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Lyu J, Yue R, Wang Z, Zhu Y. Relationship between surgical difficulty and postoperative complications of hand-assisted laparoscopic living donor nephrectomy and establishment of prediction model. BMC Urol 2024; 24:166. [PMID: 39098888 PMCID: PMC11299391 DOI: 10.1186/s12894-024-01551-3] [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: 05/22/2024] [Accepted: 07/23/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND Few studies have systematically explored the factors influencing the difficulty of hand-assisted laparoscopic living donor nephrectomy. To investigate the relationship between the difficulty of hand-assisted laparoscopic living donor nephrectomy and postoperative complications of the donor as well as the recipient, and then build a model for predicting the difficulty of surgery. METHODS In this study, 60 patients who underwent hand-assisted laparoscopic living donor nephrectomy by the same surgeon from September 2022 to March 2024 were included as the modeling group. 20 patients operated on by another surgeon served as the external validation group. The subjective score (1-3 points) of surgical difficulty was used as the quantitative index of surgical difficulty. Pearson and Spearman correlation tests were used to explore the correlation between preoperative data and surgical difficulty scores of kidney donors, and finally built a prediction model through multiple linear regression analysis. RESULTS With the increase in the difficulty of operation, both donors and recipients' complications were increased. Linear regression analysis showed that only the number of renal arteries, visceral fat thickness and MAP score were independent risk factors for the difficulty of hand-assisted laparoscopic living donor nephrectomy. The prediction equation is as follows: Difficulty score = 0.584*Number of renal arteries + 0.731*MAP score + 0.110*visceral fat thickness. CONCLUSIONS Donors with higher surgical difficulty are more likely to have serious complications after surgery as well as the recipient. We also established a reliable prediction model for the difficulty of hand-assisted laparoscopic donor nephrectomy.
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Affiliation(s)
- Jingcheng Lyu
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, 95 Yong'an Road, Xicheng District, Beijing, 100050, China
- Institute of Urology, Beijing Municipal Health Commission, 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Ruiyu Yue
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, 95 Yong'an Road, Xicheng District, Beijing, 100050, China
- Institute of Urology, Beijing Municipal Health Commission, 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Zhipeng Wang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, 95 Yong'an Road, Xicheng District, Beijing, 100050, China
- Institute of Urology, Beijing Municipal Health Commission, 95 Yong'an Road, Xicheng District, Beijing, 100050, China
| | - Yichen Zhu
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, 95 Yong'an Road, Xicheng District, Beijing, 100050, China.
- Institute of Urology, Beijing Municipal Health Commission, 95 Yong'an Road, Xicheng District, Beijing, 100050, China.
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Olumba FC, Vachharajani N, Yu J, Scherer M, Matson S, Hill AL, Kiani A, Lin Y, Doyle MMB, Chapman WC, Wellen JR, Khan AS. Robotic donor nephrectomy: optimizing outcomes beyond the limitations of laparoscopy. Surg Endosc 2023; 37:7511-7519. [PMID: 37415014 DOI: 10.1007/s00464-023-10246-z] [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: 03/09/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Robotic donor nephrectomy (RDN) has emerged as a safe alternate to laparoscopic donor nephrectomy (LDN), offering improved visualization, instrument dexterity and ergonomics. There is still concern about how to safely transition from LDN to RDN. METHODS We performed a retrospective review of 150 consecutive living donor operations (75 LDN and 75 RDN) at our center, comparing the first 75 RDN's with the last 75 LDN's performed prior to the initiation of the robotic transplant program. Operative times and complications were used as surrogates of efficiency and safety, respectively, to estimate the learning curve with RDN. RESULTS RDN was associated with a longer total operative time (RDN 182 vs LDN 144 min; P < 0.0001) but a significantly shorter post-operative length of stay (RDN 1.8 vs LDN 2.1 days; P = 0.0213). Donor complications and recipient outcomes were the same between both groups. Learning curve of RDN was estimated to be about 30 cases. CONCLUSIONS RDN is a safe alternate to LDN with acceptable donor morbidity and no negative impact on recipient outcomes even during the early part of the RDN learning curve. Surgeon preferences for the robotic approach compared to traditional laparoscopy will require further scrutiny to improve ergonomics and operative efficiency.
