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Papa S, Popovic A, Loerzel S, Iskhagi S, Gallay B, Leggat J, Saidi R, Hod Dvorai R, Shahbazov R. Laparoscopic to robotic living donor nephrectomy: Is it time to change surgical technique? Int J Med Robot 2023; 19:e2550. [PMID: 37452584 DOI: 10.1002/rcs.2550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/09/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND We aimed to explore differences in outcomes of robotic and laparoscopic donor nephrectomies (LDN). METHODS This study compared robotic and laparoscopic surgical techniques for live donor nephrectomies in 153 patients at a single centre. RESULTS Left nephrectomies were more common in both groups, but with no significant difference between the groups (76.6% vs. 77.6%, p = 0.88). The robotic donor nephrectomies (RDN) group experienced significantly less blood loss (60 vs. 134 mL, p < 0.01), but warm ischaemia time was similar between groups (3.2 vs. 3.7 min, p = 0.54).The RDN group had decreased subjective pain scores (3.54 vs. 4.21, p = 0.04) and shorter length of hospitalisation (2.22 vs. 3.04 days, p < 0.01).There were also fewer complications in the RDN than the LDN group (4 vs. 8, p = 0.186). CONCLUSION This study demonstrated that RDN is a safe and alternative to LDN. Decreased blood loss and hospital stays and fewer complications may reflect decreased tissue manipulation with robotic assistance.
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Affiliation(s)
- Sarah Papa
- Department of Surgery, Division of Transplantation, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Aleksandar Popovic
- Department of Surgery, Division of Urology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Sharon Loerzel
- Department of Surgery, Division of Transplantation, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Samir Iskhagi
- Department of Surgery, Division of Transplantation, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Brian Gallay
- Department of Medicine, Division of Nephrology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - John Leggat
- Department of Medicine, Division of Nephrology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Reza Saidi
- Department of Surgery, Division of Transplantation, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Reut Hod Dvorai
- Department of Pathology and Laboratory Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Rauf Shahbazov
- Department of Surgery, Division of Transplantation, SUNY Upstate Medical University, Syracuse, New York, USA
- Department of Surgery, Albany Medical Center, Albany, New York, USA
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2
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Park JW, Lee HH, Lee HS, Kim YS. Reproducibility and Step-By-Step Learning Curve of Retroperitoneal Video-Assisted Mini-Laparotomy Surgery for Living Donor Nephrectomy: A Single-Center Experience. EXP CLIN TRANSPLANT 2022; 20:657-662. [DOI: 10.6002/ect.2022.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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3
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Windisch OL, Matter M, Pascual M, Sun P, Benamran D, Bühler L, Iselin CE. Robotic versus hand-assisted laparoscopic living donor nephrectomy: comparison of two minimally invasive techniques in kidney transplantation. J Robot Surg 2022; 16:1471-1481. [PMID: 35254601 PMCID: PMC9606056 DOI: 10.1007/s11701-022-01393-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/18/2022] [Indexed: 11/23/2022]
Abstract
Robot-assisted donor nephrectomy (RDN) is increasingly used due to its advantages such as its precision and reduced learning curve when compared to laparoscopic techniques. Concerns remain among surgeons regarding possible longer warm ischemia time. This study aimed to compare patients undergoing robotic living donor nephrectomy to the more frequently used hand-assisted laparoscopic nephrectomy (HLDN) technique, focusing on warm ischemia time, total operative time, learning curve, hospital length of stay, donor renal function and post-operative complications. Retrospective study comparing RDN to HLDN in a collaborative transplant network. 176 patients were included, 72 in RDN and 104 in HLDN. Left-sided nephrectomy was favored in RDN (82% vs 52%, p < 0.01). Operative time was longer in RDN (287 vs 160 min; p < 0.01), while warm ischemia time was similar (221 vs 213 secs, p = 0.446). The hospital stay was shorter in RDN (3.9 vs 5.7 days, p < 0.01).Concerning renal function, a slightpersistent increase of 7% of the creatinine ratio was observed in the RDN compared to the HLDN group (1.56 vs 1.44 at 1-month checkup, p < 0.01). The results show that RDN appears safe and efficient in comparison to the gold-standard HLDN technique. Warm ischemia time was similar for both techniques, whereas RDN operative time was longer. Patients undergoing RDN had a shorter hospital stay, this being possibly mitigated by differences in center release criteria. Donor renal function needs to be assessed on a longer-term basis for both techniques.
