1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Garrard L, Hakeem A, Robertson S, Farid S, Hostert L, Baker R, Jameel M, Morris-Stiff G, Ahmad N. The Prevailing Preference for Left Nephrectomy in Living Donor Transplantation Does Not Adversely Affect Long-Term Donor and Recipient Outcomes. Transplant Proc 2021; 53:1897-1904. [PMID: 34247861 DOI: 10.1016/j.transproceed.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/02/2021] [Accepted: 06/01/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND In living donor renal transplantation, surgeons traditionally prefer the left kidney for donation. The aim of this study was to assess the effects of the choice of laterality of donor nephrectomy on donor and recipient outcomes. METHODS The data was obtained from the UK National Health Service Blood and Transplant (NHSBT). During the study period, 7919 donor nephrectomy and transplantation were carried out in 24 transplant centers. Of these procedures, 6407 (80.9%) were left and 1512 (19.1%) were right kidney donors. RESULTS Right kidney donation was associated with higher incidence of surgical site infection in the donor. Recipient outcome was superior for left-sided kidneys in terms of immediate graft function, delayed graft function, graft loss within 30 days, and graft survival at 3 years, but not at 1 and 5 years. Open donor nephrectomy (n = 2396, 30.2%) was associated with higher rates of pneumothorax and hemorrhage, longer hospital stay, and inferior graft survival at 3 and 5 years compared with laparoscopic donor nephrectomy (n = 5523, 69.8%). CONCLUSIONS A right donor nephrectomy is associated with higher rate of wound infection in the donor and similar long-term graft outcomes in the recipients. Laparoscopic donor nephrectomy offers lower rate of major complications in the donor and a better overall graft survival.
Collapse
Affiliation(s)
- Lucy Garrard
- Division of Surgery, Department of Transplantation Surgery, St James's University Hospital, Leeds, United Kingdom
| | - Abdul Hakeem
- Division of Surgery, Department of Transplantation Surgery, St James's University Hospital, Leeds, United Kingdom
| | - Scot Robertson
- Division of Surgery, Department of Transplantation Surgery, St James's University Hospital, Leeds, United Kingdom
| | - Shahid Farid
- Division of Surgery, Department of Transplantation Surgery, St James's University Hospital, Leeds, United Kingdom
| | - Lutz Hostert
- Division of Surgery, Department of Transplantation Surgery, St James's University Hospital, Leeds, United Kingdom
| | - Richard Baker
- Department of Renal Medicine, St James's University Hospital, Leeds, United Kingdom
| | - Muhammad Jameel
- Department of Transplantation Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Kingdom of Saudi Arabia
| | - Gareth Morris-Stiff
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Niaz Ahmad
- Division of Surgery, Department of Transplantation Surgery, St James's University Hospital, Leeds, United Kingdom; Department of Transplantation Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Kingdom of Saudi Arabia.
| |
Collapse
|
3
|
Cho SJ, Moon HW, Kang SM, Choi SW, Kim KS, Choi YS, Hong SH, Ha US, Lee JY, Kim SW, Kim JC, Cho HJ. Evolution of Laparoscopic Donor Nephrectomy Techniques and Outcomes: A Single-Center Experience with More than 1000 Cases. Ann Transplant 2020; 25:e918189. [PMID: 32041930 PMCID: PMC7034519 DOI: 10.12659/aot.918189] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Laparoscopic donor nephrectomy (LDN) has evolved and has been established as a surgical standard of care for kidney transplantation. Material/Methods This study retrospectively reviews 1132 patients who underwent 4 different laparoscopic living-donor nephrectomies: hand-assisted laparoscopic nephrectomy (HALDN), pure laparoscopic donor nephrectomy (PLDN), laparoendoscopic single-site plus 1-port donor nephrectomy (LESSOP-DN), and mini laparoscopic donor nephrectomy (MLDN). Results The mean estimated blood loss (EBL) for the HALDN group was meaningfully higher than those of LESSOP-DN and MLDN (57.5±52.2 mL versus 21.0±30.0 mL versus 18.2±28.7 mL) (P<0.001). The EBL for PLDN (53.3±35.3 mL) was also significantly higher than those of LESSOP-DN and MLDN (P<0.001). Length of stay (LOS) for HALDN was longer than that for LESSOP-DN (4.2±1.2 day versus 4.0±1.4 days, P=0.002). There was 1 intraoperative open conversion in the HALDN group and 2 HALDN surgeries that required postoperative exploratory laparotomy. LESSOP-DN had 3 (0.8%) postoperative incisional hernias. For recipients, the results revealed no significant differences between all 4 groups in terms of estimated glomerular filtration rate (eGFR) and the 1-year graft failure rate. Conclusions The LESSOP-DN group was associated with a shorter incision length than those of HALDN and PLDN and shorter LOS than that of HALDN. Recipient results showed no meaningful difference regarding laparoscopic donor nephrectomy technique.
