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Branchereau J, Prudhomme T, Bessede T, Verhoest G, Boissier R, Culty T, Matillon X, Defortescu G, Sallusto F, Terrier N, Drouin S, Karam G, Badet L, Timsit MO. [Living donor nephrectomy: The French guidelines from CTAFU]. Prog Urol 2021; 31:50-56. [PMID: 33423748 DOI: 10.1016/j.purol.2020.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To propose surgical recommendations for living donor nephrectomy. METHOD Following a systematic approach, a review of the literature (Medline) was conducted by the CTAFU regarding functional and anatomical assessment of kidney donors, including which side the kidney should be harvested from. Distinct surgical techniques and approaches were evaluated. References were considered with a predefined process to propose recommendations with the corresponding levels of evidence. RESULTS The recommendations clarify the legal and regulatory framework for kidney donation in France. A rigorous assessment of the donor is one of the essential prerequisites for donor safety. The impact of nephrectomy on kidney function needs to be anticipated. In case of modal vascularization of both kidneys without a relative difference in function or urologic abnormality, removal of the left kidney is the preferred choice to favor a longer vein. Mini-invasive approaches for nephrectomy provide faster donor recovery, less donor pain and shorter hospital stay than open surgery. CONCLUSION These French recommendations must contribute to improving surgical management of candidates for kidney donation.
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Affiliation(s)
- J Branchereau
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Nantes, 5, allée de lÎle-Gloriette, 44093 Nantes cedex 01, France
| | - T Prudhomme
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Toulouse, avenue du Pr-Jean-Poulhès, 31059 Toulouse, France
| | - T Bessede
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital de Bicêtre, université de Paris-Saclay, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - G Verhoest
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - R Boissier
- Service d'urologie et transplantation, hôpital de La Conception, université Aix-Marseille, 47, boulevard Baille, 13005 Marseille, France
| | - T Culty
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - X Matillon
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - G Defortescu
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU Rouen, 37, boulevard Gambetta, 76000 Rouen, France
| | - F Sallusto
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Toulouse, avenue du Pr-Jean-Poulhès, 31059 Toulouse, France
| | - N Terrier
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU Grenoble Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - S Drouin
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital de la Pitié-Salpêtrière, université Paris Sorbonne, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - G Karam
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Nantes, 5, allée de lÎle-Gloriette, 44093 Nantes cedex 01, France
| | - L Badet
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - M-O Timsit
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; PARCC, INSERM, équipe labellisée par la Ligue Contre le Cancer, 56, rue Leblanc, université de Paris, 75015 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France.
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Xiao Q, Fu B, Song K, Chen S, Li J, Xiao J. Comparison of Surgical Techniques in Living Donor Nephrectomy: A Systematic Review and Bayesian Network Meta-Analysis. Ann Transplant 2020; 25:e926677. [PMID: 33122621 PMCID: PMC7607668 DOI: 10.12659/aot.926677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The aim of this study was to compare and evaluate surgical techniques used for living donor nephrectomy (LDN). Material/Methods We performed a meta-analysis to compare 4 surgical techniques: open LDN (OLDN), laparoscopic LDN (LLDN), hand-assisted LLDN (HALLDN), and robot-assisted LLDN (RLDN). Results No significant differences were found among these surgical techniques in terms of BMI, donor postoperative complications, 1-year graft survival, and DGF. Compared to the OLDN, the other 3 surgical techniques preferred to harvest the left kidney. When the right kidney was chosen as a donor, OLDN was the first-choice surgical technique. EBL was significantly lower in the HALLDN, LLDN, and RLDN groups when compared to the OLDN group. However, operative time and WIT were significantly shorter in the OLDN group. The RLDN group had an increased rate of donor intraoperative complications and a significantly lower VAS on day 1. The OLDN group required more morphine intake than the LLDN group. The length of hospital stay was significantly longer and AR was significantly higher in the OLDN group than in the LLDN and HALLDN groups. Conclusions There are no significant differences in donor postoperative complications, recipient DGF, and graft survival among the 4 surgical techniques. OLDN reduces WIT and operation time, but increases EBL and AR. RLDN and LLDN reduce the length of hospital stay, morphine intake, and VAS, and thus accelerate recovery. However, RLDN is associated with increased intraoperative complications.