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Affiliation(s)
- Olivier Laurent Windisch
- Geneva-Lausanne Transplant Center (Centre Universitaire Romand de Transplantation), Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland. .,Division of Urologic Surgery, Geneva University Hospital, Genève, Switzerland.
| | - Maurice Matter
- Geneva-Lausanne Transplant Center (Centre Universitaire Romand de Transplantation), Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland.,Department of Visceral Surgery, Lausanne University Hospital, and University of Lausanne, Lausannne, Switzerland
| | - Manuel Pascual
- Geneva-Lausanne Transplant Center (Centre Universitaire Romand de Transplantation), Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland.,Transplantation Center, Lausanne University Hospital, and University of Lausanne, Lausannne, Switzerland
| | - Pamela Sun
- Geneva-Lausanne Transplant Center (Centre Universitaire Romand de Transplantation), Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland.,Division of Urologic Surgery, Geneva University Hospital, Genève, Switzerland
| | - Daniel Benamran
- Geneva-Lausanne Transplant Center (Centre Universitaire Romand de Transplantation), Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland.,Division of Urologic Surgery, Geneva University Hospital, Genève, Switzerland
| | - Leo Bühler
- Section of Medicine, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Christophe Emmanuel Iselin
- Geneva-Lausanne Transplant Center (Centre Universitaire Romand de Transplantation), Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland.,Division of Urologic Surgery, Geneva University Hospital, Genève, Switzerland
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van der Merwe A, Ebinger Mundorf NN, van Heerden H, Bonkat G, van Deventer H, Mantica G, Keyser Z, Bachmann A. Evaluating the differences in the early laparoscopic donor nephrectomy learning curves of a Swiss high volume transplant program and a South African low volume transplant program after knowledge transfer. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00215-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To describe the retroperitoneoscopic donor nephrectomy learning curve differences between a high volume (training) hospital in Basel, Switzerland, and a low volume (trainee) hospital in Cape Town, South Africa, after knowledge transfer. The South African hospital is resource constraint in hospital and training equipment. Techniques for performing the surgery were near identical.
Methods
Both units maintained prospective databases. Comparisons were made of the first 74 cases in each database: Basel’s series were from 19 January 2001 until 28 June 2004, while the Cape Town Hospital were from 8 April 2008 until 15 July 2008. Four surgeons operated in the Basel group, while only one surgeon operated in the Cape Town group. Variables compared include operating time (first skin incision until kidney was extracted), warm ischaemic time (renal arterial occlusion until cold bench reperfusion), blood loss, graft function, and hospital stay. We also analysed the first and last 25 cases of each series. Subgroup analysis of a single Basel surgeon was conducted.
Results
Donor age (means: Basel vs. Cape Town 54 vs. 33 p < 0.0001) and gender (males vs. females Cape Town 57% male and Basel 31% male) differed widely. The Basel group did more left-sided operations (72% vs. 58%). Operative times, blood loss and donor creatinine did not differ. Warm ischaemic time was significantly shorter in the Basel group (Cape Town mean 204 s Basel mean 130 s P = 0.0023). There was double the number of early graft failures in the South African group (six vs. three)—not related to donor surgery. Both groups showed a decline in operating times, plateauing at 30–34 cases.
Conclusions
There are statistically significant differences in some aspects of the learning curves of the Swiss (training) and South African (trainee) hospitals. These differences are clinically not pronounced, and the knowledge transfer was worth the effort.
