the Cochrane Library from the inception of these databases to March 2012. The following keywords were searched: "transvaginal", "NOTES", "single incision", and "single port". From the total of 231 potentially eligible abstracts, 87 papers were retrieved and evaluated as fulfilling the eligibility criteria. The final analysis included 32 articles. The overall complications rate was 4.4 %, and complications related to the transvaginal port reached 2.4 %. Conversion rate to open surgery was 3.4 %. The incidence of postoperative urinary tract infection was 0.8 %. The mean operative time was 119 min. The mean hospital stay was 3.1 days (range 6 h-12 days). The technique of transvaginal access can offer several advantages for a patient and is associated with an acceptable rate of complications.
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Affiliation(s)
- Andrzej L Komorowski
- Department of Surgical Oncology, Cancer Centre, Maria Skłodowska-Curie Memorial Institute, Kraków ul. Garncarska 11, 31-115 Kraków, Poland
| | - Francisco Alba Mesa
- Consorcio Sanitario Publico del Aljarafe, Hospital San Juan de Dios, Bormujos, Sevilla Spain
| | - Małgorzata M Bała
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy W Mituś
- Department of Surgical Oncology, Cancer Centre, Maria Skłodowska-Curie Memorial Institute, Kraków ul. Garncarska 11, 31-115 Kraków, Poland ; Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Wojciech M Wysocki
- Department of Surgical Oncology, Cancer Centre, Maria Skłodowska-Curie Memorial Institute, Kraków ul. Garncarska 11, 31-115 Kraków, Poland
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Kishore T, Shetty A, Balan T, John MM, Iqbal M, Jose J, Vinodan K. Laparoscopic Donor Nephrectomy with Transvaginal Extraction: Initial Experience of 30 Cases. J Endourol 2013; 27:1361-5. [DOI: 10.1089/end.2013.0412] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T.A. Kishore
- Department of Urology and Nephrology, Medical Trust Hospital, Cochin, Kerala, India
| | - Abijit Shetty
- Department of Urology and Nephrology, Medical Trust Hospital, Cochin, Kerala, India
| | - Tarun Balan
- Department of Urology and Nephrology, Medical Trust Hospital, Cochin, Kerala, India
| | - Mammen M. John
- Department of Urology and Nephrology, Medical Trust Hospital, Cochin, Kerala, India
| | - Mohammed Iqbal
- Department of Urology and Nephrology, Medical Trust Hospital, Cochin, Kerala, India
| | - Joshy Jose
- Department of Anesthesiology, Medical Trust Hospital, Cochin, Kerala, India
| | - K. Vinodan
- Department of Anesthesiology, Medical Trust Hospital, Cochin, Kerala, India
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Zou X, Zhang G, Xue Y, Yuan Y, Xiao R, Wu G, Wang X, Wu Y, Long D, Yang J, Xu H, Liu F, Zhang X. Suprapubic-assisted laparoendoscopic single-site surgery (LESS) in urology: our experience. BJU Int 2013; 112:E92-8. [PMID: 23795803 DOI: 10.1111/bju.12158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report our experience with suprapubic-assisted laparoendoscopic single-site surgery (SA-LESS) in urology. PATIENTS AND METHODS In all, 236 patients underwent SA-LESS A 5- and 10-mm (or two 5-mm) trocars were inserted at the medial margin of the umbilicus. A 10- or 5-mm trocar was inserted into the abdominal cavity below the ipsilateral pubic hairline. The technique for the SA-LESS is similar to that of the standard laparoscopy, with conventional instruments placed in the abdominal trocars, under direct vision achieved by a 10-mm conventional 30 ° or 5-mm flexible-tip 0 ° laparoscope placed through the trocar below the pubic hairline. RESULTS SA-LESS was successfully completed in 229 patients, without the need for ancillary trocars or additional instruments. Six patients required conversion to standard laparoscopy because of intraoperative bleeding (five) and failure to progress (one). One patient underwent open conversion because of gradual bleeding during the dissection of a dense adhesive renal pedicle due to infection and fibrosis The various SA-LESS procedures performed included adrenalectomy (15), renal cyst excision (19), nephrectomy (78; simple 63, radical 15), nephroureterectomy (three), nephron-sparing surgery (three), heminephroureterectomy (five), pyeloplasty (nine), pyelolithotomy (six), and ureterolithotomy (98). The median operative time was 81, 106, 92, 140, and 85 min, and the estimated blood loss was 60, 205, 115, 75, and 55 mL for adrenalectomy, simple nephrectomy, radical nephrectomy, pyeloplasty, and ureterolithotomy, respectively. At a mean (range) follow-up of 14.8 (2-27) months there was a hidden umbilicus scar. The scar below the pubic hairline was not detectable because of pubic hair covering. CONCLUSIONS SA-LESS appears to be feasible, safe and effective. Compared with umbilical LESS, the placement of a trocar at the umbilicus and below the pubic hairline not only decreases the difficulty of surgery but also leads to little postoperative pain and good cosmetic results.