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Affiliation(s)
- Qi Xiao
- Department of Transplantation, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Biqi Fu
- Department of Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Keqin Song
- Department of Transplantation, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Sufen Chen
- Department of Transplantation, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Jianfeng Li
- Department of Transplantation, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Jiansheng Xiao
- Department of Transplantation, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
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Vu L, Nghia N, Thanh D, Giang T, Nga V, Bui L, Chu D. Laparoscopic living donor right nephrectomy: Assessment of outcome and association of BMI to length of right renal vein. Actas Urol Esp 2019; 43:536-542. [PMID: 31405530 DOI: 10.1016/j.acuro.2019.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/27/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
AIMS The aim of this study was to describe outcomes of laparoscopic living donor right nephrectomy (LLDRN) and study factors affecting the length of right renal vein from the donors. MATERIAL AND METHODS This study was conducted in 60 donors (48 males and 12 females) from January 2016 to December 2017. We performed a retrospective review of consecutive patients who underwent transperitoneal right laparoscopic living donor nephrectomy at our unit. RESULTS LLDRN was successfully performed in all subjects by the same surgeons. Among 60 cases, 47 donors had single renal artery and vein, 2 cases had one artery and 2 veins, and 5 donors had 2 arteries and one vein, and the rest had 2-3 arteries with 1-3 veins. Operative time was 142.60±33.73min. Warm ischemic time was 2.64±0.76min. The mean hospital stay was 6.69±0.63 days. The median length of right renal vein was 1.92±0.41cm. All transplanted kidneys showed immediate function. No graft losses were recorded. Almost no gender differences were found in study variables except BMI and warm ischemic time, that was higher BMI but shorter warm ischemic time in female versus male donors. Further analysis showed a negative correlation between BMI and right renal vein (r=-0.282, P<0.05), but a positive correlation between operative time and estimate blood loss (r=0.37, P<0.01). CONCLUSIONS LLDRN is a feasible safe procedure, less traumatic approach, and provides good outcomes kidney for recipients. Notably, in the study group the higher BMI was associated with resulting more difficult LLDRN and kidney transplantation.
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Broe MP, Galvin R, Keenan LG, Power RE. Laparoscopic and hand-assisted laparoscopic donor nephrectomy: A systematic review and meta-analysis. Arab J Urol 2018; 16:322-334. [PMID: 30140469 PMCID: PMC6104662 DOI: 10.1016/j.aju.2018.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 02/08/2018] [Indexed: 01/11/2023] Open
Abstract
Objective To compare the perioperative outcomes of hand-assisted laparoscopic donor nephrectomy (HALDN) and pure LDN, as HALDN and LDN are the two most widely used techniques of DN to treat end-stage renal disease. Methods In this systematic review and meta-analysis, we performed a literature search of PubMed, Embase, Web of Science, and Cochrane from 01/01/1995 to 31/12/2014. The primary outcome was conversion to an open procedure. Secondary outcomes were warm ischaemia time (WIT), operation time (OT), estimated blood loss (EBL), complications, and length of stay (LOS). Data analysed were presented as odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs), I2, and P values. Subgroup analysis was performed. Results There were 24 studies included in the meta-analysis; three randomised controlled trials (RCTs), one randomised pilot study, two prospective, and 18 retrospective cohort studies. There were no differences in conversion to an open procedure between the two techniques for both RCTs (OR 0.42, 95% CI 0.06, 2.90; I2 = 0%, P < 0.001) and cohort studies (OR 1.06, 95% CI 0.63, 1.78; I2 = 0%, P = 0.84). WIT was shorter for the HALDN (-41.79 s, 95% CI -71.85, -11.74; I2 = 96%, P = 0.006), as was the OT (-26.32 min, 95% CI -40.67, -11.97; I2 = 95%, P < 0.001). There was no statistically significant difference in EBL, complications or LOS. Conclusion There is little statistical evidence to recommend one technique. HALDN is associated with a shorter WIT and OT. LDN has equal safety to HALDN. Further studies are required.