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The Evolution of Living Donor Nephrectomy Program at A Hellenic Transplant Center. Laparoscopic vs. Open Donor Nephrectomy: Single-Center Experience. J Clin Med 2021; 10:jcm10061195. [PMID: 33809339 PMCID: PMC8001196 DOI: 10.3390/jcm10061195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/27/2021] [Accepted: 03/05/2021] [Indexed: 01/11/2023] Open
Abstract
Since its introduction in 1995, laparoscopic nephrectomy has emerged as the preferred surgical approach for living donor nephrectomy. Given the ubiquity of the surgical procedure and the need for favorable outcomes, as it is an elective operation on otherwise healthy individuals, it is imperative to ensure appropriate preoperative risk stratification and anticipate intraoperative challenges. The aim of the present study was to compare peri-and postoperative outcomes of living kidney donors (LD), who had undergone laparoscopic nephrectomy (LDN), with a control group of those who had undergone open nephrectomy (ODN). Health-related quality of life (QoL) was also assessed using the validated SF-36 questionnaire. Data from 252 LD from a single transplant center from March 2015 to December 2020 were analyzed retrospectively. In total, 117 donors in the LDN and 135 in the ODN groups were assessed. Demographics, type of transplantation, BMI, duration of surgery, length of hospital stay, peri- and postoperative complications, renal function at discharge and QoL were recorded and compared between the two groups using Stata 13.0 software. There was no difference in baseline characteristics, nor in the prevalence of peri-and postoperative complications, with a total complication rate of 16% (mostly minor, Clavien–Dindo grade II) in both groups, while a different pattern of surgical complications was noticed between them. Duration of surgery was significantly longer in the ODN group (median 240 min vs. 160 min in LDN, p < 0.01), warm ischemia time was longer in the LDN group (median 6 min vs.2 min in ODN, p < 0.01) and length of hospital stay shorter in the LDN group (median 3 days vs. 7 days in ODN). Conversion rate from laparoscopic to open surgery was 2.5%. There was a drop in estimated glomerular filtration rate (eGFR) at discharge of 36 mL/min in the LDN and 32 mL/min in the ODN groups, respectively (p = 0.03). No death, readmission or reoperation were recorded. There was a significant difference in favor of LDN group for each one of the eight items of the questionnaire (SF1–SF8). As for the two summary scores, while the total physical component summary (PCS) score was comparable between the two groups (57.87 in the LDN group and 57.07 in the ODN group), the mental component summary (MCS) score was significantly higher (62.14 vs. 45.22, p < 0.001) in the LDN group. This study provides evidence that minimally invasive surgery can be performed safely, with very good short-term outcomes, providing several benefits for the living kidney donor, thereby contributing to expanding the living donor pool, which is essential, especially in countries with deceased-donor organ shortage.
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6
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Silva ANS, Georgiades F, Bath MF, Hosgood SA, Nicholson ML. Iliac Fossa Muscle Splitting Incision in Laparoscopic Donor Nephrectomy: A comparison With the Suprapubic Approach. Urology 2020; 143:142-146. [PMID: 32562777 DOI: 10.1016/j.urology.2020.05.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the outcomes of a transverse suprapubic incision with peritoneal access through the midline (SPM) and an iliac fossa muscle splitting (IFMS) incision for kidney retrieval during laparoscopic donor nephrectomy (LDN). MATERIAL AND METHODS This observational retrospective comparative cohort study was performed using data from a prospectively maintained database to compare the outcomes of 2 different incisions (SPM n = 35 and IFMS n = 35) used for kidney retrieval during LDN. All incisions were infiltrated with local anesthesia at the time of closure. The primary outcome measure was postoperative analgesic requirements. Secondary outcome measures included donor complication rates and recipient outcomes. Selection bias was minimized by the study of 2 consecutive series of donors. RESULTS Overall, 28 of the 70 (40%) of the total cohort were male. There was no difference between age (IFMS 49 ± 12 vs SPM 49 ± 11 years, P = .317), body mass index (IFMS 26.5 ± 3.9 vs SPM 25.9 ± 3.3 kg/m2, P = .493), and total postoperative opioid analgesic requirements (IFMS 213 ± 168 vs SPM 211 ± 168 mg, P = .807) between the 2 groups. The volume of local anesthetic infiltrated during wound closure was higher in the IFMS 0.470 ± 0.160 vs SPM 0.370 ± 0.234 mL/kg (P = .030) and associated with a reduction in postoperative opioid requirements (r = -0.511, P = .002). There were no major donor or recipient postoperative complications in either group and no difference in renal allograft function at 3-, 6-, 9-, or 12 months post-transplant. CONCLUSION An iliac fossa muscle splitting incision is a straightforward and safe approach, providing a reasonable alternative to the more traditional and widely used suprapubic incision for kidney retrieval during LDN.
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Affiliation(s)
- Arnaldo N S Silva
- Division of Surgery, Department of Surgery, Cambridge University Hospitals, Addenbrooke's, Cambridge, United Kingdom.