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Affiliation(s)
- Xiaofeng Zou
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China.
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Kallidonis P, Kontogiannis S, Kyriazis I, Georgiopoulos I, Al-Aown A, Stolzenburg JU, Liatsikos E. Laparoendoscopic single-site surgery in kidney surgery: clinical experience and future perspectives. Curr Urol Rep 2013; 14:496-505. [PMID: 23740382 DOI: 10.1007/s11934-013-0346-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Laparoscopic surgery of the upper urinary tract has reduced the morbidity related to large abdominal incisions and has resulted in significant advantages over open surgery. Nevertheless, the pursuit for even more minimally invasive alternatives to laparoscopy has led to the concept of scarless surgery and the approach of laparoendoscopic single-site surgery (LESS). LESS is currently a feasible approach for the majority of kidney surgical procedures, and there is intense debate regarding its efficiency and advantages. In the present review of the literature, the current status of upper urinary LESS and its advantages and disadvantages, as well the technological and technical evolution, are presented.
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Matsuda T. Recent advances in urologic laparoscopic surgeries: laparoendoscopic single-site surgery, natural orifice transluminal endoscopic surgery, robotics and navigation. Asian J Endosc Surg 2013; 6:68-77. [PMID: 23601994 DOI: 10.1111/ases.12032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 02/26/2013] [Accepted: 03/05/2013] [Indexed: 12/17/2022]
Abstract
Laparoscopic surgery was developed at the end of the 1980s and has been utilized in almost all urologic surgical procedures. It offers the benefits of less invasiveness and earlier recovery than open surgery. The introduction of laparoendoscopic single-site surgery has offered reduced pain and improved cosmetic satisfaction to patients. Scarless nephrectomy has been realized with transvaginal natural orifice transluminal endoscopic surgery in women. The development of surgical robots has decreased the technical difficulty of complicated procedures, shortened the learning curve, and improved perioperative outcomes relative to laparoscopic surgery. Surgical navigation using real-time sonography, augmented reality, fluorescence, or radioisotope images will improve the quality of these surgeries.
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Affiliation(s)
- Tadashi Matsuda
- Department of Urology and Andrology, Kansai Medical University, Shinmachi 2-5-1, Hirakata, Osaka 573-1010, Japan.
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[Surgical aspects of living donor nephrectomy]. Actas Urol Esp 2013; 37:181-7. [PMID: 22840385 DOI: 10.1016/j.acuro.2012.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 05/11/2012] [Indexed: 11/21/2022]
Abstract
CONTEXT Living donor renal transplant surgery has evolved from the classical nephrectomy by lumbotomy to less invasive surgery, the laparoscopic and robotic nephrectomy currently being the most important. It is important to know the available evidence on whether nephrectomy in patients with multiple arteries, right kidney and in obese patients can be performed safely when there is a correct indication. OBJECTIVE To perform a review of the different surgical techniques in living donor nephrectomy, adapted to the current surgical evidence and other aspects related to the indication. EVIDENCE ACQUISITION A systematic review was made in PubMed (1997-2011). This included previous reviews randomized controlled clinical studies, cohort studies, and meta-analyses of this surgical aspects of living donor nephrectomy. CONCLUSIONS Currently, there is sufficient evidence to consider living donor laparoscopic nephrectomy as the technique of choice, although the role of hand-assisted retroperitoneoscopic technique is still not totally clear. Open surgery techniques using mini-incision are an acceptable alternative for the sites that have not yet implemented laparoscopic surgery. Right kidney nephrectomy, of those cases that present multiple pedicles and in obese donors, is justified in selected cases.
