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Caylan AE, Uçar M, Gürman R, Kutlu Ö. Diagnosis and Management of Ureteropelvic Obstruction in Kidney Transplant Recipients and Outcomes of Foley Y-V Pyeloplasty. EXP CLIN TRANSPLANT 2024; 22:277-283. [PMID: 38742318 DOI: 10.6002/ect.2023.0269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
OBJECTIVES To evaluate the etiology and diagnostic tools for ureteropelvic obstruction in kidney transplant recipients, we investigated the short-term and long-term outcomes of Foley Y-V pyeloplasty. MATERIALS AND METHODS We retrospectively reviewed 10 patients who underwent kidney transplant followed by additional interventions to treat obstructive ureteral pathologies between 2016 and 2020. We enrolled 4 patients who had received intervention to treat ureteropelvic obstruction. For these 4 patients, serum creatinine and estimated glomerular filtration rate levels were recorded at baseline, during the symptomatic period, and long-term. In this single center study, we investigated diagnostic tools and management strategies for ureteropelvic obstruction and assessed performance of Foley Y-V nondismembered pyeloplasty in kidney transplant recipients. RESULTS Among 4 patients, graft function (assessed by serum creatinine and estimated glomerular filtration rate) worsened significantly (P = .03) in the symptomatic period of ureteropelvic obstruction in all patients; however, graft function levels improved rapidly to levels similar to baseline (P = .07) after Y-V pyeloplasty. In addition, no statistically significant difference was detected between baseline and longterm graft functions afterY-V pyeloplasty in follow-up (P = .28). CONCLUSIONS Diagnosis and management of ureteropelvic obstruction in kidney transplant recipients are challenging due to rarity and lack of an ideal management algorithm.There is no specific diagnostic tool to discriminate this pathology from other ureteral pathologies; therefore, a regimen of conventional imaging modalities and diuretic renogram combined with endoscopic evaluation is more reliable. Moreover, nondismembered Foley Y-V pyeloplasty is effective and safe for graft function in the short-term and long-term.
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Affiliation(s)
- Ahmet Ender Caylan
- From the Department of Urology, Akdeniz University School of Medicine, Antalya, Turkey
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Igbokwe MC, Olatise OO, Asaolu SO, Aremu AA, Abu S, Onwuasoanya U, Adetunbi AR, Alhassan S. Donor Nephrectomy Through Mini-Flank Incision: A Single-Centre Experience Among Nigerian Patients. Cureus 2022; 14:e25206. [PMID: 35747009 PMCID: PMC9211377 DOI: 10.7759/cureus.25206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2022] [Indexed: 11/05/2022] Open
Abstract
Background and objective The field of kidney transplantation in sub-Saharan Africa is still in the rudimentary stages. The majority of patients with chronic kidney disease have no access to renal replacement therapy, leading to very high mortality rates. Donor nephrectomy (DN) is an important aspect of kidney transplantation. Over the last two decades, open DN (ODN) has given way to minimally invasive techniques like laparoscopic DN (LDN) and robotic-assisted DN. In this study, we aimed to describe our experience with mini-flank incision donor nephrectomy (MIDN) at a Nigerian renal transplant center. Materials and methods We conducted a retrospective review of all DN cases performed at a single Nigerian kidney transplantation center over a three-year period. Information obtained from these patients was classified into pre-, intra-, and postoperative. The data included sociodemographic characteristics, preoperative preparation, details of intraoperative techniques, and postoperative findings. These were entered into a proforma and analyzed using SPSS Statistics version 21 (IBM Corp., Armonk, NY). Results A total of 230 patients underwent ODN during the study period. The majority of the donors were males (92.8%) with a mean age of 30.83 ±8.43 years. The body mass index (BMI) of most (76.1%) of the donors was within the normal range (18.5-24.9 kg/m2). The duration of DNs ranged from 72 to 154 minutes with a mean duration of 130 ±28 minutes. The length of flank incisions ranged from 7.8 to 12 cm with a mean incision length of 10.8 ±1.0 cm. Donors who had MIDN attained satisfactory postoperative pain control with about 90% of them having a BMI of <30 kg/m2. Oral intake and ambulation were commenced on the first postoperative day, and the cosmetic outcomes were deemed acceptable in over 90% of kidney donors. Conclusion Mini-incision for DN through the flank approach is a suitable alternative to LDN in the developing world where facilities and skills for LDN or robotic nephrectomies are largely unavailable. It offers a short recovery time, early ambulation, and excellent allograft outcomes.
