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Choi CI, Kim DI, Baek SH, Chung YS, Kim DH, Jeon TY, Kim DH, Rhee H, Song SH, Seong EY, Kwak IS. Initial Experience With Hand-Assisted Laparoscopic Living Donor Nephrectomy: Training and Clinical Practice as a General Surgeon. Transplant Proc 2018; 50:3113-3120. [PMID: 30577176 DOI: 10.1016/j.transproceed.2018.08.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/20/2018] [Accepted: 08/16/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND To analyze our initial results of hand-assisted laparoscopic living donor nephrectomy, executed by a skilled gastrointestinal surgeon. METHODS A total of 22 consecutive patients underwent the hand-assisted laparoscopic living donor nephrectomy between December 2014 and January 2017. We retrospectively analyze the patient's perioperative clinical data, which were collected prospectively. RESULTS The right kidney was harvested in 12 patients. The mean operative time and intraoperative blood loss was 241.0 ± 43.4 minutes (range, 140-310 min) and 293.2 ± 203.1 mL (range, 50-700 mL), respectively. The mean warm ischemic time was 288.4 ± 103.4 seconds (range, 179-610 s). Postoperative complications included chyle leakage in 2 patients who were left kidney donors and oliguria in 1 patient who was a right kidney donor. All patients recovered with conservative care, and the mean hospital stay was 7.5 ± 1.7 days. The mean creatinine level was 0.7 ± 0.2 mg/dL before surgery, 1.1 ± 0.3 mg/dL at postoperative day (POD) 1, and 1.0 ± 0.2 mg/dL after discharge. The mean glomerular filtration rate was 97.9 ± 18.2 mL/min/1.73 m2 before surgery, 60.7 ± 10.4 at POD 1, and 67.3 ± 11.1 after discharge. Operation time was not associated with patient body mass index and case number. No significant differences, other than postoperative complications, were found in the perioperative data for the side of kidney donation. CONCLUSION A skilled surgeon with experience in laparoscopic abdominal surgery (such as gastrectomy or colectomy) might safely perform hand-assisted donor nephrectomy. However, we could not identify a clear case number to complete the learning curve.
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Affiliation(s)
- C I Choi
- Department of Surgery, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - D I Kim
- Department of Surgery, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - S H Baek
- Department of Surgery, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - Y S Chung
- Department of Surgery, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea.
| | - D H Kim
- Department of Surgery, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - T Y Jeon
- Department of Surgery, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - D H Kim
- Department of Surgery, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - H Rhee
- Department of Nephrology, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - S H Song
- Department of Nephrology, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - E Y Seong
- Department of Nephrology, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
| | - I S Kwak
- Department of Nephrology, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital 179, Gudeok-Ro, Seo-Gu, Busan, Korea
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Abstract
PURPOSE OF REVIEW To review the most recent literature and contemporary role of the use of porcine and chicken models in laparoscopic and robotic simulation exercises, for training and skill assessment. RECENT FINDINGS There are multiple types of the simulators which include mechanical, virtual reality, hybrid simulators and animal models. The recent literature has seen insurgence of several of such simulators, specifically the animate ones comprising porcine and chicken models. The different training models reported have evolved from generalized and simpler, to a more task dedicated and complex versions. Unlike in the past, the recent publications include analysis of these models incorporating different measures of validity assessment. SUMMARY On account of the natural tissue properties inherent to these porcine and chicken models, they are proving to be instrumental in acquisition of higher surgical skills such as dissection, suturing and use of energy sources, all of which are required in real-time clinical scenarios be it laparoscopy or robotic-assisted procedures. In-vivo training in the animal model continues to be, perhaps, the most sophisticated training method before resorting to real-time surgery.
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Maartense S, Idu M, Bemelman FJ, Balm R, Surachno S, Bemelman WA. Hand-assisted laparoscopic live donor nephrectomy. Br J Surg 2004; 91:344-8. [PMID: 14991637 DOI: 10.1002/bjs.4432] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Background
Hand-assisted laparoscopic donor nephrectomy (HLDN) may have advantages over laparoscopic donor nephrectomy, such as shorter learning curve, operation and warm ischaemia times. The aim of this study was to evaluate the feasibility and safety of HLDN.
Methods
Between January 2000 and October 2002, 50 consecutive HLDN procedures were performed through a low transverse abdominal incision, 23 right sided and 27 left sided.
Results
The median age of the donors was 44 years. No HLDN required conversion to an open procedure. The median operating time for HLDN was 153 min. The median warm ischaemia time was 3 (range 1·0–4·5) min and the median blood loss was 50 (range 20–500) ml in both left- and right-sided procedures. Eight patients suffered ten minor complications during their admission. The duration of hospital stay was 5 days for donors. Three recipients developed graft failure owing to acute rejection, renal vein thrombosis and ischaemic necrosis.