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Affiliation(s)
- Franklin C Olumba
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Neeta Vachharajani
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Jennifer Yu
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Meranda Scherer
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Sarah Matson
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Angela L Hill
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Amen Kiani
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Yiing Lin
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Majella M B Doyle
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - William C Chapman
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Jason R Wellen
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Adeel S Khan
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA.
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Huynh N, Yoon P, Hort A, Yao J, Lee T, Yuen L, Laurence JM, Pleass H. Utilizing the same incision for staged renal transplant in patients with polycystic kidney disease requiring hand-assisted laparoscopic nephrectomy. ANZ J Surg 2022; 92:3004-3010. [PMID: 36128601 DOI: 10.1111/ans.18038] [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: 06/01/2022] [Revised: 08/01/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUNDS Many autosomal dominant polycystic kidney disease (ADPKD) patients undergo nephrectomy and subsequent renal transplantation. We report our outcomes after hand-assisted laparoscopic nephrectomy (HALN) where a Rutherford-Morrison incision is used as a hand-port site and kidney extraction site, as well the future incision site for staged transplantation. METHODS A retrospective review was performed on all adult nephrectomies for ADPKD by the Transplant Surgery department at Westmead Hospital between June 2011 and June 2021. Outcomes were compared between HALN, laparoscopic nephrectomy (LN) and open nephrectomy (ON) including operation time, hospital length of stay (LOS), post-operative complications, subsequent transplantation and post-transplantation wound complications. RESULTS Twenty-two HALN, 8 LN and 5 ON were performed during the study period. Median kidney weights for HALN, LN and ON were significantly different (1575, 403, 3420 g respectively, P = 0.001). There was a significant difference in LOS between the HALN and ON (5.8 versus 9.8 days, P = 0.04), but not between HALN and LN (5.8 versus 5.1, P = 0.06). There was no significant difference for operation time (P = 0.34) and major complication rates (P = 0.58). There were 8 HALN, 5 LN and 2 ON who have had subsequent renal transplantation with one wound complication, an incisional hernia in the HALN group. CONCLUSION Our HALN is associated with a shorter LOS and similar complication rate to ON and can be efficiently performed for significantly larger kidneys than LN without a significant difference in operation time or LOS. The same Rutherford-Morrison incision site can be used for transplantation.
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Affiliation(s)
- Nguyen Huynh
- Division of Transplant Surgery, Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Specialty of Surgery, FMH, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter Yoon
- Division of Transplant Surgery, Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Specialty of Surgery, FMH, The University of Sydney, Sydney, New South Wales, Australia
| | - Amy Hort
- Division of Transplant Surgery, Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Specialty of Surgery, FMH, The University of Sydney, Sydney, New South Wales, Australia
| | - Jinna Yao
- Division of Transplant Surgery, Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Specialty of Surgery, FMH, The University of Sydney, Sydney, New South Wales, Australia
| | - Taina Lee
- Division of Transplant Surgery, Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Specialty of Surgery, FMH, The University of Sydney, Sydney, New South Wales, Australia
| | - Lawrence Yuen
- Division of Transplant Surgery, Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Specialty of Surgery, FMH, The University of Sydney, Sydney, New South Wales, Australia
| | - Jerome Martin Laurence
- Division of Transplant Surgery, Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Specialty of Surgery, FMH, The University of Sydney, Sydney, New South Wales, Australia.,Department of Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Henry Pleass
