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Kiani AZ, Progar K, Hill AL, Vachharajani N, Olumba F, Yu J, Chapman WC, Doyle MB, Wellen JR, Khan AS. Robotic living donor nephrectomy is associated with reduced post-operative opioid use compared to hand-assisted laparoscopic approach. Surg Endosc 2024; 38:3654-3660. [PMID: 38777895 DOI: 10.1007/s00464-024-10925-5] [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: 02/12/2024] [Accepted: 05/05/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Robotic donor nephrectomy (RDN) has emerged as a safe alternative to laparoscopic donor nephrectomy (LDN). Having previously demonstrated comparable efficacy, this study aims to examine postoperative analgesia use (opioid and non-opioid) in the two groups. METHODS We conducted a retrospective review of 300 living donor nephrectomies performed at our center, comparing 150 RDN's with a contemporary cohort of 150 hand-assisted LDN's. In addition to clinical and demographic information, data on postoperative inpatient opioid and non-opioid analgesia (from patient's arrival to the surgical floor after surgery till the time of discharge) was collected. Opioid dosages were standardized by conversion to morphine milligram equivalents (MME). All patients were managed post-operatively under a standardized ERAS pathway for living donor nephrectomy patients. RESULTS There were no significant differences in donor age, gender, and BMI between RDN and LDN groups. Total post-operative opioid use (MME's) was significantly lower in RDN patients (RDN 27.1 vs. LDN 46.3; P < 0.0001). Breakdown of opioid use with post-operative (POD) day demonstrated significantly lower use in RDN group on POD1 (RDN 8.6 vs. LDN 17.0; P < 0.05), and POD2 (RDN 3.9 vs LDN 10; P < 0.05). RDN patients had a shorter post-operative length of stay (LOS) (RDN 1.69 days vs. LDN 1.98; P = 0.0003). There were no differences between groups in non-opioid medication use, complications, and readmission rates. CONCLUSION RDN has comparable safety to hand-assist LDN and offers additional benefits of lower postoperative opioid requirement and a shorter hospital LOS.
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Affiliation(s)
- Amen Z Kiani
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, MO, 63110, USA.
- Department of Surgery, Division of Abdominal Transplant Surgery, Washington University School of Medicine, 660 Euclid Ave St., Louis, MO, 63110, USA.
| | - Kristin Progar
- Department of Pharmacy, Barnes-Jewish Hospital, Barnes-Jewish Hospital Plaza, Saint Louis, MO, 63130, USA
| | - Angela L Hill
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Neeta Vachharajani
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Franklin Olumba
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Jennifer Yu
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - William C Chapman
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Majella B Doyle
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Jason R Wellen
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Adeel S Khan
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, MO, 63110, USA
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Wang H, Chen R, Li T, Peng L. Robot-assisted laparoscopic vs laparoscopic donor nephrectomy in renal transplantation: A meta-analysis. Clin Transplant 2019; 33:e13451. [PMID: 30461073 DOI: 10.1111/ctr.13451] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/02/2018] [Accepted: 11/09/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Haifeng Wang
- Department of Urological Organ Transplantation; Center of Organ Transplantation; The Second Xiangya Hospital of Central South University; Changsha P. R. China
| | - Rao Chen
- Department of Urological Organ Transplantation; Center of Organ Transplantation; The Second Xiangya Hospital of Central South University; Changsha P. R. China
| | - Tengfang Li
- Department of Urological Organ Transplantation; Center of Organ Transplantation; The Second Xiangya Hospital of Central South University; Changsha P. R. China
| | - Longkai Peng
- Department of Urological Organ Transplantation; Center of Organ Transplantation; The Second Xiangya Hospital of Central South University; Changsha P. R. China
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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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Ferrario M, Buckel E, Astorga C, Godoy J, Aguiló J, González G, Ormazábal J, Cámbara Á, Derosas C, Herzog C, Calabrán L. Results in Laparoscopic Living Donor Nephrectomy: A Multicentric Experience. Transplant Proc 2013; 45:3716-8. [DOI: 10.1016/j.transproceed.2013.08.089] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chandak P, Kessaris N, Challacombe B, Olsburgh J, Calder F, Mamode N. How safe is hand-assisted laparoscopic donor nephrectomy?--Results of 200 live donor nephrectomies by two different techniques. Nephrol Dial Transplant 2008; 24:293-7. [DOI: 10.1093/ndt/gfn463] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Moody EM, Clemens KK, Storsley L, Waterman A, Parikh CR, Garg AX. Improving on-line information for potential living kidney donors. Kidney Int 2007; 71:1062-70. [PMID: 17361119 DOI: 10.1038/sj.ki.5002168] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Individuals who consider becoming living kidney donors often search the internet for reliable information before contacting the transplant center. The quality of such information requires due consideration. Using the search engines Google and Yahoo and the WebMD information portal, two reviewers independently abstracted data on the classification, readability, and general quality of websites. The coverage and accuracy of each site's discussion of the risks, benefits, and process of living donation was also assessed against a checklist of recommended information. Eighty-six unique websites on living kidney donation were found. Most were created by transplant programs and transplant organizations. Although the content of most sites was accurate, almost all (98%) were written above the recommended patient reading level (i.e., fifth grade). On average, each site covered 38% of the recommended information on living donation (range 8-76%). Educational topics of potential long-term medical risks, psychological risks, and expected benefits to the donor were often missing. The most visited websites were often not ranked among the best sites to provide information. By better understanding the nature of on-line information, transplant professionals can direct their patients to the best available websites. Local educational efforts, including the effective use of internet resources, will ensure living donation and complete understanding of the risks by potential donors and recipients.
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Affiliation(s)
- E M Moody
- Division of Nephrology, University of Western Ontario, London, Canada
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