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Zaytoun O, Elsawy M, Ateba K, Khalifa A, Hamdy A, Mostafa A. Laparoscopic donor nephrectomy: technique and outcome, a single-center experience. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00254-7] [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
Laparoscopic donor nephrectomy (LDN) has been established as a surgical standard for living kidney donation. The aim of this work is to report our own experience with LDN regarding outcome and technique.
Methods
We prospectively identified 110 LDN cases between May 2017 and April 2020. Donor case files and operative notes were analyzed for age, sex, laterality, body mass index, warm ischemia time (WIT), intraoperative and postoperative complications, operative time, and length of hospital stay (LOS). Data were analyzed using SPSS version 10 (SPSS: An IBM Company, IBM Corporation, Armonk, NY, the USA).
Results
The mean age was 38 years, and 77% were males. Three cases (2.72%) required conversion to conventional open donor nephrectomy (ODN). Nevertheless, none of cases required intraoperative blood transfusion. The mean WIT was 2.6 min. Two cases (1.8%) developed major vascular injury (Clavien grade IIIb) and required conversion to ODN. Postoperatively, one patient (0.9%) needed transfusion of one unit of packed RBCs (Clavien grade II). The mean LOS was 2 days. Most common early postoperative complication was ileus (Clavien grade II) that developed in 4 (3.6%) cases. Incisional hernia (Clavien grade IIIb) was encountered in two (1.8%) cases. Two (1.8%) cases developed wound infection at the incision site and treated conservatively (Clavien grade I).
Conclusions
LDN is a safe technique with accepted intraoperative and postoperative morbidity. It offers short hospital stay, better cosmesis and early convalescence. In experienced hands, it can effectively deal with various vascular and ureteral anomalies without compromising early graft function.
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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.
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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
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Is suturing of the bladder defect in benign Enterovesical fistula necessary? BMC Surg 2019; 19:85. [PMID: 31286905 PMCID: PMC6615302 DOI: 10.1186/s12893-019-0542-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 06/24/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Enterovesical fistula (EVF) is a abnormal connection between the intestine and the bladder. The aim of the study was to analyze whether closure of the defect in the bladder wall during surgery is always necessary. METHODS Fifty-nine patients with benign EVF undergoing surgical treatment were enrolled. A one-stage surgical procedure was performed in all patients. After the separation of the diseased bowel segment, methylene blue was introduced. Through a catheter into the bladder. Only patients with urinary bladder leakage were sutured. RESULTS The most common intestinal fistula involving the urinary bladder was colovesical fistula, observed in 53% of cases. Two-thirds of patients had diverticular disease as the underlying pathology. There was no relationship between suturing of the bladder and perioperative complications. Recurrent EVF was observed in one patient with bladder suturing and in two patients without suture. CONCLUSIONS These findings suggest that closure of the bladder defect is not necessary in cases where a leak is not demonstrated from the bladder intraoperatively. This study is limited by its retrospective design and small numbers and a randomized controlled trial is recommended to answer this question definitively.