| | - Fanourios Georgiades
- Division of Surgery, Department of Surgery, Cambridge University Hospitals, Addenbrooke's, Cambridge, United Kingdom
| | - Michael F Bath
- Division of Surgery, Department of Surgery, Cambridge University Hospitals, Addenbrooke's, Cambridge, United Kingdom
| | - Sarah A Hosgood
- Division of Surgery, Department of Surgery, Cambridge University Hospitals, Addenbrooke's, Cambridge, United Kingdom
| | - Michael L Nicholson
- Division of Surgery, Department of Surgery, Cambridge University Hospitals, Addenbrooke's, Cambridge, United Kingdom
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7
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Quality Improvement in Laparoscopic Donor Nephrectomy by Self-Imposed Proctored Preceptorship Model. Indian J Surg 2019. [DOI: 10.1007/s12262-019-01912-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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8
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Choi CI, Kim DI, Baek SH, Chung YS, Kim DH, Jeon TY, Kim DH, Rhee H, Song SH, Seong EY, Kwak IS. Initial Experience With Hand-Assisted Laparoscopic Living Donor Nephrectomy: Training and Clinical Practice as a General Surgeon. Transplant Proc 2018; 50:3113-3120. [PMID: 30577176 DOI: 10.1016/j.transproceed.2018.08.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/20/2018] [Accepted: 08/16/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND To analyze our initial results of hand-assisted laparoscopic living donor nephrectomy, executed by a skilled gastrointestinal surgeon. METHODS A total of 22 consecutive patients underwent the hand-assisted laparoscopic living donor nephrectomy between December 2014 and January 2017. We retrospectively analyze the patient's perioperative clinical data, which were collected prospectively. RESULTS The right kidney was harvested in 12 patients. The mean operative time and intraoperative blood loss was 241.0 ± 43.4 minutes (range, 140-310 min) and 293.2 ± 203.1 mL (range, 50-700 mL), respectively. The mean warm ischemic time was 288.4 ± 103.4 seconds (range, 179-610 s). Postoperative complications included chyle leakage in 2 patients who were left kidney donors and oliguria in 1 patient who was a right kidney donor. All patients recovered with conservative care, and the mean hospital stay was 7.5 ± 1.7 days. The mean creatinine level was 0.7 ± 0.2 mg/dL before surgery, 1.1 ± 0.3 mg/dL at postoperative day (POD) 1, and 1.0 ± 0.2 mg/dL after discharge. The mean glomerular filtration rate was 97.9 ± 18.2 mL/min/1.73 m2 before surgery, 60.7 ± 10.4 at POD 1, and 67.3 ± 11.1 after discharge. Operation time was not associated with patient body mass index and case number. No significant differences, other than postoperative complications, were found in the perioperative data for the side of kidney donation. CONCLUSION A skilled surgeon with experience in laparoscopic abdominal surgery (such as gastrectomy or colectomy) might safely perform hand-assisted donor nephrectomy. However, we could not identify a clear case number to complete the learning curve.
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Affiliation(s)
- C I Choi
- Department of Surgery, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - D I Kim
- Department of Surgery, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - S H Baek
- Department of Surgery, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - Y S Chung
- Department of Surgery, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea.
| | - D H Kim
- Department of Surgery, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - T Y Jeon
- Department of Surgery, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - D H Kim
- Department of Surgery, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - H Rhee
- Department of Nephrology, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - S H Song
- Department of Nephrology, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - E Y Seong
- Department of Nephrology, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - I S Kwak
- Department of Nephrology, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
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Park JS, Ahn HK, Na J, Lee HH, Yoon YE, Yoon MG, Han WK. Cumulative sum analysis of the learning curve for video-assisted minilaparotomy donor nephrectomy in healthy kidney donors. Medicine (Baltimore) 2018; 97:e0560. [PMID: 29703043 PMCID: PMC5944565 DOI: 10.1097/md.0000000000010560] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 04/04/2018] [Indexed: 11/26/2022] Open
Abstract
Video-assisted minilaparotomy surgery (VAMS) is a hybrid of open and laparoscopic surgical techniques, so has advantages of both approaches. Here, we examined the learning curve for this procedure.We retrospectively evaluated 50 consecutive patients who underwent VAMS donor nephrectomy performed by a single surgeon (YEY) between March 2015 and March 2016. The learning curve was evaluated using the cumulative sum (CUSUM) method. Measures of surgical performance included total operation time, warm ischemic time, and estimated blood loss.The mean patient age, body mass index, and body surface area were 43.5 years, 23.8 kg/m, and 1.7 m, respectively. The mean operation time and warm ischemic time were 160.0 minutes and 124.4 seconds. The learning curve of total operation time was best modeled as a second-order polynomial with equation CUSUMOT (minutes) = -0.3802 × case number + 20.315 × case number - 41.333 (R = 0.7707). The curve included 3 unique phases: phase 1 (the initial 17 cases), which is the initial learning curve; phase 2 (the middle 23 cases), expert competence, and phase 3 (the subsequent cases), mastery. In terms of warm ischemic time and estimated blood loss, the initial learning was achieved after 16 cases and after 9 to 10 cases, one could achieve competency.The VAMS donor nephrectomy learning curve is shorter than for laparoscopic or robotic hand-assisted donor nephrectomy. Surgeons can become familiar with the procedure and perform it without complications after approximately 16 to 17 operations.