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Key Words
- (L)DN, (laparoscopic) donor nephrectomy
- BMI, body mass index
- EBL, estimated blood loss
- FEM, fixed-effects model
- HALDN, hand-assisted laparoscopic donor nephrectomy
- HARPDN, hand-assisted retroperitoneal donor nephrectomy
- Hand-assisted donor nephrectomy
- LOS, length of stay
- Laparoscopic donor nephrectomy
- OR, odds ratio
- OT, operation time
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analyses
- RALDN, robot-assisted laparoscopic donor nephrectomy
- RCT, randomised controlled trial
- REM, random-effects model
- Renal transplantation
- WIT, warm ischaemia time
- WMD, weighted mean difference
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Affiliation(s)
- Mark P Broe
- Department of Urology and Renal Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Rose Galvin
- Department of Postgraduate Studies, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Lorna G Keenan
- Department of Urology and Renal Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Richard E Power
- Department of Urology and Renal Transplantation, Beaumont Hospital, Dublin, Ireland
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Zachariou A, Mamoulakis C, Filiponi M, Dimitriadis F, Giannakis J, Skouros S, Tsounapi P, Takenaka A, Sofikitis N. The effect of mirabegron, used for overactive bladder treatment, on female sexual function: a prospective controlled study. BMC Urol 2018; 18:61. [PMID: 29940933 PMCID: PMC6020185 DOI: 10.1186/s12894-018-0377-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 06/20/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Αim of the study was to determine the effect of mirabegron, used for overactive bladder (OAB) treatment, on female sexual function. METHODS Eighty five sexually active women suffering from overactive bladder were prospectively enrolled in this study. Females were divided into two groups. In Group A (control), 48 patients received no treatment and in Group B, 37 patients received mirabegron 50 mg/daily for 3 months. Patients were evaluated with FSFI-Gr at the beginning of the study and again after a period of 3 months. RESULTS In Group B, there was a significant increase post-treatment compared to baseline (p < 0.001) in total FSFI (20.3 (3.8) to 26.6 (4.2)) and all domains (desire: 3.0 (1.2) to 4.8 (1.2)), arousal: 3.0 (0.8) to 4.8 (0.9), lubrication: 3.9 (1.1) to 4.8 (1.2), orgasm: 3.6 (0.8) to 4.8 (1.0), satisfaction: 3.2 (0.4) to 4.0 (0.8) and pain: 3.2 (0.8) to 4.4 (1.2)). In Group A, there were no statistically significant changes in pre- and post-observation values. CONCLUSIONS This study is one of the few demonstrating that management of OAB with mirabegron improves female sexual function. TRIAL REGISTRATION TRN ISRCTN17199301 , 20/10/2017, retrospectively registered.
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Affiliation(s)
- A. Zachariou
- Department of Urology, School of Medicine, Ioannina University, Ioannina, Greece
- 3 Spyridi Street, 38221 Volos, Greece
| | - C. Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Greece
| | - M. Filiponi
- Department of Urology, ELPIS Hospital, Volos, Greece
| | - F. Dimitriadis
- Department of Urology, School of Medicine, Ioannina University, Ioannina, Greece
| | - J. Giannakis
- Department of Urology, School of Medicine, Ioannina University, Ioannina, Greece
| | - S. Skouros
- Department of Urology, School of Medicine, Ioannina University, Ioannina, Greece
| | - P. Tsounapi
- Department of Urology, School of Medicine, Tottori University, Yonago, Japan
| | - A. Takenaka
- Department of Urology, School of Medicine, Tottori University, Yonago, Japan
| | - N. Sofikitis
- Department of Urology, School of Medicine, Ioannina University, Ioannina, Greece
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Widmer JD, Schlegel A, Kron P, Schiesser M, Brockmann JG, Muller MK. Hand-assisted living-donor nephrectomy: a retrospective comparison of two techniques. BMC Urol 2018; 18:39. [PMID: 29747596 PMCID: PMC5946389 DOI: 10.1186/s12894-018-0355-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 05/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Living-donor nephrectomy (LDN) is challenging, as surgery is performed on healthy individuals. Minimally invasive techniques for LDN have become standard in most centers. Nevertheless, numerous techniques have been described with no consensus on which is the superior approach. Both hand-assisted retroperitoneoscopic (HARS) and hand-assisted laparoscopic (HALS) LDNs are performed at Zurich University Hospital. The aim of this study was to compare these two surgical techniques in terms of donor outcome and graft function. METHOD Retrospective single-center analysis of 60 consecutive LDNs (HARS n = 30; HALS n = 30) from June 2010 to May 2012, including a one-year follow-up of the recipients. RESULTS There was no mortality in either group and little difference in the overall complication rates. Median warm ischemia time (WIT) was significantly shorter in the HARS group. The use of laxatives and the incidence of postoperative vomiting were significantly greater in the HALS group. There was no difference between right- and left-sided nephrectomies in terms of donor outcome and graft function. CONCLUSIONS Both techniques appear safe for both donors and donated organs. The HARS technique is associated with a shorter WIT and a reduced incidence of postoperative paralytic ileus. Therefore, we consider HARS LDN a valuable alternative to HALS LDN.