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Izquierdo L, Peri L, García-Cruz E, Musquera M, Piqueras M, Gosálbez D, Alcaraz A. Recent advances of natural orifice transluminal endoscopic surgery in urological surgery. Int J Urol 2013; 20:462-6. [PMID: 23294123 DOI: 10.1111/iju.12066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 12/02/2012] [Indexed: 11/30/2022]
Abstract
Natural orifice transluminal endoscopic surgery designates a surgical procedure that utilizes one or more patent natural orifices of the body with the intention to puncture a hollow viscera in order to enter the abdominal cavity. First carried out at the beginning of the 2000s in experimental models, it can be considered the natural evolution of laparoscopy towards the ideal of scarless surgery, as the avoidance of a large abdominal scar is associated with better cosmetic results and better recovery. However, the technology currently available does not allow the performance of complete pure natural orifice transluminal endoscopic surgery procedures. The surgical tools used are not specially designed for this approach, so difficulties in retracting organs, bleeding control and clashing of instruments are the main obstacle surgeons face. For this reason, the current available technique is the so-called hybrid approach, where a natural orifice approach is combined with some abdominal trocars, using the natural orifice as the exit door for the specimen removal. As not many comparative studies have been published evaluating the advantages of natural orifice transluminal endoscopic surgery in front of traditional laparoscopic surgery, a review of the history of natural orifice transluminal endoscopic surgery, and an assessment of the available evidence of this technique regarding renal and urological pelvic surgery are performed in this article.
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Affiliation(s)
- Laura Izquierdo
- Department of Urology, Hospital Clinic, University of Barcelona, Barcelona, Spain
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Abstract
Living kidney donation is on the rise, either due to cultural or ethical reasons or due to a lack of deceased donor kidneys. For adequately counseling of a potential living kidney donor, medical professionals must know not only the immediate risks of kidney donation but also possible long-term effects of kidney donation on the donor's physical and psychological well-being. This also includes a range of aspects such as quality of life, insurance issues, and family planning following kidney donation. This review article is based on a Medline and PubMed search and elucidates the risks living kidney donors face with regard to all aspects just mentioned. Living kidney donation does not end with the operative procedure--long-term cost-free physical and psychological follow-up should be offered to each donor for the gift he or she is willing to give to the recipient.
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Affiliation(s)
- M Giessing
- Department of Urology, Heinrich Heine University Hospital, Duesseldorf, Germany.
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Chu Y, Liu CY, Wu YC, Hsieh MJ, Chen TP, Chao YK, Wu CY, Yuan HC, Ko PJ, Liu YH, Liu HP. Comparison of hemodynamic and inflammatory changes between transoral and transthoracic thoracoscopic surgery. PLoS One 2013; 8:e50338. [PMID: 23300944 PMCID: PMC3536809 DOI: 10.1371/journal.pone.0050338] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 10/17/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Natural orifice transluminal endoscopy has been developed for abdominal surgical procedures. The aim of this study was to compare the surgical outcome between a novel transoral approach and a standard transthoracic approach for the thoracic cavity in a canine model. METHODS Twenty-eight dogs were assigned to transoral (n = 14) or standard thoracoscopy (n = 14). Each group underwent thoracic exploration, pre-determined surgical lung biopsy, and pericardial window creation. Blood draws were obtained before surgery and at postoperative days 1, 3, 7, and 14. Operative time, complications, laboratory parameters, hemodynamic parameters, and inflammatory parameters were compared between the two procedures. The animals were monitored for two weeks and necropsy were performed for surgical outcome evaluation. RESULTS The thoracic procedures were successfully performed in all of the dogs, with the exception of one animal in the transoral group. There were no serious acute or delayed complications related to surgery. There was no difference between the two surgical groups for each of the hemodynamic parameters that were evaluated. Regarding the immunological impact of the surgeries, transoral thoracoscopy was associated with significant elevations in interleukin 6 and c-reactive protein levels on postoperative days 1 and 3, respectively, when compared with the standard thoracoscopy. All dogs recovered well, without signs of mediastinitis or thoracic infection. Necropsy revealed absence of infection, no injury to vital organs, and confirmed the success of the novel procedure. CONCLUSIONS This study suggests that both techniques were comparable with respect to procedure success rate, hemodynamic impact, and inflammatory changes. Furthermore, there was no difference in the incidence of postoperative discomfort between groups.
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Affiliation(s)
- Yen Chu
- Department of Thoracic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Ying Liu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Cheng Wu
- Department of Thoracic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Ju Hsieh
- Department of Thoracic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Tzu-Ping Chen
- Department of Thoracic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Kai Chao
- Department of Thoracic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Yang Wu
- Department of Thoracic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Hsu-Chia Yuan
- Laboratory Animal Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Po-Jen Ko
- Department of Thoracic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Hen Liu
- Department of Thoracic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
- * E-mail: (Y-HL); (H-PL)
| | - Hui-Ping Liu
- Department of Thoracic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
- * E-mail: (Y-HL); (H-PL)
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Liss MA, Kopp RP, Derweesh IH. Editorial comment. Urology 2012. [PMID: 23206760 DOI: 10.1016/j.urology.2012.08.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Transvaginal Hybrid Natural Orifice Transluminal Surgery Robotic Donor Nephrectomy: First Clinical Application. Urology 2012. [DOI: 10.1016/j.urology.2012.08.061] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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