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Affiliation(s)
- Jee Soo Park
- Department of Urology, Urological Science Institute, Yonsei
University College of Medicine
| | - Hyun Kyu Ahn
- Department of Urology, Urological Science Institute, Yonsei
University College of Medicine
| | - Joonchae Na
- Department of Urology, Urological Science Institute, Yonsei
University College of Medicine
| | - Hyung Ho Lee
- Department of Urology, National Health Insurance Service
Ilsan Hospital, Goyang, Gyeonggi-do
| | - Young Eun Yoon
- Department of Urology, Hanyang University College of
Medicine
| | - Min Gee Yoon
- Department of Urology, Urological Science Institute, Yonsei
University College of Medicine
| | - Woong Kyu Han
- Department of Urology, Urological Science Institute, Yonsei
University College of Medicine
- Brain Korea 21 PLUS Project for Medical Science, Department
of Urology, Yonsei University, Seoul, Republic of Korea
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10
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Qiu Y, Wang X, Song T, Rao Z, Liu J, Huang Z, Lin T. Comparison of Both Sides for Retroperitoneal Laparoscopic Donor Nephrectomy: Experience From a Single Center in China. Transplant Proc 2018; 49:1244-1248. [PMID: 28735988 DOI: 10.1016/j.transproceed.2017.02.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/14/2016] [Accepted: 02/07/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Laparoscopic donor nephrectomy (LDN) has gradually become the main approach to obtain live donor kidneys. However, the shorter right renal vein limits its wider application. The aim of this study was to compare the outcomes of left- and right-side retroperitoneal LDN. METHODS We reviewed the perioperative data of 527 consecutive donors receiving retroperitoneal pure LDN with a new method at our center between April 2009 and April 2014. The patients were divided into group A (the first 100 patients) and group B (the remaining 427 patients). A total of 423 cases of left donor surgery and 104 cases of right donor surgery were compared. The comparison of the laterality of LDN was also performed between group A and group B. RESULTS This is currently the largest case series of LDN in our country. Although right-side LDN patients had longer operation time and a slightly higher incidence of intraoperative complications compared with left-side LDN patients, the operation time was shorter in both the groups compared with previous reports. In group B, patients undergoing right-side LDN had longer operation time and more frequent complications. Once the learning curve of 100 cases was completed, the incidence of complications and operation time were greatly reduced in both sides for LDN. There was no significant difference in the serum creatinine levels in recipients at 6 months of follow-up. CONCLUSIONS Despite a slightly higher incidence of complications and longer operation time, right-side LDN can achieve equally safe and effective transplantation outcomes. This expands the source of potential donor kidneys.
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Affiliation(s)
- Y Qiu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - X Wang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - T Song
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Z Rao
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - J Liu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Z Huang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - T Lin
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Hiess M, Seitz C. Robot-assisted renal surgery: current status and future directions. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2016; 3:1-12. [PMID: 30697551 PMCID: PMC6193442 DOI: 10.2147/rsrr.s71328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This paper examines the current role of robot-assisted renal surgery as complex and partial nephrectomies, including vena cava thrombus, combined nephroureterectomies, living donor nephrectomy, autotransplantation, and difficult anatomy as in patients with obesity or adhesions. Indications for robot-assisted renal surgery are comparable to those of conventional laparoscopic approaches. A reduction in the learning curve leads to a stabilization of the procedure and further increases the number of minimally invasive procedures performed. A Medline literature search for publications on the field of robotic kidney surgery has been performed using the MeSH terms: robotic surgical procedures and kidney. Future directions include progress in robotic technology and instrumentation with further miniaturization of robotic procedures as laparoendoscopic single-site interventions and progress in image-guided robotic surgery.
