1
|
Ferhatoglu MF, Sahin OZ, Kivilcim T, Gurkan A. The positive effects of preoperative chlorhexidine rinse to reduce postoperative pneumonia after kidney transplantation surgery. Surgeon 2024:S1479-666X(24)00066-0. [PMID: 38981842 DOI: 10.1016/j.surge.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Postoperative pneumonia is one of the most observed hospital-acquired infections and increases the postoperative mortality rate. Further, it drives the healthcare systems under a severe financial burden. Preventing postoperative pneumonia is an incredibly challenging issue for clinicians. Since immunosuppression therapy, the patients who had kidney transplants are more vulnerable to postoperative infections. There is no data in the scientific literature focusing on the effects of preoperative oral care with chlorhexidine antiseptic solutions on postoperative pneumonia in kidney transplantation surgery cases. In the present research, we studied this topic. METHODS A prospective, randomized clinical trial was conducted at our institution between August 2020 and August 2022. Group A: Received 0.12 % chlorhexidine oral rinse preoperatively; Group B: Not received 0.12 % chlorhexidine oral rinse preoperatively. We analyzed the differences between the two trial groups using a chi-square or t-test. The Mann-Whitney U test was used for the categorical data. RESULTS Nine patients (17.6 %) were diagnosed with postoperative pneumonia in Group A and fourteen (25.9 %) in Group B (p < 0.05). Hospitalization time of Group B was prolonged (p < 0.05). In multivariate analysis, significant risk factors associated with postoperative pneumonia were advanced age, diabetes mellitus, smoking, delayed graft function and not gargling with 0.12 % chlorhexidine (p < 0.05). CONCLUSIONS To reduce postoperative pneumonia risk in patients undergoing kidney transplantation surgery, an oral health protocol including 0.12 % chlorhexidine mouth rinse seems beneficial.
Collapse
Affiliation(s)
| | - Osman Z Sahin
- Istanbul Okan University, Faculty of Medicine, Department of Nephrology, Istanbul, Turkey
| | - Taner Kivilcim
- Istanbul Okan University, Faculty of Medicine, Department of Surgery, Istanbul, Turkey
| | - Alp Gurkan
- Istanbul Okan University, Faculty of Medicine, Department of Surgery, Istanbul, Turkey
| |
Collapse
|
2
|
Mac Curtain BM, Qian W, Temperley HC, O'Mahony A, Ng ZQ, He B. Incisional hernias post renal transplant: a systematic review and meta-analysis. Hernia 2024; 28:301-319. [PMID: 37715026 DOI: 10.1007/s10029-023-02879-9] [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: 07/20/2023] [Accepted: 08/29/2023] [Indexed: 09/17/2023]
Abstract
PURPOSE Incisional hernia (IH) post renal transplant (RT) is relatively uncommon and can be challenging to manage clinically due to the presence of the kidney graft and patient immunosuppression. This systematic review and meta-analysis synthesises the current literature in relation to IH rates, risk factors and outcomes post RT. METHODS PubMed, EMBASE, and Cochrane Central Registry of Controlled Trials (CENTRAL) were searched up to July 2023. The most up to date Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines were followed. Pertinent clinical information was synthesised. A meta-analysis of the pooled proportions of IH rates, the rates of patients requiring surgical repair and the rates of recurrence post RT are reported. RESULTS Twenty studies comprising 16,018 patients were included in this analysis. The pooled rate of IH occurrence post RT was 4% (CI 3-5%). The pooled rate of IH repair post RT was 61% (CI 14-100%). The pooled rate of IH recurrence after repair was 16% (CI 9-23%). Risk factors identified for IH development post RT are BMI, immunosuppression, age, smoking, incision type, reoperation, concurrent abdominal wall hernia, lymphocele formation and pulmonary disease. CONCLUSIONS IH post RT is uncommon and the majority of IH post RT are repaired surgically on an elective basis.