Conclusion
Both left- and right-sided HLDN procedures were feasible and safe through a low transverse abdominal incision.
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Affiliation(s)
- S Maartense
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
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Shalhav AL, Siqueira TM, Gardner TA, Paterson RF, Stevens LH. Manual specimen retrieval without a pneumoperitoneum preserving device for laparoscopic live donor nephrectomy. J Urol 2002; 168:941-4. [PMID: 12187195 DOI: 10.1016/s0022-5347(05)64547-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE We present a novel method of kidney retrieval based on a modified Pfannenstiel incision and insertion of the assistant hand into the abdominal cavity without a device for pneumoperitoneum preservation. This maneuver is performed as the last step in pure laparoscopic live donor nephrectomy. Also, we assessed the effect of this technique on warm ischemia time compared with the standard laparoscopic bag retrieval technique. MATERIALS AND METHODS A total of 70 laparoscopic live donor nephrectomies were performed at our institutions between October 1998 and March 2001. The first 43 cases were completed using an EndoCatch bag device (Auto Suture, Norwalk, Connecticut) for specimen retrieval, while the last 27 were done using a novel manual retrieval technique through a modified Pfannenstiel incision. We retrospectively analyzed the results in regard to warm ischemia time and intraoperative complications related to the procedure. RESULTS A statistically significant difference was noted in the EndoCatch and manual retrieval groups in regard to warm ischemia time (p <0.001). There were 2 complications related to the EndoCatch device and none related to the manual technique. No differences were detected regarding recipient outcomes. CONCLUSIONS Manual specimen retrieval after live donor nephrectomy allows shorter warm ischemia time, while saving the cost of an EndoCatch bag or pneumoperitoneum preserving device that would be used during hand assisted live donor nephrectomy. It was shown to be a safe method without increased donor morbidity.
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Affiliation(s)
- Arieh L Shalhav
- Department of Urology, Indiana University School of Medicine and Methodist Hospital of Indiana and Clarian Health Partners, Indianapolis, Indiana, USA
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Tokuda N, Nakamura M, Tanaka M, Naito S. Hand-assisted laparoscopic live donor nephrectomy using newly produced LAP DISC: initial three cases. J Endourol 2001; 15:571-4. [PMID: 11552778 DOI: 10.1089/089277901750426319] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A new abdominal sealing device, called the LAP DISC, was used for the first time in hand-assisted laparoscopic live donor nephrectomy (HALDN) on three donors. The LAP DISC is made of three layers of rings connected by a rubber membrane, which covers the peritoneum and abdominal wall. The upper ring can adjust to the surgeon's hand size for insertion. METHODS The LAP DISC was seated through an approximately 7-cm midline incision under the xiphoid process. The laparoscopic port was inserted through the LAP DISC, and thereafter, pneumoperitoneum was established. Three trocars were then placed under direct vision. The surgeon's left arm was inserted into the LAP DISC and used for manual retraction, dissection, and hemostasis. In the three operations, the kidneys were removed through the LAP DISC. RESULTS The total warm ischemic times of the kidney were 15, 8, and 4 minutes, and the total operative times were 323, 195, and 240 minutes, respectively. After the subsequent transplantation into the recipient, the kidneys produced clear urine immediately on reperfusion. The recipient creatinine fell to 4.2, 5.6, and 3.9 mg/mL on postoperative day 1. All three donors resumed consistent oral intake within 24 hours after surgery and returned to normal, nonstrenuous activity by postoperative day 6. CONCLUSION The LAP DISC device is excellent for HALDN and may increase the number of surgeons and donors who select HALDN.
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Affiliation(s)
- N Tokuda
- Department of Urology, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
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Bemelman WA, van Doorn RC, de Wit LT, Kox C, Surachno J, Busch OR, Gouma DJ. Hand-assisted laparoscopic donor nephrectomy. Surg Endosc 2001; 15:442-4. [PMID: 11353956 DOI: 10.1007/s004640090091] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2000] [Accepted: 12/07/2000] [Indexed: 11/27/2022]
Abstract
BACKGROUND The hand-assisted approach to laparoscopic donor nephrectomy (LDN) might minimize the learning curve and shorten both the operation and the warm ischemia time. Our initial results from hand-assisted LDN are presented and compared with data from the literature. METHODS From January to September 2000, ten hand-assisted LDNs of the right kidney were performed. RESULTS The median operation time was 140 min (range, 120-400 min), and the warm ischemia time was 2.5 min (range, 1-4 min). There were no conversions. Postoperative morbidity included one urinary tract infection. All but one patient returned to a normal diet within 48 h. Opiates were needed a maximum of 48 h. One recipient experienced initial loss of graft function as a result of unknown causes. CONCLUSIONS Even at the beginning of the learning curve, operation time and warm ischemia time are significantly reduced by the hand-assisted approach, as compared with conventional LDN.
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Affiliation(s)
- W A Bemelman
- Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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