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Affiliation(s)
- Manuela Hiess
- Department of Urology, Medical University of Vienna, Vienna, Austria,
| | - Christian Seitz
- Department of Urology, Medical University of Vienna, Vienna, Austria,
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12
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Raque J, Billeter AT, Lucich E, Marvin MM, Sutton E. Training techniques in laparoscopic donor nephrectomy: a systematic review. Clin Transplant 2015; 29:893-903. [DOI: 10.1111/ctr.12592] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Jessica Raque
- Hiram C. Polk Jr. MD Department of Surgery; University of Louisville School of Medicine; Louisville KY USA
| | - Adrian T. Billeter
- Hiram C. Polk Jr. MD Department of Surgery; University of Louisville School of Medicine; Louisville KY USA
| | - Elizabeth Lucich
- Xavier University College of Arts and Sciences; Cincinnati OH USA
| | - Michael M. Marvin
- Hiram C. Polk Jr. MD Department of Surgery; University of Louisville School of Medicine; Louisville KY USA
| | - Erica Sutton
- Hiram C. Polk Jr. MD Department of Surgery; University of Louisville School of Medicine; Louisville KY USA
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Surgical team composition has a major impact on effectiveness and costs in laparoscopic donor nephrectomy. World J Urol 2014; 33:733-41. [DOI: 10.1007/s00345-014-1428-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 10/19/2014] [Indexed: 12/16/2022] Open
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Wolff T, Schumacher M, Dell-Kuster S, Rosenthal R, Dickenmann M, Steiger J, Bachmann A, Gürke L. Surgical complications in kidney transplantation: no evidence for a learning curve. JOURNAL OF SURGICAL EDUCATION 2014; 71:748-755. [PMID: 24913427 DOI: 10.1016/j.jsurg.2014.03.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 02/13/2014] [Accepted: 03/16/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate whether surgical complications after kidney transplantation correlate with surgeon's experience and whether individual surgeons' complication rates improve during their learning process. STUDY DESIGN Retrospective analysis: A generalized linear mixed-effects model was used to identify risk factors for surgical complications. Plots of cumulative sums of complications were used to evaluate the individual surgeons' performance. SETTING Single-center experience of a teaching hospital in Switzerland. PARTICIPANTS Consecutive kidney transplant recipients operated from 1962 until 2003. RESULTS A total of 1496 kidney transplants were analyzed; 73% were from deceased donors and 27% from living donors. At least 1 surgical complication occurred in 352 patients (24%). Male gender (odds ratio [OR] = 1.35, 95% CI: 1.04-1.74), donor's age (OR = 1.14, 95% CI: 1.06-1.24 per decade increment), and third or fourth vs. first or second transplant in a recipient (OR = 2.90, 95% CI: 1.02-8.24) were significantly associated with surgical complications. The surgeon's transplant experience was not found to be associated with surgical complications. Even surgeons with an experience of less than 10 kidney transplants did not have higher complication rates, 30-day mortality, or 1-year graft survival. Individual surgeons' complication rates analyzed by cumulative sum plots did not improve with increasing experience. CONCLUSIONS We present the largest single-center study on surgical complications after kidney transplantation, with unique data on the surgeon's experience for every single procedure. We found no evidence for a learning curve during training for kidney transplantation. We conclude that carefully selected experienced general and vascular surgeons can achieve good results in kidney transplantation after a relatively short training period.
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Affiliation(s)
- Thomas Wolff
- Department of Vascular and Transplant Surgery, Basel University Hospital, Basel, Switzerland.
| | - Marc Schumacher
- Department of Vascular and Transplant Surgery, Basel University Hospital, Basel, Switzerland
| | - Salome Dell-Kuster
- Department of Vascular and Transplant Surgery, Basel University Hospital, Basel, Switzerland; Basel Institute for Clinical Epidemiology and Biostatistics, Basel, Switzerland
| | - Rachel Rosenthal
- Department of Vascular and Transplant Surgery, Basel University Hospital, Basel, Switzerland
| | - Michael Dickenmann
- Division of Transplantation Immunology and Nephrology, Basel University Hospital, Basel, Switzerland
| | - Jürg Steiger
- Division of Transplantation Immunology and Nephrology, Basel University Hospital, Basel, Switzerland
| | | | - Lorenz Gürke
- Department of Vascular and Transplant Surgery, Basel University Hospital, Basel, Switzerland
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15
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Baron PW, Brooks J, Baldwin DD, Cutler D, Kore A, Elihu A, de Vera M, Sahney S. Comparison of outcomes of hand-assisted laparoscopic to open donor nephrectomy for pediatric recipients. Pediatr Transplant 2013; 17:374-9. [PMID: 23586434 DOI: 10.1111/petr.12082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2013] [Indexed: 01/10/2023]
Abstract
The purpose of this study is to compare the outcome of pediatric recipients of kidneys procured using a hand-assisted laparoscopic (HALDN group) to an open technique (ODN group). Twenty-eight patients ≤18 yr old (HALDN group) were compared with 17 patients (ODN group). The serum creatinine for HALDN and ODN groups at discharge were 0.93 ± 0.48 and 0.94 ± 0.54 mg/dL (p = 0.917), respectively. The serum creatinine for HALDN and ODN groups at six and 12 months was 1.01 ± 0.44 and 1.11 ± 0.55, and 1.04 ± 0.52 and 1.14 ± 0.46 mg/dL (p = 0.516, p = 0.554), respectively. The eGFR for HALDN and ODN groups at discharge was 108.66 ± 37.23 and 106.1 ± 50.55 mL/min/1.73 m(2) (p = 0.845), respectively. The eGFR for HALDN and ODN groups at six and 12 months was 97.77 ± 28.25 and 81.73 ± 27.46, and 94.56 ± 28.3 and 85.74 ± 30.1 mL/min/1.73 m2 (p = 0.085, p = 0.344), respectively. The patient and graft survival for both groups were 100% at 12 months post-transplant. In conclusion, the short-term outcome of recipients of kidneys procured via HALDN is comparable to that of kidneys procured via ODN in pediatric patients.