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Affiliation(s)
- Jeannette D Widmer
- Department of Surgery, Kantonsspital Frauenfeld, 8500, Frauenfeld, Switzerland.
| | - Andrea Schlegel
- Division of Visceral and Transplantation Surgery, University Hospital, Zurich, Switzerland
| | - Philipp Kron
- Division of Visceral and Transplantation Surgery, University Hospital, Zurich, Switzerland
| | - Marc Schiesser
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Jens G Brockmann
- Department of Surgery, Kidney and Pancreas Transplantation, King Faisal Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Markus K Muller
- Division of Visceral and Transplantation Surgery, University Hospital, Zurich, Switzerland
- Department of Surgery, Kantonsspital Frauenfeld, 8500, Frauenfeld, Switzerland
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Perioperative Events and Complications in Minimally Invasive Live Donor Nephrectomy: A Systematic Review and Meta-Analysis. Transplantation 2017; 100:2264-2275. [PMID: 27428715 DOI: 10.1097/tp.0000000000001327] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Minimally invasive live donor nephrectomy has become a fully implemented and accepted procedure. Donors have to be well educated about all risks and details during the informed consent process. For this to be successful, more information regarding short-term outcome is necessary. METHODS A literature search was performed; all studies discussing short-term complications after minimally invasive live donor nephrectomy were included. Outcomes evaluated were intraoperative and postoperative complications, conversions, operative and warm ischemia times, blood loss, length of hospital stay, pain score, convalescence, quality of life, and costs. RESULTS One hundred ninety articles were included in the systematic review, 41 in the meta-analysis. Conversion rate was 1.1%. Intraoperative complication rate was 2.3%, mainly bleeding (1.5%). Postoperative complications occurred in 7.3% of donors, including infectious complications (2.6%), of which mainly wound infection (1.6%) and bleeding (1.0%). Reported mortality rate was 0.01%. All minimally invasive techniques were comparable with regard to complication or conversion rate. CONCLUSIONS The used techniques for minimally invasive live donor nephrectomy are safe and associated with low complication rates and minimal risk of mortality. These data may be helpful to develop a standardized, donor-tailored informed consent procedure for live donor nephrectomy.
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Nashan B, Abbud-Filho M, Citterio F. Prediction, prevention, and management of delayed graft function: where are we now? Clin Transplant 2016; 30:1198-1208. [PMID: 27543840 DOI: 10.1111/ctr.12832] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2016] [Indexed: 12/28/2022]
Abstract
Delayed graft function (DGF) remains a major barrier to improved outcomes after kidney transplantation. High-risk transplant recipients can be identified, but no definitive prediction model exists. Novel biomarkers to predict DGF in the first hours post-transplant, such as neutrophil gelatinase-associated lipocalin (NGAL), are under investigation. Donor management to minimize the profound physiological consequences of brain death is highly complex. A hormonal resuscitation package to manage the catecholamine "storm" that follows brain death is recommended. Donor pretreatment with dopamine prior to procurement lowers the rate of DGF. Hypothermic machine perfusion may offer a significant reduction in the rate of DGF vs simple cold storage, but costs need to be evaluated. Surgically, reducing warm ischemia time may be advantageous. Research into recipient preconditioning options has so far not generated clinically helpful interventions. Diagnostic criteria for DGF vary, but requirement for dialysis and/or persistent high serum creatinine is likely to remain key to diagnosis until current work on early biomarkers has progressed further. Management centers on close monitoring of graft (non)function and physiological parameters. With so many unanswered questions, substantial reductions in the toll of DGF in the near future seem unlikely but concentrated research on many levels offers long-term promise.