Collapse
Affiliation(s)
- Shin Jay Cho
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyong Woo Moon
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung-Min Kang
- Department of Urology, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Sae Woong Choi
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kang Sup Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Yong-Sun Choi
- Department of Urology, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Sung-Hoo Hong
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - U-Syn Ha
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ji Youl Lee
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sae Woong Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Joon Chul Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Bucheon, South Korea
| | - Hyuk Jin Cho
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| |
Collapse
|
4
|
Cooper M, Kramer A, Nogueira JM, Phelan M. Recipient outcomes of dual and multiple renal arteries following 1000 consecutive laparoscopic donor nephrectomies at a single institution. Clin Transplant 2013; 27:261-6. [DOI: 10.1111/ctr.12062] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2012] [Indexed: 12/22/2022]
Affiliation(s)
- Matthew Cooper
- Division of Transplantation; Department of Surgery; University of Maryland School of Medicine; Baltimore; MD; USA
| | - Andrew Kramer
- Division of Urology; Department of Surgery; University of Maryland School of Medicine; Baltimore; MD; USA
| | - Joseph M. Nogueira
- Division of Nephrology; Department of Medicine; University of Maryland School of Medicine; Baltimore; MD; USA
| | - Michael Phelan
- Division of Urology; Department of Surgery; University of Maryland School of Medicine; Baltimore; MD; USA
| |
Collapse
|
5
|
McGill RL, Ko TY. Transplantation and the primary care physician. Adv Chronic Kidney Dis 2011; 18:433-8. [PMID: 22098662 DOI: 10.1053/j.ackd.2011.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 10/14/2011] [Accepted: 10/18/2011] [Indexed: 01/10/2023]
Abstract
Increasing appreciation of the survival benefits of kidney transplantation, compared with chronic dialysis, has resulted in more patients with kidney disease being referred and receiving organs. The evolving disparity between a rapidly increasing pool of candidates and a smaller pool of available donors has created new issues for the physicians who care for kidney patients and their potential living donors. This article outlines current efforts to address the growing number of patients who await transplantation, including relaxation of traditional donation criteria, maximization of living donation, and donation schemas that permit incompatible donor-recipient pairs to participate through paired donation and transplantation chains. New ethical issues faced by donors and recipients are discussed. Surgical advances that reduce the morbidity of donors are also described, as is the role of the primary physician in medical issues of both donors and recipients.
Collapse
|
6
|
|
7
|
Andonian S, Rais-Bahrami S, Atalla MA, Herati AS, Richstone L, Kavoussi LR. Laparoendoscopic single-site Pfannenstiel versus standard laparoscopic donor nephrectomy. J Endourol 2010; 24:429-32. [PMID: 20105032 DOI: 10.1089/end.2009.0185] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To compare laparoendoscopic single-site (LESS) Pfannenstiel donor nephrectomy with a contemporary series of standard laparoscopic (SL) donor nephrectomies. METHODS The initial 6 LESS donor nephrectomies were compared with a case-matched 6 SL donor nephrectomies within the same time period (June 2008 till March 2009). Patient characteristics (sex, age, body mass index, graft volume, and vascular anatomy), perioperative data (operative time, warm ischemia time [WIT], and estimated blood loss), and postoperative information (complications, length of stay, visual analog scale [VAS], and total morphine requirements) were collected prospectively and analyzed retrospectively. RESULTS In the LESS group, there were no conversions to SL or open. There was no significant difference between the two groups in terms of baseline characteristics (age, body mass index, allograft volume). However, SL group included more right-sided patients (three compared with one) and more venous anomalies (retrorenal veins in two patients and multiple veins in another). There was no significant difference between SL and LESS in terms of operative time (117 vs. 142 minutes), WIT (5 minutes in both groups), estimated blood loss (150 vs. 100 mL), median length of stay (2 days in both), and total morphine equivalents (42 vs. 83 mg). None of the patients received transfusions perioperatively. A patient in the SL group developed a wound infection requiring packing and antibiotics. There were no perioperative complications in the LESS group. Although VAS scores were lower in the LESS versus SL group at each of post-operative day (POD) #2 (1.5 vs. 4) and discharge (0 vs. 2), this did not reach statistical significance. CONCLUSIONS In this small retrospective series, SL was associated with more complex renal anatomy. However, there was no difference between the two groups in terms of WIT, narcotic requirements, and VAS scores. Therefore, the advantages of LESS may only be cosmesis. To verify these results, both procedures need to be compared prospectively in a randomized fashion.
Collapse
Affiliation(s)
- Sero Andonian
- Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York 11040, USA
| | | | | | | | | | | |
Collapse
|
8
|
Modi P. The mini-incision donor nephrectomy is best suited for Indian patients undergoing live donor nephrectomy: against the motion. Indian J Urol 2010; 26:142-4. [PMID: 20535306 PMCID: PMC2878431 DOI: 10.4103/0970-1591.60465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Pranjal Modi
- Department of Urology and Transplantation Surgery, Institute of Kidney Diseases and Research Centre, Institute of Trans plantation Sciences, Civil Hospital Campus, Asarwa, Ahmedabad - 380 016, Gujarat, India
| |
Collapse
|
9
|
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.
Collapse
|
10
|
Laparoendoscopic Single-site Pfannenstiel Donor Nephrectomy. Urology 2010; 75:9-12. [DOI: 10.1016/j.urology.2009.08.074] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2009] [Revised: 07/25/2009] [Accepted: 08/06/2009] [Indexed: 11/15/2022]
|
11
|
Current World Literature. Curr Opin Obstet Gynecol 2009; 21:353-63. [DOI: 10.1097/gco.0b013e32832f731f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|