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Calpin GG, Hehir C, Davey MG, MacCurtain BM, Little D, Davis NF. Right and left living donor nephrectomy and operative approach: A systematic review and meta-analysis of donor and recipient outcomes. Transplant Rev (Orlando) 2024:100880. [PMID: 39244429 DOI: 10.1016/j.trre.2024.100880] [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: 08/16/2024] [Revised: 08/26/2024] [Accepted: 08/28/2024] [Indexed: 09/09/2024]
Abstract
INTRODUCTION The left kidney is preferable in living donor nephrectomy (LDN). We aimed to investigate the safety and efficacy of right versus left LDN in both donor and recipients. A subgroup analysis of outcomes based on operative approach was also performed. METHODS A systematic review and meta-analysis was performed as per PRISMA guidelines. Outcomes of interest were extracted from included studies and analysed. RESULTS There were 31 studies included with 79,912 transplants. Left LDN was performed in 84.1 % of cases and right LDN in 15.9 %. Right LDN was associated with reduced EBL (P = 0.010), intra-operative complications (P = 0.030) and operative time (P = 0.006), but higher rates of conversion to open surgery (1.4 % vs 0.9 %). However, right living donor renal transplantation (LDRT) had higher rates of delayed graft function (5.4 % vs 4.2 %, P < 0.0001) and graft loss (2.6 % vs 1.1 %, P < 0.0001). Graft survival was reduced in right LDRT at 3 years (92.0 % vs 94.2 %, P = 0.001) but comparable to left LDRT at 1- and 5-years. Otherwise, donor and recipient peri-operative outcomes and serum creatinine levels were comparable in both groups. Hand-assisted LDN was associated with shorter warm ischaemia time (P < 0.0001) but longer length of stay (LOS) than laparoscopic LDN and robotic-assisted LDN (P < 0.0001). RA-LDN was associated with less EBL and shorter LOS (both P < 0.0001) while patients who underwent L-LDN had a lower mean serum creatinine (SCr) level on discharge (P < 0.0001). CONCLUSION Right LDRT has higher rates of delayed graft function and graft loss compared to left LDRT. Minimally-invasive surgical approaches potentially offer improved outcomes but further large-scale randomised controlled trials studies are required to confirm this finding.
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Affiliation(s)
- Gavin G Calpin
- Department of Urology, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland.
| | - Cian Hehir
- Department of Urology, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland
| | - Matthew G Davey
- Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland
| | | | - Dilly Little
- Department of Urology, Beaumont Hospital, Dublin, Ireland
| | - Niall F Davis
- Department of Urology, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland
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Carolan C, Tingle SJ, Thompson ER, Sen G, Wilson CH. Comparing outcomes in right versus left kidney transplantation: A systematic review and meta-analysis. Clin Transplant 2021; 35:e14475. [PMID: 34496090 DOI: 10.1111/ctr.14475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/29/2021] [Accepted: 09/02/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Transplantation of right kidneys can pose technical challenges due to the short right renal vein. Whether this results in inferior outcomes remains controversial. METHOD Healthcare Database Advanced Search (HDAS) was used to identify relevant studies. Two authors independently reviewed each study. Statistical analyses were performed using random effects models and results expressed as HR or relative risk (RR) with 95% confidence intervals. Subgroup analyses were performed in kidneys from deceased donors (DD) and living donors (LD). RESULTS A total of 35 studies (257,429 participants) were identified. Both deceased and living donor right kidneys were at increased risk of delayed graft function (DGF; RR = 1.12[1.06-1.18] and RR = 1.33[1.21-1.46] respectively; both p < .0001). In absolute terms, for each 100 kidney pairs of DD kidneys transplanted there are 2.72 (1.67-3.78, p < .00001) excess episodes of DGF in right kidneys. Graft thromboses and graft loss due to technical failure was also significantly more likely in right kidneys, in both DD and LD settings. There was no evidence that laterality alters long term graft survival in LD or DD. CONCLUSION Right kidneys have inferior early outcomes, with higher rates of DGF, technical failure and graft thrombosis. However, these differences are small in absolute terms, and long-term graft survival is equivalent.