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Golabek T, Szymanska A, Szopinski T, Bukowczan J, Furmanek M, Powroznik J, Chlosta P. Enterovesical fistulae: aetiology, imaging, and management. Gastroenterol Res Pract 2013; 2013:617967. [PMID: 24348538 PMCID: PMC3857900 DOI: 10.1155/2013/617967] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 10/29/2013] [Indexed: 12/26/2022] Open
Abstract
Background and Study Objectives. Enterovesical fistula (EVF) is a devastating complication of a variety of inflammatory and neoplastic diseases. Radiological imaging plays a vital role in the diagnosis of EVF and is indispensable to gastroenterologists and surgeons for choosing the correct therapeutic option. This paper provides an overview of the diagnosis of enterovesical fistulae. The treatment of fistulae is also briefly discussed. Material and Methods. We performed a literature review by searching the Medline database for articles published from its inception until September 2013 based on clinical relevance. Electronic searches were limited to the keywords: "enterovesical fistula," "colovesical fistula" (CVF), "pelvic fistula", and "urinary fistula". Results. EVF is a rare pathology. Diverticulitis is the commonest aetiology. Over two-thirds of affected patients describe pathognomonic features of pneumaturia, fecaluria, and recurrent urinary tract infections. Computed tomography is the modality of choice for the diagnosis of enterovesical fistulae as not only does it detect a fistula, but it also provides information about the surrounding anatomical structures. Conclusions. In the vast majority of cases, this condition is diagnosed because of unremitting urinary symptoms after gastroenterologist follow-up procedures for a diverticulitis or bowel inflammatory disease. Computed tomography is the most sensitive test for enterovesical fistula.
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Affiliation(s)
- Tomasz Golabek
- Department of Urology, Collegium Medicum of the Jagiellonian University, Ulica Grzegorzecka 18, 31-531 Cracow, Poland
| | - Anna Szymanska
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Ulica Jaczewskiego 8, 20-954 Lublin, Poland
| | - Tomasz Szopinski
- Department of Urology, Collegium Medicum of the Jagiellonian University, Ulica Grzegorzecka 18, 31-531 Cracow, Poland
| | - Jakub Bukowczan
- Department of Endocrinology and Diabetes, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
| | - Mariusz Furmanek
- Department of Radiology, Central Clinical Hospital Ministry of Interior in Warsaw, ul. Wolowska 137, 02-507 Warsaw, Poland
| | - Jan Powroznik
- The 1st Department of Urology, Postgraduate Medical Education Centre, European Health Centre in Otwock, ul. Borowa 14/18, 05-400 Otwock, Poland
| | - Piotr Chlosta
- Department of Urology, Collegium Medicum of the Jagiellonian University, Ulica Grzegorzecka 18, 31-531 Cracow, Poland
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Tonolini M, Bianco R. Multidetector CT cystography for imaging colovesical fistulas and iatrogenic bladder leaks. Insights Imaging 2012; 3:181-7. [PMID: 22696044 PMCID: PMC3314733 DOI: 10.1007/s13244-011-0145-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 11/06/2011] [Accepted: 12/19/2011] [Indexed: 11/28/2022] Open
Abstract
Multidetector computed tomography (MDCT) cystography currently represents the modality of choice to image the urinary bladder in traumatized patients. In this review we present our experience with MDCT cystography applications outside the trauma setting, particularly for diagnosing bladder fistulas and leaks. A detailed explanation is provided concerning exam preparation, acquisition technique, image reconstruction and interpretation. Colovesical fistulas most commonly occur as a complication of sigmoid diverticular disease, and often remain occult after extensive diagnostic work-up including cystoscopy and contrast-enhanced CT. We consistently achieved accurate preoperative visualization of colovesical fistulas using MDCT cystography. Urinary leaks and injuries represent a non-negligible occurrence after pelvic surgery, particularly obstetric and gynaecological procedures: in our experience MDCT cystography is useful to investigate iatrogenic bladder leaks or fistulas. In our opinion, MDCT cystography should be recommended as the first line modality for direct visualization or otherwise confident exclusion of both spontaneous enterovesical fistulas and bladder injuries following instrumentation procedures, obstetric or surgical interventions. Main Messages • Explanation of exam preparation, acquisition technique, image reconstruction and interpretation. • Preoperative visualization of colovesical fistulas, usually secondary to sigmoid diverticulitis. • Visualization or exclusion of iatrogenic bladder injuries following instrumentation or surgery.