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Affiliation(s)
- Pedro W Baron
- Transplantation Institute, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
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16
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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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17
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Friedersdorff F, Werthemann P, Cash H, Kempkensteffen C, Magheli A, Hinz S, Waiser J, Liefeldt L, Miller K, Deger S, Fuller TF. Outcomes after laparoscopic living donor nephrectomy: comparison of two laparoscopic surgeons with different levels of expertise. BJU Int 2012; 111:95-100. [DOI: 10.1111/j.1464-410x.2012.11348.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Peter Werthemann
- Department of Urology; Charité Universitätsmedizin Berlin; Berlin
| | - Hannes Cash
- Department of Urology; Charité Universitätsmedizin Berlin; Berlin
| | | | - Ahmed Magheli
- Department of Urology; Charité Universitätsmedizin Berlin; Berlin
| | - Stefan Hinz
- Department of Urology; Charité Universitätsmedizin Berlin; Berlin
| | - Johannes Waiser
- Department of Nephrology; Charité Universitätsmedizin Berlin; Berlin
| | - Lutz Liefeldt
- Department of Nephrology; Charité Universitätsmedizin Berlin; Berlin
| | - Kurt Miller
- Department of Urology; Charité Universitätsmedizin Berlin; Berlin
| | - Serdar Deger
- Department of Urology; Paracelsus-Krankenhaus Ruit; Ostfildern; Germany
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18
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Abstract
The last two decades have witnessed the rapid dissemination of robot-assisted laparoscopic urological surgery related to the technical advantages of this new laparoscopic tool. Master-slave systems ease intracorporeal anastomosis and the performance of technically highly demanding procedures, as reflected by a steep learning curve. Robot-assistance is particularly useful for partial nephrectomy, live-donor kidney transplantation, extended procedures, e.g. upper and lower urogenital tract resection and difficult anatomy as encountered in obese patients or patient with a history of multiple intraperitoneal procedures.
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19
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Laparoscopic Living-Donor Nephrectomy: Analysis of the Existing Literature. Eur Urol 2010; 58:498-509. [DOI: 10.1016/j.eururo.2010.04.003] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 04/07/2010] [Indexed: 01/10/2023]
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21
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Abstract
Renal transplantation is an effective treatment for patients with end-stage renal disease. Unfortunately, the number of patients waiting for transplantation greatly exceeds the number of suitable organs. Use of live kidney donors can increase the donor pool. Historically, donor nephrectomy was performed as an open technique. Its associated prolonged convalescence and long-term morbidity was likely a disincentive to donate. Laparoscopic donor nephrectomy, however, has been shown to have fewer long-term complications without compromising graft function. Since its inception, there has been an increase in the number of live donor renal transplantations performed.
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Affiliation(s)
- Mary Eng
- Department of Surgery, Division of Transplantation, University of Louisville, Louisville, Kentucky
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22
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Dols LFC, Kok NFM, IJzermans JNM. Live donor nephrectomy: a review of evidence for surgical techniques. Transpl Int 2010; 23:121-30. [DOI: 10.1111/j.1432-2277.2009.01027.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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23
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Ma L, Ye J, Huang Y, Hou X, Zhao L, Wang G. Retroperitoneoscopic live-donor nephrectomy: 5-year single-center experience in China. Int J Urol 2010; 17:158-62. [DOI: 10.1111/j.1442-2042.2009.02443.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Donor complications following laparoscopic compared to hand-assisted living donor nephrectomy: an analysis of the literature. J Transplant 2010; 2010:825689. [PMID: 20130811 PMCID: PMC2814225 DOI: 10.1155/2010/825689] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 11/02/2009] [Indexed: 12/24/2022] Open
Abstract
There are two approaches to laparoscopic donor nephrectomy: standard laparoscopic donor nephrectomy (LDN) and hand-assisted laparoscopic donor nephrectomy (HALDN). In this study we report the operative statistics and donor complications associated with LDN and HALDN from large-center peer-reviewed publications. Methods. We conducted PubMed and Ovid searches to identify LDN and HALDN outcome studies that were published after 2004. Results. There were 37 peer-reviewed studies, each with more than 150 patients. Cumulatively, over 9000 patients were included in this study. LDN donors experienced a higher rate of intraoperative complications than HALDN donors (5.2% versus. 2.0%, P < .001). Investigators did not report a significant difference in the rate of major postoperative complications between the two groups (LDN 0.5% versus HALDN 0.7%, P = .111). However, conversion to open procedures from vascular injury was reported more frequently in LDN procedures (0.8% versus 0.4%, P = .047). Conclusion. At present there is no evidence to support the use of one laparoscopic approach in preference to the other. There are trends in the data suggesting that intraoperative injuries are more common in LDN while minor postoperative complications are more common in HALDN.