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Affiliation(s)
- Björn Nashan
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Mario Abbud-Filho
- Department of Nephrology, Medical School FAMERP, Director Organ Transplantation Center Foundation FUNFARME, São José do Rio Preto, SP, Brazil
| | - Franco Citterio
- Department of Surgery, Renal Transplantation, Catholic University, Rome, Italy
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Friedersdorff F, Kothmann L, Manus P, Roigas J, Kempkensteffen C, Magheli A, Busch J, Liefeldt L, Giessing M, Deger S, Schostak M, Miller K, Fuller TF. Long-Term Donor Outcomes after Pure Laparoscopic versus Open Living Donor Nephrectomy: Focus on Pregnancy Rates, Hypertension and Quality of Life. Urol Int 2016; 97:450-456. [PMID: 27577572 DOI: 10.1159/000447064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/24/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of the present study was to compare long-term donor outcomes after open and laparoscopic living donor nephrectomy. The focus was on pregnancy rates, hypertension and quality of life parameters. MATERIALS AND METHODS Data were retrospectively collected using our institution's electronic database and a structured questionnaire. The study included 30 donors after open donor nephrectomy (ODN) and 131 donors after laparoscopic donor nephrectomy (LDN). RESULTS Demographic data did not differ between groups. When asked for their preference, significantly more donors in the LDN group would choose the same surgical approach again. The overall frequency of postoperative complications was significantly lower in the LDN group. The incidence of grade III complications was 2% after LDN and 10% after ODN (p = 0.79). Only 2 out of 15 female donors aged between 18 and 45 years delivered a healthy child after DN. On interview, only 4 out of 15 female donors declared the desire to have children after DN. CONCLUSIONS From the donor perspective, long-term outcomes after LDN are more favorable than after ODN. To ensure favorable functional outcomes, strict preoperative donor selection and diligent long-term donor follow-up are required.
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Khalil A, Mujtaba MA, Taber TE, Yaqub MS, Goggins W, Powelson J, Sundaram C, Sharfuddin AA. Trends and outcomes in right vs. left living donor nephrectomy: an analysis of the OPTN/UNOS database of donor and recipient outcomes - should we be doing more right-sided nephrectomies? Clin Transplant 2015; 30:145-53. [DOI: 10.1111/ctr.12668] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 01/23/2023]
Affiliation(s)
- Ali Khalil
- Division of Nephrology; Department of Medicine; Indiana University; Indianapolis IN USA
| | - Muhammad A. Mujtaba
- Division of Nephrology; Department of Medicine; Indiana University; Indianapolis IN USA
| | - Tim E. Taber
- Division of Nephrology; Department of Medicine; Indiana University; Indianapolis IN USA
| | - Muhammad S. Yaqub
- Division of Nephrology; Department of Medicine; Indiana University; Indianapolis IN USA
| | - William Goggins
- Division of Transplant Surgery; Department of Surgery; Indiana University; Indianapolis IN USA
| | - John Powelson
- Division of Transplant Surgery; Department of Surgery; Indiana University; Indianapolis IN USA
| | | | - Asif A. Sharfuddin
- Division of Nephrology; Department of Medicine; Indiana University; Indianapolis IN USA
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Rajab A, Pelletier RP. The safety of hand-assisted laparoscopic living donor nephrectomy: The Ohio State University experience with 1500 cases. Clin Transplant 2015; 29:204-10. [DOI: 10.1111/ctr.12501] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Amer Rajab
- Division of Transplant Surgery; Department of Surgery; The Ohio State University; Columbus OH USA
| | - Ronald P. Pelletier
- Division of Transplant Surgery; Department of Surgery; The Ohio State University; Columbus OH USA
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Abstract
From open surgery to laparoscopic surgery, there has been an evolution in the surgical technique for live donor nephrectomy which goes beyond patient comfort. As a unique operation where the margin for error is nearly nil, and where the patient is essentially harmed for an altruistic goal, ensuring the best possible result is vital. Additionally, as the morbidity of the operation decreases, there is a theoretical increase in the donor pool. In this review, the latest techniques for minimally invasive live donor nephrectomy are covered, including new approaches such as laparoendoscopic single-site surgery, natural orifice surgery, and new tools such as robotics.
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Affiliation(s)
- Jorge R Caso
- Department of Urology, PO Box 016960 (M-814), Miami, FL, 33101, USA,
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Tusheva OA, Cohen SL, Einarsson JI. Hand-Assisted Approach to Laparoscopic Myomectomy and Hysterectomy. J Minim Invasive Gynecol 2013; 20:234-7. [DOI: 10.1016/j.jmig.2012.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 12/01/2012] [Accepted: 12/04/2012] [Indexed: 11/25/2022]
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