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Affiliation(s)
- Massimo Tonolini
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy,
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9
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Feifer A, Anidjar M. [Laparoscopic nephrectomy in a living donor]. ANNALES D'UROLOGIE 2007; 41:158-172. [PMID: 18260606 DOI: 10.1016/j.anuro.2007.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Kidney transplantation is the therapeutic option of choice for patients with end-stage renal disease. With the advent of safer harvesting techniques and immunosuppression, both donor and recipient outcomes have markedly improved in recent years. Kidney donation from Living donors remains the single most important factor responsible for improving patient and graft survival. The laparoscopic donor nephrectomy has revolutionized renal transplantation, allowing expansion of the donor pool by diminishing surgical morbidity while maintaining equivalent recipient outcome. This technique is now becoming the gold-standard harvesting procedure in transplant centres worldwide, despite its technical challenge and ongoing procedural maturation, especially early in the learning curve. Previous contraindications to laparoscopic donor nephrectomy are no longer absolute. In the following analysis, the procedural aspects of the laparoscopic donor nephrectomy are detailed including pre-operative assessment, operative technique and a review of the current literature delineating aspects of both donor and recipient morbidity and mortality compared with open harvesting techniques.
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Affiliation(s)
- A Feifer
- McGill University Health Center, Royal Victoria Hospital, Department of urology, S6.88 Pine Avenue West, Montréal, Québec, Canada
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Fettouh HA, Raouf HA, Shenoufy A, El Feel A, Agabo H, Hakim AA, Fettouh IA. Laparoscopic Donor Nephrectomy: Single-Center Experience in Egypt With 400 Consecutive Cases. Transplant Proc 2007; 39:807-10. [PMID: 17524817 DOI: 10.1016/j.transproceed.2007.03.080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION In this study, we present our experience with laparoscopic donor nephrectomy and evaluate the outcomes of donors and recipients. PATIENTS AND METHODS Between March 2003 and August 2006, 400 laparoscopic donor nephrectomies were performed in our institution. Donors were evaluated for renal vasculature using computed tomography angiography. We used the left kidney in 329 donors and the right kidney in 71. Donor surgeries were done transperitoneally using three trocars on the left side and four trocars on the right side. Kidneys were extracted manually through a 7-cm Pfanenstiel incision. RESULTS All cases were completed laparoscopically. Mean operative time was 117 +/- 34 minutes. Mean blood loss was 56 +/- 28 mL. None of the donors required a blood transfusion. Mean warm ischemia time was 2.6 +/- 0.4 minutes. The mean renal artery length was 3.1 +/- 0.4 cm; the mean renal vein length was 2.4 +/- 1.2 cm. Mean hospital stay was 2.1 days. No donor required readmission. Kidneys were transplanted successfully and the mean recipient creatinine on discharge was 1.2 +/- 0.6 mg/dL. One patient had a renal artery thrombosis on postoperative day 2. Another patient with double renal arteries had thrombosis of the smaller artery just after surgery. Acute tubular necrosis was seen in 17 patients, four of whom required dialysis. Kidney function recovered thereafter in all acute tubular necrosis cases. CONCLUSION Laparoscopic surgery is a minimally invasive approach for living donor nephrectomy with good functional outcomes. The donor benefits from lesser morbidity without compromising the anatomic or physiological outcome of the nephrectomized kidney.
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Affiliation(s)
- H A Fettouh
- Wadi el Nile Transplant Center, Cairo University Hospital, Cairo, Egypt.