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Affiliation(s)
- Caitlin Carolan
- Northumbria Healthcare NHS Foundation Trust, Cramlington, UK
| | - Samuel J Tingle
- Department of HPB and Transplant Surgery, Freeman Hospital, Freeman Rd, High Heaton, Newcastle upon Tyne, UK.,Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, UK
| | - Emily R Thompson
- Department of HPB and Transplant Surgery, Freeman Hospital, Freeman Rd, High Heaton, Newcastle upon Tyne, UK.,Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, UK
| | - Gourab Sen
- Department of HPB and Transplant Surgery, Freeman Hospital, Freeman Rd, High Heaton, Newcastle upon Tyne, UK
| | - Colin H Wilson
- Department of HPB and Transplant Surgery, Freeman Hospital, Freeman Rd, High Heaton, Newcastle upon Tyne, UK.,Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, UK
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Perioperative Events and Complications in Minimally Invasive Live Donor Nephrectomy: A Systematic Review and Meta-Analysis. Transplantation 2017; 100:2264-2275. [PMID: 27428715 DOI: 10.1097/tp.0000000000001327] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Minimally invasive live donor nephrectomy has become a fully implemented and accepted procedure. Donors have to be well educated about all risks and details during the informed consent process. For this to be successful, more information regarding short-term outcome is necessary. METHODS A literature search was performed; all studies discussing short-term complications after minimally invasive live donor nephrectomy were included. Outcomes evaluated were intraoperative and postoperative complications, conversions, operative and warm ischemia times, blood loss, length of hospital stay, pain score, convalescence, quality of life, and costs. RESULTS One hundred ninety articles were included in the systematic review, 41 in the meta-analysis. Conversion rate was 1.1%. Intraoperative complication rate was 2.3%, mainly bleeding (1.5%). Postoperative complications occurred in 7.3% of donors, including infectious complications (2.6%), of which mainly wound infection (1.6%) and bleeding (1.0%). Reported mortality rate was 0.01%. All minimally invasive techniques were comparable with regard to complication or conversion rate. CONCLUSIONS The used techniques for minimally invasive live donor nephrectomy are safe and associated with low complication rates and minimal risk of mortality. These data may be helpful to develop a standardized, donor-tailored informed consent procedure for live donor nephrectomy.
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Sur RL. Editorial comment for Tosoian et al. J Endourol 2015; 29:442-3. [PMID: 25706814 DOI: 10.1089/end.2015.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Roger L Sur
- Department of Surgery/Urology, University of California , San Diego, San Diego, California
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Inoue T, Tsuchiya N, Narita S, Tsuruta H, Akihama S, Saito M, Satoh S, Habuchi T. Successful introduction of laparoendoscopic single-site donor nephrectomy after experience with laparoscopic single-site plus-one trocar donor nephrectomy. J Endourol 2014; 29:435-42. [PMID: 25286117 DOI: 10.1089/end.2014.0509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To assess the feasibility, safety, and efficacy of the laparoendoscopic single-site (LESS) donor nephrectomy (LESSDN) procedure after experience with the LESS-plus-one-trocar donor nephrectomy (LEPODN) procedure. PATIENTS AND METHODS From 2009 to 2014, 126 left laparoscopic donor nephrectomies (LDNs) were performed, including 59 Standard (Std)-LDN, 30 LEPODN, and 37 LESSDN. In the LEPODN procedure, a 5-mm trocar was added as a right-hand working trocar to the LESSDN procedure. A GelPOINT(®) platform was applied on a pararectal single incision in both LEPODN and LESSDN procedures. After performing the LEPODN procedure several times, each surgeon performed the LESSDN procedure. RESULTS Std-LDN, LEPODN, and LESSDN procedures were performed by 10, 10, and 7 surgeons, respectively. The mean operative time, estimated blood loss, warm ischemia time, time to ambulation, and length of postoperative hospital stay were the shortest for the LESSDN procedure (P<0.012, P=0.007, P<0.001, P=0.027, and P=0.001, respectively). No significant difference in the complication rate, delayed graft function rate, and mean 7-day post-transplant serum creatinine levels was observed among the three procedures. Individual results of the operative time and estimated blood loss for the LESSDN procedure were not significantly inferior to those of Std-LDN and LEPODN procedures for each surgeon. CONCLUSIONS The LESSDN procedure can be introduced safely and effectively without compromising the operative time, complication rate, and graft function after experience with the LEPODN procedure among multiple surgeons. The LEPODN procedure may be an effective bridge from standard multiport LDN to LESSDN.