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25
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A Fast and Safe Living Donor “Finger-Assisted” Nephrectomy Technique: Results of 359 Cases. Transplant Proc 2010; 42:165-70. [DOI: 10.1016/j.transproceed.2009.12.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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26
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Bittner JG, Sajadi K, Brown JA. Comparison of Renal Artery Occlusion Techniques in Hand-Assisted Laparoscopic Living Donor Nephrectomy. J Endourol 2009; 23:933-7. [DOI: 10.1089/end.2008.0297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- James G. Bittner
- Department of Surgery, Medical College of Georgia, Augusta, Georgia
| | - Kamran Sajadi
- Department of Surgery, Medical College of Georgia, Augusta, Georgia
| | - James A. Brown
- Department of Surgery, Medical College of Georgia, Augusta, Georgia
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27
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Cavallari G, Tsivian M, Bertelli R, Neri F, Faenza A, Nardo B. A New Swine Training Model of Hand-Assisted Donor Nephrectomy. Transplant Proc 2008; 40:2035-7. [DOI: 10.1016/j.transproceed.2008.05.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Percegona L, Bignelli A, Adamy A, Machado C, Pilz F, Meyer F, Hokazono S, Riella M. Early Graft Function in Kidney Transplantation: Comparison Between Laparoscopic Donor Nephrectomy and Open Donor Nephrectomy. Transplant Proc 2008; 40:685-6. [DOI: 10.1016/j.transproceed.2008.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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29
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Perez M, Quiaios F, Andrivon P, Husson D, Dufaut M, Felblinger J, Hubert J. Paradigms and experimental set-up for the determination of the acceptable delay in telesurgery. ACTA ACUST UNITED AC 2008; 2007:453-6. [PMID: 18001987 DOI: 10.1109/iembs.2007.4352321] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The aim of this work was to develop an experimental set-up and realistic paradigms to study the effect of delay on video flux transmission and surgical performance. Four exercises were performed by 15 surgeons with 5 different simulated transmission delays. Large standard deviation of the duration of an exercise was found. Even with a short transmission delay of 150ms, some surgeon found that the surgical procedure was not possible. Further work has to be done to have a better evaluation of the surgical precision.
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Affiliation(s)
- M Perez
- INSERM ERI13, and department of Chirurgie Générale & Urgences, Pr Grosdidier, Hôpital Central, Nancy, France.
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30
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Sener A, Cooper M. Live donor nephrectomy for kidney transplantation. ACTA ACUST UNITED AC 2008; 5:203-10. [PMID: 18268550 DOI: 10.1038/ncpuro1047] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Accepted: 01/03/2008] [Indexed: 11/09/2022]
Abstract
The number of patients with end-stage renal disease is increasing substantially every year around the world. Renal transplantation is the best treatment option to improve survival and quality of life. Although the numbers of living, related and deceased transplant donors has also increased, this growth is insufficient to keep up with the expansion rate of the renal failure population. The introduction of laparoscopic donor nephrectomy has gained widespread acceptance by physicians and patients, and seems to be better than open donor nephrectomy in terms of reduced postoperative pain, quick recovery and improved cosmetic outcomes. Evidence strongly suggests that graft survival is similar in recipients of kidneys from living related and unrelated donors. Fortunately, this information has raised awareness of the suitability of potential live, unrelated donors, including spouses, friends, or even anonymous donors. In this Review we touch on sociological aspects of living related kidney transplantation and review the available and proposed methods of increasing the live donor pool, including organ exchange and desensitization protocols for ABO-incompatible and cross-match-positive donor pairs.
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Affiliation(s)
- Alp Sener
- Division of Transplantation, University of Maryland Medical Center, Baltimore, MD 21201, USA
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