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Laparoscopic Versus Open Donor Nephrectomy. Transplantation 2006. [DOI: 10.1097/01.tp.0000233345.93935.af] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Amukele SA, Belletete B, Samadi AA, Edye M, El-Sabrout R, Butt K, Eshghi M. Urologic complications in renal transplant recipients by donor type. J Endourol 2006; 20:771-5. [PMID: 17094753 DOI: 10.1089/end.2006.20.771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Reduced donor morbidity has been established after laparoscopic donor nephrectomy compared with open harvest, but differences in recipient outcomes remain less obvious. We compared the urologic complications in patients receiving kidneys procured by cadaveric, open, and laparoscopic harvest. PATIENTS AND METHODS A retrospective study of all the kidney transplantations performed between January 1998 and December 2003 was undertaken to extract 100 consecutive patients in each group. All urologic complications were obtained and grouped by the type of donor procurement. RESULTS Overall, 48 of the 276 transplant patients (17%) had urologic complications: 14% of the cadaveric-donor recipients, 20% of the open-donor recipients, and 18% of the laparoscopic-donor recipients. There were no ureteral complications in the laparoscopic group. CONCLUSIONS Laparoscopically procured donor kidneys were associated with significantly fewer recipient ureteral complications than open cadaver or live-donor procurement.
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Affiliation(s)
- S A Amukele
- Department of Urology, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
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Fuller TF, Deger S, Büchler A, Roigas J, Schönberger B, Schnorr D, Tüllmann M, Loening SA, Giessing M. Ureteral Complications in the Renal Transplant Recipient after Laparoscopic Living Donor Nephrectomy. Eur Urol 2006; 50:535-40; discussion 540-1. [PMID: 16632185 DOI: 10.1016/j.eururo.2006.03.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2006] [Accepted: 03/09/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We report on ureteral and surgical complications in our first 110 consecutive recipients of kidneys procured with laparoscopic living donor nephrectomy (LLDN). METHODS The records of all living donor transplants with LLDN performed between February 1999 and December 2004, including 10 pediatric transplants, were reviewed retrospectively. Three urologists performed LLDN using a pure laparoscopic non-hand-assisted transperitoneal technique. Kidney transplantation was performed in a standard fashion. For ureteroneocystostomy, the intravesical Politano-Leadbetter (P-L) technique was used. RESULTS Two-year patient and graft survival was 99% and 98%, respectively. Serum creatinine at 12 months was 1.36+/-0.1mg/dl in adult and 0.99+/-0.23 mg/dl in pediatric recipients. Nineteen right donor kidneys were transplanted into adult recipients. Surgical complications included three symptomatic lymphoceles, one peritransplant haematoma and one kinking of a lower pole artery. All five (4.5%) ureteral complications occurred in adult recipients with a mean age of 33.2+/-2.8 years. The incidence of ureteral complications was not clustered around the early phase of our LLDN experience. Of the three (2.7%) patients diagnosed with ureteral obstruction, two required ureteral reimplantation, and one was managed conservatively. Another two patients (1.8%) with a urinary leak received a double J stent and a cystostomy catheter for 3 and 5 months, respectively. Of the five patients with a ureteral complication, three had received a donor kidney with more than one renal artery. CONCLUSIONS LLDN combined with the intravesical (P-L) ureteral implantation technique provides excellent graft outcomes with low recipient morbidity. Renal artery multiplicity may increase the risk of ureteral complications.
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Affiliation(s)
- T Florian Fuller
- Department of Urology, Charité Universitaetsmedizin Berlin Campus Mitte, Berlin, Germany.