Collapse
Affiliation(s)
- B M Mac Curtain
- School of Medicine, University of Galway, Galway, Ireland.
- Dept. of Surgery, St John of God Subiaco Hospital, Subiaco, WA, Australia.
| | - W Qian
- Dept. of Surgery, St John of God Subiaco Hospital, Subiaco, WA, Australia
| | | | - A O'Mahony
- University Hospital Limerick, Limerick, Ireland
| | - Z Q Ng
- Dept. of General Surgery, Royal Perth Hospital, Perth, WA, Australia
| | - B He
- Renal Surgery and Transplant Unit, Austin Health, Melbourne, VIC, Australia
| |
Collapse
|
3
|
Akinci S, Altinel M. Does the Use of Mini-Incisions In Renal Transplantation Surgery Affect Postoperative Parameters: Single Center Experience. Transplant Proc 2023:S0041-1345(23)00206-3. [PMID: 37137766 DOI: 10.1016/j.transproceed.2023.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/13/2023] [Accepted: 03/27/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Kidney transplantation can be performed with different surgical approaches, such as conventional open kidney transplantation (CKT), minimally invasive kidney transplantation (MIKT), laparoscopic kidney transplantation, and robot-assisted kidney transplantation. Conventional open kidney transplantation is usually performed using a Gibson or hockey stick incision, may be associated with higher wound complication rates, and results in worse cosmetic outcomes compared with minimally invasive methods. Minimally invasive kidney transplantation is performed with a smaller skin incision than CKT but may result in limited surgical exposure. This study aimed to compare the surgical results of MIKT and CKT. METHODS Fifty-nine patients with a body mass index of 22 kg/m2 and below and with no anatomic variations in computed tomography were included in the study. Thirty-seven patients who underwent CKT were included in group 1, and twenty-two patients who underwent MIKT were included in group 2. Patient data were collected retrospectively. This study was conducted in compliance with The Helsinki Congress and The Declaration of Istanbul. RESULTS The mean incision length was calculated as 12.7 cm in group 1 and 7.3 cm in group 2 (P < .05). There was no statistically significant difference between the groups in terms of lodge preparation time, vein clamp time, artery clamp time, ureteroneocystostomy time, visual analog scale scores, postoperative creatinine levels, or complication rates (P > .05 for each comparison). CONCLUSIONS Without compromising the goals and primary concerns of transplantation surgery, MIKT can be offered to selected transplant patients with cosmetic concerns.
Collapse
Affiliation(s)
- Serkan Akinci
- Urology and Organ Transplantation Department, Memorial Hizmet Hospital, Istanbul, Turkey.
| | - Mert Altinel
- Urology and Organ Transplantation Department, Memorial Hizmet Hospital, Istanbul, Turkey
| |
Collapse
|
4
|
Colak H, Kivılcim T, Unverdi OF, Yildiz G, Gurkan A. Description and Outcomes of Three Different End-to-Side Microsurgical Techniques for the Anastomosis of Accessory Renal Artery With the Dominant Renal Artery in Kidney Transplantation. Transplant Proc 2021; 53:2900-2906. [PMID: 34782171 DOI: 10.1016/j.transproceed.2021.08.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/04/2021] [Accepted: 08/30/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND In this study, we compared the outcomes of three different surgical microscope-assisted end-to-side anastomosis techniques between the dominant and accessory renal arteries during living donor kidney transplant. METHODS The demographics, serum creatinine levels, warm and cold ischemia times, rate of complications, and incidence of delayed graft function of 135 kidney recipients were analyzed according to the type of arterial anastomosis. Group A (n = 98) had one dominant renal artery (DRA) with one end-to-side anastomosis to the external iliac artery (EIA) using a surgical microscope. Group B (n = 17) had one DRA plus one accessory renal artery (ARA) with two separate end-to-side anastomoses to the EIA using a surgical microscope. Group C (n = 20) had one DRA with end-to-side anastomosis to the EIA and one ARA with an ex vivo on-bench end-to-side anastomosis to the DRA using a surgical microscope. RESULTS Compared with groups A and B, the cold ischemia time and the rate of delayed graft function were significantly higher in group C (P ≤ .001). At 6 months after transplant, group B demonstrated a higher creatinine value (2.40 ± 3.41 mg/dL) than group A and group B (P = .032). Also, the decrease in creatinine at postoperative month 6 was limited in group B as compared with groups A and C. CONCLUSIONS An end-to-side anastomosis between ARA (group B) and DRA (group A) of the kidney graft using a surgical microscope on the bench ex vivo results in superior outcomes. Single arterial anastomosis techniques are associated with a better function in a 6-month follow-up than two separate arterial anastomoses.