- Division of Transplant Surgery, Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Specialty of Surgery, FMH, The University of Sydney, Sydney, New South Wales, Australia.,Department of Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Partezani AD, Duarte-Santos HO, Amaral BS, Gomes Barbosa AR, Apezzato M, Brunhara J, Bianco B, Lemos GC, Carneiro A. Outcomes of nephrectomy for renal cell carcinoma: An ecologic retrospective study in a middle-income country. Arch Ital Urol Androl 2022; 94:129-133. [PMID: 35775333 DOI: 10.4081/aiua.2022.2.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/31/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to describe and compare the outcomes and indirect costs of oncological radical (RN) and partial nephrectomies (PN) in hospitals from the São Paulo public health system, Brazil. MATERIALS AND METHODS An ecologic retrospective study was performed from 2008 to 2019, using the TabNet Platform of the Brazilian Unified Health System Department of Informatics. Hospitals were classified according to volume of surgeries (low and high-volume, and also into four quartiles according to volume of surgeries), and with or without medical residency program in urology. The results were compared between groups. RESULTS In the period analyzed were performed 2.606 RN in 16 hospitals. Data available for PN ranged only from 2013-2019 and included 1.223 surgeries comprising 15 hospitals. Overall mortality rates were 0.41% for PN and 2.87% for RN. The length of hospital stay was significantly higher in low-volume hospitals for both RN and PN (8.97 vs. 5.62 days, p = 0.001, and 7.75 vs. 4.37 days, p = 0.001, respectively), and also for the RN in hospitals without residency program in Urology (9.37 vs. 6.54 days, p = 0.03). When the volume of surgeries was divided into four quartiles, the length of hospital stay and ICU hospitalization days were significantly higher in the first quartile hospitals for RN (p = 0.016) and PN (p = 0.009), respectively. The mortality rates and indirect costs were not different considering PN and RN in the different types of hospitals. CONCLUSIONS The length of hospital stay was significantly lower for both PN and RN in high-volume hospitals, and also for RN in hospitals with residency program in Urology.
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Affiliation(s)
| | | | | | | | - Marcelo Apezzato
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, SP.
| | - João Brunhara
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, SP.
| | - Bianca Bianco
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, SP.
| | | | - Arie Carneiro
- Department of Urology, Hospital Israelita Albert Einstein, São Paulo, SP.
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Favi E, Iesari S, Catarsini N, Sivaprakasam R, Cucinotta E, Manzia T, Puliatti C, Cacciola R. Outcomes and surgical complications following living-donor renal transplantation using kidneys retrieved with trans-peritoneal or retro-peritoneal hand-assisted laparoscopic nephrectomy. Clin Transplant 2020; 34:e14113. [PMID: 33051895 DOI: 10.1111/ctr.14113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 01/06/2023]
Abstract
The best minimally invasive procedure for living-donor kidney retrieval remains debated. Our objective was to assess trans-peritoneal (TP) and retro-peritoneal (RP) hand-assisted laparoscopic donor nephrectomy (HALDN). In this single-center retrospective study, we analyzed results from 317 living-donor renal transplants (RT) performed between 2008 and 2016. Donor and recipient outcomes were compared between TP-HALDN (n = 235) and RP-HALDN (n = 82). Conversion to open nephrectomy (0.4% vs 0%; P = 1.000), intra-operative complications (1.7% vs 1.2%; P = 1.000), and 1-year overall post-operative complications (11.9% vs 17.1%; P = .258) rates were similar in TP-HALDN and RP-HALDN. Overall surgical site infections were higher in RP-HALDN (6.1% vs 1.7%; P = .053), whereas incisional hernias were only recorded following TP-HALDN (3.4% vs 0%; P = .118). The duration of the procedure was 11-minute shorter for TP-HALDN than RP-HALDN (P < .001) but extraction time was equivalent (2, IQR 1.5-2.5 minutes; P = 1.000). RT following TP-HALDN and RP-HALDN showed comparable one-year death-censored allograft survival (97% vs 98.8%; P = .685), primary non-function (0.4% vs 0%; P = .290), delayed graft function (1.3% vs 4.9%; P = .077), and urological complications (2.6% vs 4.9%; P = .290) rates. In our series, donor and recipient outcomes were not substantially affected by the approach used for donor nephrectomy. TP-HALDN and RP-HALDN were both safe and effective.