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Affiliation(s)
- Takamitsu Inoue
- 1 Department of Urology, Akita University Graduate School of Medicine , Akita, Japan
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Maximizing the donor pool: left versus right laparoscopic live donor nephrectomy—systematic review and meta-analysis. Int Urol Nephrol 2014; 46:1511-9. [DOI: 10.1007/s11255-014-0671-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 02/12/2014] [Indexed: 10/25/2022]
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Inoue T, Tsuchiya N, Narita S, Saito M, Maita S, Numakura K, Obara T, Tsuruta H, Horikawa Y, Satoh S, Habuchi T. Laparoendoscopic Single-site Plus One Trocar Donor Nephrectomy Using the GelPort: Initial Clinical Experience. Urology 2013; 81:308-12. [DOI: 10.1016/j.urology.2012.09.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 09/06/2012] [Accepted: 09/10/2012] [Indexed: 12/01/2022]
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Saito M, Tsuchiya N, Narita S, Kumazawa T, Maita S, Numakura K, Obara T, Tsuruta H, Inoue T, Horikawa Y, Satoh S, Habuchi T. Comparison of the Clinical Outcome and Systemic Inflammatory Marker Levels Between Retroperitoneal and Transperitoneal Laparoscopic Donor Nephrectomy. J Endourol 2012; 26:1038-43. [DOI: 10.1089/end.2012.0015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Mitsuru Saito
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Norihiko Tsuchiya
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Shintaro Narita
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Teruaki Kumazawa
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Shinya Maita
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuyuki Numakura
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Takashi Obara
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroshi Tsuruta
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Takamitsu Inoue
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Yohei Horikawa
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Shigeru Satoh
- Division of Renal Replacement Therapeutic Science, Akita University Graduate School of Medicine, Akita, Japan
| | - Tomonori Habuchi
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
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Introducing Hand-Assisted Retroperitoneoscopic Live Donor Nephrectomy: Learning Curves and Development Based on 413 Consecutive Cases in Four Centers. Transplantation 2011; 91:462-9. [DOI: 10.1097/tp.0b013e3182052baf] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Biglarnia AR, Tufveson G, Lorant T, Lennmyr F, Wadström J. Efficacy and safety of continuous local infusion of ropivacaine after retroperitoneoscopic live donor nephrectomy. Am J Transplant 2011; 11:93-100. [PMID: 21199350 DOI: 10.1111/j.1600-6143.2010.03358.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Morphine-based analgesia is effective but can compromise donor safety. We investigated whether continuous infusion of local anesthetics (CILA) can provide sufficient pain control and reduce morbidity related to opiate analgesics after hand-assisted retroperitoneoscopic (HARS) live donor nephrectomy. Forty consecutive live kidney donors underwent HARS and were treated with the ON-Q system providing CILA with 0.5% ropivacaine through two SilvaGard catheters placed in the retroperitoneal cavity and the rectus sheath, respectively. The case control group consisted of 40 donors matched with regard to sex, age, BMI and surgical technique. All donors were maintained on standardized multimodal analgesia combining nurse-controlled oxycodone treatment and acetaminophen. CILA donors had lower median cumulative consumption of morphine equivalents (CCME) (7 mg [0-56] vs. 42 mg [15-127]; p < 0.0000001), lower incidence of nausea (18 [45%] vs. 35 [87.5%] donors; p < 0.001), shorter time in postoperative care unit (160 vs. 242.5 min; p < 0.001) and shorter hospital stay (4 [4-7] vs. 6 [4-11] days; p < 0.001). In 32.5% of CILA donors the CCME was 0 mg (0% in matched control group, p < 0.001). CILA with 0.5% ropivacaine provides effective postoperative pain relief, reduces the need for opioid treatment and promotes postoperative recovery.
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Affiliation(s)
- A-R Biglarnia
- Department of Surgical Sciences, Section of Transplantation Surgery, Uppsala University Hospital, Uppsala, Sweden.
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Dols LFC, Kok NFM, Terkivatan T, Tran KTC, Alwayn IPJ, Weimar W, Ijzermans JNM. Optimizing left-sided live kidney donation: hand-assisted retroperitoneoscopic as alternative to standard laparoscopic donor nephrectomy. Transpl Int 2010; 23:358-63. [DOI: 10.1111/j.1432-2277.2009.00990.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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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Ruszat R, Wyler SF, Wolff T, Forster T, Lenggenhager C, Dickenmann M, Eugster T, Gürke L, Steiger J, Gasser TC, Sulser T, Bachmann A. Reluctance Over Right-Sided Retroperitoneoscopic Living Donor Nephrectomy: Justified or Not? Transplant Proc 2007; 39:1381-5. [PMID: 17580144 DOI: 10.1016/j.transproceed.2007.02.069] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Revised: 12/28/2006] [Accepted: 02/05/2007] [Indexed: 10/23/2022]
Abstract
UNLABELLED We retrospectively compared perioperative donor outcomes and early complication rate of right- and left-sided retroperitoneoscopic living donor nephrectomy (RLDN). METHODS From November 2001 to April 2006, we performed 118 RLDN. Including 24% (n = 28) right-sided RLDN and 76% (n = 90) left-sided RLDN. Perioperative results and the rate of adverse events were compared for both sides. RESULTS We observed no significant difference in operation time, blood loss, warm ischemia time, or postoperative creatinine levels between right- and left-sided kidney donors. RLDN was successfully performed in 116 of 118 donors. One donor in each group had to be converted to an open approach. We observed one graft loss due to renal artery kinking in one recipient after left-sided RLDN. Two right donations needed a saphenous venous patch due to a short right renal vein (<2 cm). Overall, intraoperative and postoperative complications were comparable between the two donor groups. CONCLUSION Right-sided RLDN provides comparable perioperative and postoperative results to those of left-sided RLDN. Our results demonstrated that groups with significant experience in RLDN can perform right living donor nephrectomy safely and efficiently with minimal invasiveness.