Collapse
Affiliation(s)
- Hulya Colak
- Department of Nephrology, Faculty of Medicine, İzmir Health Sciences University Tepecik, Izmir, Turkey.
| | - Taner Kivılcim
- Department of General Surgery, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
| | - Omer Faruk Unverdi
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
| | - Gursel Yildiz
- Department of Nephrology, Cam Sakura Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Alp Gurkan
- Department of General Surgery, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
| |
Collapse
|
5
|
Siena G, Vignolini G, Mari A, Li Marzi V, Caroassai S, Giancane S, Sessa F, Minervini A, Breda A, Serni S. Full Robot-Assisted Living Donor Nephrectomy and Kidney Transplantation in a Twin Dedicated Operating Room: Initial Experience From a High-Volume Robotic Center. Surg Innov 2019; 26:449-455. [DOI: 10.1177/1553350619835429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose. To describe our initial experience with a full robot-assisted approach for living donor nephrectomy (RALDN) and kidney transplantation (RAKT) in a dedicated twin operating room. Methods. From January to December 2017, 5 cases of RALDN and RAKT were performed in a single high-volume robotic center. All patients underwent a standard left RALDN. The renal hilum was controlled with Hem-O-Lok clips (WECK) and the kidney extracted through a Pfannenstiel incision. RAKT was performed according to the Vattikuti Urology Institute–Medanta technique. Results. RALDN: median estimated blood loss was 182 mL (range = 80-450 mL), no postoperative blood transfusion was required. The median (range) warm ischemia time was 175 (90-220 seconds). No conversion was registered. Median console time was 143 minutes (range = 115-220 minutes). No major surgical intraoperative and postoperative early and late complications occurred. RAKT: all 5 patients successfully underwent RAKT. Median (range) console time was 230 (190-200) minutes, vascular suture time was 58.7 (48-73) minutes, cold ischemia time was 46.2 (30-88) minutes, and rewarming time was 61.2 (55-72) minutes. No conversion was required. No major surgical intraoperative and postoperative early and late complications occurred. Mean glomerular filtration rate at days 1, 3, and 7 postoperatively was 26, 42, and 57 (range = 6-90) mL/min/1.73 m2, respectively. No case of delayed graft function was observed. No anastomosis revision, urological complications, lymphocele, and surgical site infection occurred. Conclusions. In our experience, RALDN and RAKT are safe and effective. The intuitiveness of the robotic approach provided substantial benefits both for the living donor and recipient from the very beginning of our series. No intraoperative and postoperative complications occurred.