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Affiliation(s)
- Evaldo Favi
- Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Samuele Iesari
- Pôle de Chirurgie Expérimentale et Transplantation, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Nivia Catarsini
- General Surgery, Azienda Ospedaliera Universitaria Policlinico G. Martino, Messina, Italy
| | - Rajesh Sivaprakasam
- Renal Transplantation, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Eugenio Cucinotta
- General Surgery, Azienda Ospedaliera Universitaria Policlinico G. Martino, Messina, Italy
| | - Tommaso Manzia
- HPB Surgery and Transplantation, Fondazione PTV, Rome, Italy
| | | | - Roberto Cacciola
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.,HPB Surgery and Transplantation, Fondazione PTV, Rome, Italy
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Chaouch MA, Dougaz MW, Mesbehi M, Jerraya H, Nouira R, Khan JS, Dziri C. A meta-analysis comparing hand-assisted laparoscopic right hemicolectomy and open right hemicolectomy for right-sided colon cancer. World J Surg Oncol 2020; 18:91. [PMID: 32381008 PMCID: PMC7206699 DOI: 10.1186/s12957-020-01869-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/30/2020] [Indexed: 12/15/2022] Open
Abstract
Background Mini-invasive colorectal cancer surgery was adopted widely in recent years. This meta-analysis aimed to compare hand-assisted laparoscopic surgery (HALS) with open right hemicolectomy (OS) for malignant disease. Methods PRISMA guidelines with random effects model were adopted using Review Manager Version 5.3 for pooled estimates. Results Seven studies that involved 506 patients were included. Compared to OS, HALS improved results in terms of blood loss (MD = 53.67, 95% CI 10.67 to 96.67, p = 0.01), time to first flatus (MD = 21.11, 95% CI 14.99 to 27.23, p < 0.00001), postoperative pain score, and overall hospital stay (MD = 3.47, 95% CI 2.12 to 4.82, p < 0.00001). There was no difference as concerns post-operative mortality, morbidity (OR = 1.55, 95% CI 0.89 to 2.7, p = 0.12), wound infection (OR = 1.69, 95% CI 0.60 to 4.76, p = 0.32), operative time (MD = − 16.10, 95% CI [− 36.57 to 4.36], p = 0.12), harvested lymph nodes (MD = 0.59, 95% CI − 0.18 to 1.36, p = 0.13), and recurrence (OR = 0.97, 95% CI 0.30 to 3.15, p = 0.96). Conclusions HALS is an efficient alternative to OS in right colectomy which combines the advantages of OS with the mini-invasive surgery.
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Affiliation(s)
- Mohamed Ali Chaouch
- Department B of Surgery, Charles Nicolle Hospital, University Tunis El Manar, Tunis, Tunisia.
| | - Mohamed Wejih Dougaz
- Department B of Surgery, Charles Nicolle Hospital, University Tunis El Manar, Tunis, Tunisia
| | - Meriem Mesbehi
- Department B of Surgery, Charles Nicolle Hospital, University Tunis El Manar, Tunis, Tunisia
| | - Hichem Jerraya
- Department B of Surgery, Charles Nicolle Hospital, University Tunis El Manar, Tunis, Tunisia
| | - Ramzi Nouira
- Department B of Surgery, Charles Nicolle Hospital, University Tunis El Manar, Tunis, Tunisia
| | - Jim S Khan
- Department of Colorectal Surgery, Queen Alexandra Hospital, Southwick Hill road, Cosham, Portsmouth, UK
| | - Chadli Dziri
- Department B of Surgery, Charles Nicolle Hospital, University Tunis El Manar, Tunis, Tunisia
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