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Sinha T, Varma PP, Srivastava A, Karan SC, Sandhu AS, Sethi GS, Khanna R, Talwar R, Narang V. A Comparative Study of Laparoscopic with Conventional Open Donor Nephrectomy in Renal Transplantation. Med J Armed Forces India 2006; 62:236-8. [PMID: 27365685 DOI: 10.1016/s0377-1237(06)80009-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2005] [Accepted: 10/06/2005] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Laparoscopic donor nephrectomy (LDN) has been gaining popularity among kidney donors. There have been concerns about the safety and efficacy of the procedure as compared to open donor nephrectomy (ODN). We compare our results on LDN with ODN. METHODS We retrospectively analysed our data of LDN and ODN. Duration of surgery, blood loss, period of hospitalisation, per oral intake and analgesic requirements. RESULT 22 LDNs were done, the operation time ranged from 220-300 minutes, and blood loss from 100-150ml. In the first 10 laparoscopic operations four cases required conversion to open surgical dissection. Only one case was converted to open surgery in the subsequent 12 laparoscopic cases. Oral intake was started on the first postoperative day. Analgesic requirement in laparoscopy cases was less. Patients were mobilised on the first day after surgery. Patients were discharged by seventh day. There was no significant difference in the functioning of the graft after revascularisation in the recipient. CONCLUSION Laparoscopic donor nephrectomy is a safe and effective technique of donor nephrectomy.
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Affiliation(s)
- T Sinha
- Senior Advisor and Head of Dept, Delhi Cantt
| | - P P Varma
- Senior Advisor (Medicine and Nephrology) Army Hospital (R&R), Delhi Cantt
| | - A Srivastava
- Graded Specialist (Surgery), Army Hosp (R&R), Delhi Cantt
| | - S C Karan
- Senior Advisor (Surgery and Urology), AH(R&R), Delhi Cantt
| | - A S Sandhu
- Classified Specialist (Surgery and Urology), AH (R&R), Delhi Cantt
| | - G S Sethi
- Classified Specialist (Surgery and Urology), AH (R&R), Delhi Cantt
| | - R Khanna
- Classified Specialist (Surg), CH (SC) Pune
| | - R Talwar
- Classified Specialist (Surg), CH (SC) Pune
| | - V Narang
- Resident (Urology), AH (R&R), Delhi Cantt
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Giessing M, Fuller TF, Deger S, Roigas J, Tüllmann M, Liefeldt L, Budde K, Fischer T, Winkelmann B, Schnorr D, Loening SA. [Ten years of laparoscopic living kidney donation. From an extravagant to a routine procedure]. Urologe A 2006; 45:46-52. [PMID: 16328213 DOI: 10.1007/s00120-005-0963-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Ten years ago the first laparoscopic living donor nephrectomy (LDN) was performed. Today, LDN is a routine operation in many US-American transplantation centers and an increasing number of centers in Europe are practicing LDN. In this article the different aspects of LDN for donor, kidney, recipient and operating surgeon are evaluated. We performed a literature research concerning LDN and the different aspects. Our own experience, as the largest LDN center in Germany, is part of the evaluation. Laparoscopic extraction of a kidney from a living donor is as safe for the donor as the open approach. At the same time, LDN offers multiple advantages like reduced pain and shorter convalescence. For the donated kidney and the recipient no disadvantages occur from the laparoscopic technique, as long as special intra- and perioperative demands are met. For the operating surgeon multiple developments have expanded the technical armentarium. LDN is safe for donor, recipient and kidney. Central issue of an optimal LDN is sufficient experience with laparoscopic urological techniques.
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Affiliation(s)
- M Giessing
- Klinik für Urologie, Campus Mitte, Charité Universitätsmedizin Berlin, Schumannstrasse 20-21, 10098 Berlin.
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Alston C, Spaliviero M, Gill IS. Laparoscopic donor nephrectomy. Urology 2005; 65:833-9. [PMID: 15882706 DOI: 10.1016/j.urology.2004.10.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2004] [Revised: 09/22/2004] [Accepted: 10/11/2004] [Indexed: 10/25/2022]
Affiliation(s)
- Celeste Alston
- Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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17
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Current World Literature. Curr Opin Urol 2005. [DOI: 10.1097/01.mou.0000160630.81978.ac] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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LiteratureWatch, January-June 2004. J Endourol 2004; 18:686-90. [PMID: 15597664 DOI: 10.1089/end.2004.18.686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Affiliation(s)
- Ben Challacombe
- Department of Transplantation, Guy's Hospital, London SE1 9RT, UK
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