Collapse
Affiliation(s)
- Giampaolo Siena
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Graziano Vignolini
- Department of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Mari
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Vincenzo Li Marzi
- Department of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Simone Caroassai
- Department of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Saverio Giancane
- Department of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Sessa
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Minervini
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Alberto Breda
- Department of Urology, Fundaciòn Puigvert, University Autonoma of Barcelona, Barcelona, Spain
| | - Sergio Serni
- Department of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| |
Collapse
|
6
|
Uwechue R, Chandak P, Ahmed Z, Gogalniceanu P, Kessaris N, Mamode N. Minimally invasive surgical techniques for kidney transplantation. Hippokratia 2017. [DOI: 10.1002/14651858.cd012698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Raphael Uwechue
- Department of Transplantation; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - Pankaj Chandak
- Department of Transplant Surgery; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - Zubir Ahmed
- General and Transplant Surgery; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - Petrut Gogalniceanu
- Department of Transplantation; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - Nicos Kessaris
- Department of Transplantation; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - Nizam Mamode
- Department of Transplantation; Guy's and St Thomas' NHS Foundation Trust; London UK
| |
Collapse
|
7
|
Phillips SH, Hill SK, Lipscomb LD, Africa JB. Altering the Approach: Open Minimally Invasive Renal Transplant in Obese Patients Through the Anterior Rectus Sheath. Urology 2017; 105:192-196. [DOI: 10.1016/j.urology.2017.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/15/2017] [Accepted: 03/08/2017] [Indexed: 10/19/2022]
|
8
|
Wagenaar S, Nederhoed JH, Hoksbergen AWJ, Bonjer HJ, Wisselink W, van Ramshorst GH. Minimally Invasive, Laparoscopic, and Robotic-assisted Techniques Versus Open Techniques for Kidney Transplant Recipients: A Systematic Review. Eur Urol 2017; 72:205-217. [PMID: 28262412 DOI: 10.1016/j.eururo.2017.02.020] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 02/09/2017] [Indexed: 12/14/2022]
Abstract
CONTEXT Literature on conventional and minimally invasive operative techniques has not been systematically reviewed for kidney transplant recipients. OBJECTIVE To systematically evaluate, summarize, and review evidence supporting operating technique and postoperative outcome for kidney transplant recipients. EVIDENCE ACQUISITION A systematic review was conducted in PubMed-Medline, Embase, and Cochrane Library between 1966 up to September 1, 2016, according to Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Articles were included and scored by two independent reviewers using Group Reading Assessment and Diagnostic Evaluation (GRADE), Newcastle-Ottawa Quality Assessment Scale (NOS), and Oxford guidelines for level of evidence. Main outcomes were graft survival, surgical site infection, incisional hernia, and cosmetic result. In total, 18 out of 1954 identified publications were included in this analysis. EVIDENCE SYNTHESIS Included reports described conventional open, minimally invasive open, laparoscopic, and robotic-assisted techniques. General level of evidence of included studies was low (GRADE: 1-3; NOS: 0-4; and Oxford level of evidence: 4-2). No differences in graft or patient survival were found. For open techniques, Gibson incision showed better results than the hockey-stick incision for incisional hernia (4% vs 16%), abdominal wall relaxation (8% vs 24%), and cosmesis. Minimally invasive operative recipient techniques showed lowest surgical site infection (range 0-8%) and incisional hernia rates (range 0-6%) with improved cosmetic result and postoperative recovery. Disadvantages included prolonged cold ischemia time, warm ischemia time, and total operation time. CONCLUSIONS Although the level of evidence was generally low, minimally invasive techniques showed promising results with regard to complications and recovery, and could be considered for use. For open surgery, the smallest possible Gibson incision appeared to yield favorable results. PATIENT SUMMARY In this paper, the available evidence for minimally invasive operation techniques for kidney transplantation was reviewed. The quality of the reviewed research was generally low but suggested possible advantages for minimally invasive, laparoscopic, and robot-assisted techniques.
Collapse
Affiliation(s)
- Sven Wagenaar
- Department of Surgery, VU Medical Center, Amsterdam, The Netherlands; Department of Urology, Meander Medical Centre, Amersfoort, The Netherlands.
| | | | | | - H Jaap Bonjer
- Department of Surgery, VU Medical Center, Amsterdam, The Netherlands
| | - Willem Wisselink
- Department of Surgery, VU Medical Center, Amsterdam, The Netherlands
| | - Gabrielle H van Ramshorst
- Department of Surgery, VU Medical Center, Amsterdam, The Netherlands; Department of Surgery, Dutch Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| |
Collapse
|