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Affiliation(s)
- R Ruszat
- Department of Urology, University Hospital Basel, Spitalstrasse 21, Basel 4031, Switzerland
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Yashi M, Yagisawa T, Ishikawa N, Nukui A, Fujiwara T, Sakuma Y. Retroperitoneoscopic Hand-Assisted Live-Donor Nephrectomy According to the Basic Principle of Transplantation in Donor Kidney Selection. J Endourol 2007; 21:589-94. [PMID: 17638551 DOI: 10.1089/end.2006.0326] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE We assessed the feasibility of retroperitoneoscopic hand-assisted live-donor nephrectomy according to the basic principle of transplantation in kidney selection, namely, leaving the better-functioning kidney in the donor. PATIENTS AND METHODS Thirty consecutive live-donor nephrectomies, including 10 right-sided and 20 left-sided procedures, were evaluated. The surgery was started endoscopically using three ports, followed by hand assistance for dissecting the renal pedicles through the extended inner-port incision. A vascular Endostapler and polymer clips were used to transect the renal vessels. RESULTS Two right-sided cases required open conversion because of multiple renal vessels and uncontrollable bleeding. The median operative time, warm ischemia time (WIT), blood loss, and renal vein length were 244 minutes (upper and lower quartile 215 and 274 minutes), 186 seconds (134, 239 seconds), 175 mL (45, 305 mL), and 22 mm (19, 26 mm), respectively. The operative time and WIT were longer, and the renal vein was shorter, in the right-sided than in the left-sided procedures (P < 0.05), but no difference was found in the other perioperative data for the two sides. No delayed graft function was observed, and the kidney function 1 month postoperatively was acceptable in all donors and all recipients. CONCLUSION Our technical devices, such as the site and timing of hand assistance and control of the renal vessels, seem feasible. Although we could not draw a conclusion about the safety of the right-sided procedure, this alternative procedure should be applicable for laparoscopic donor nephrectomy uninfluenced by the side of the donor kidney provided the surgical team has sufficient expertise.
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Affiliation(s)
- Masahiro Yashi
- Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Tochigi, Japan.
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Modi P, Kadam G, Devra A. Obtaining Cuff of Inferior Vena Cava by Use of the Endo-TA Stapler in Retroperitoneoscopic Right-Side Donor Nephrectomy. Urology 2007; 69:832-4. [PMID: 17482916 DOI: 10.1016/j.urology.2007.01.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Revised: 10/06/2007] [Accepted: 01/09/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To determine the feasibility of obtaining an adequate cuff of the inferior vena cava (IVC) for vascular anastomosis during retroperitoneoscopic donor nephrectomy. METHODS Between September 2004 and May 2005, a total 100 retroperitoneoscopic donor nephrectomies were performed. Fifteen cases were performed on the right side. The Endo-TA stapler was used to obtain the cuff of IVC in all cases of right-side donor nephrectomy. RESULTS Mean warm ischemia time was 4.9 minutes (range, 2.96 to 8.0 minutes). Mean length of the cuff of IVC was 4 mm (range, 3 to 6 mm) at the upper end and 6 mm (range, 4 to 8 mm) at the lower end of the vein. All grafts functioned immediately, and there was one graft loss due to vascular rejection. CONCLUSIONS Control of the renal vein by use of the Endo-TA stapler during retroperitoneoscopic donor nephrectomy helps in obtaining a good vascular cuff of the IVC.
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Affiliation(s)
- Pranjal Modi
- Department of Urology, Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Civil Hospital Campus, Ahmedabad, India.
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