1
|
Lachkar S, Boualaoui I, Ibrahimi A, El Sayegh H, Nouini Y. Clip or staple in laparoscopic live donor nephrectomy? A systematic literature review. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102656. [PMID: 38821383 DOI: 10.1016/j.fjurol.2024.102656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 05/09/2024] [Accepted: 05/26/2024] [Indexed: 06/02/2024]
Abstract
INTRODUCTION Ligation of the renal pedicle is a crucial step in laparoscopic renal harvesting. Currently, two devices are widely used: Hem-o-Lok® clips and staplers. Each has its advantages and disadvantages. METHODS A systematic literature review was conducted following the PRISMA methodology on PubMed, EMBASE, and Cochrane databases with no time restrictions. Registered in the PROSPERO database (CRD42023460585), the study's primary outcome measures include the failure rate of the ligation tool, conversion to open surgery, rate of severe bleeding, and device-related death. Other secondary variables are also explored. An assessment of the quality of included comparative studies was performed using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. RESULTS Out of 393 articles identified using our keywords, 32 were included. Overall, clips have a lower failure rate during application, elongate graft vessel length, and are more cost-effective. Staples are associated with a shorter warm ischemia time and lower blood loss. There is no significant difference between the two devices in terms of conversion, severe bleeding, death, and blood transfusion. CONCLUSION There is no perfect modality for renal pedicle control during laparoscopic harvesting, as each instrument has its pros and cons. Hem-o-Lok® clips are a safe and cost-effective option, particularly suitable for right-sided harvesting or in cases of vascular variations. However, they are still associated with a risk of secondary displacement with potentially serious consequences. Certain technical tricks can mitigate this risk.
Collapse
Affiliation(s)
- Salim Lachkar
- Department of Urology A, Ibn Sina University Hospital, avenue Bettouga, 10000 Rabat, Morocco.
| | - Imad Boualaoui
- Department of Urology A, Ibn Sina University Hospital, avenue Bettouga, 10000 Rabat, Morocco.
| | - Ahmed Ibrahimi
- Department of Urology A, Ibn Sina University Hospital, avenue Bettouga, 10000 Rabat, Morocco.
| | - Hachem El Sayegh
- Department of Urology A, Ibn Sina University Hospital, avenue Bettouga, 10000 Rabat, Morocco.
| | - Yassine Nouini
- Department of Urology A, Ibn Sina University Hospital, avenue Bettouga, 10000 Rabat, Morocco.
| |
Collapse
|
2
|
Burgos Revilla FJ, Artiles Medina A, Domínguez Gutiérrez A, Muriel García A, Figueiredo A, Gómez Dos Santos V. Vascular closure devices in living-donor nephrectomy: a much-needed systematic review and meta-analysis focusing on safety. BJU Int 2023; 132:239-251. [PMID: 37017627 DOI: 10.1111/bju.16025] [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] [Indexed: 04/06/2023]
Abstract
OBJECTIVE To assess the safety of vascular closure devices in living-donor nephrectomy (LDN), as staplers and non-transfixion techniques (polymer locking and metal clips) are the methods employed to secure the renal vessels during laparoscopic and robotic LDN, but the use of clips has come into question since the United States Food and Drug Administration and manufacturers issued a contraindication. METHODS A systematic review and meta-analysis were conducted to assess the safety of vascular closure devices (International Prospective Register of Systematic Reviews [PROSPERO] registration: CRD42022364349). The PubMed, Scopus, the Excerpta Medica dataBASE (EMBASE), and the Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) databases were searched in September 2022. For comparative and non-comparative studies, incidence estimates and odds ratios (ORs), respectively, for the main variables regarding safety of vascular closure devices were pooled by using random effects meta-analyses. Quality assessment of the included comparative studies was conducted using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. RESULTS Of the 863 articles obtained, data were retrieved from 44 studies, which included 42 902 patients. In non-comparative studies, the pooled estimate rates for device failure, severe haemorrhage rate, conversion to open surgery, and mortality were similar for both clips and staplers. Regarding the meta-analyses for comparative studies (three studies), there were no significant differences between the two groups for the severe haemorrhage rate (OR 0.57, 95% confidence interval [CI] 0.18-1.75; P = 0.33), conversion to open surgery (OR 0.35, 95% CI 0.08-1.54; P = 0.16), or death rate (OR 3.64, 95% CI 0.47-28.45; P = 0.22). Based on weak evidence, device failure was lower in the polymer clip group (OR 0.41, 95% CI 0.23-0.75; P = 0.00). CONCLUSIONS This study has confirmed that there is no evidence for the superiority of any vascular closure device in terms of safety in LDN. Standardised recommendations for vascular control in this context should be carefully designed and prospectively evaluated.
Collapse
Affiliation(s)
- Francisco Javier Burgos Revilla
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
- Board of the EAU Section of Transplantation Urology (ESTU), Coimbra, Portugal
| | - Alberto Artiles Medina
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | - Ana Domínguez Gutiérrez
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | - Alfonso Muriel García
- Clinical Biostatistics Unit, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBERESP, University of Alcalá, Madrid, Spain
| | - Arnaldo Figueiredo
- Board of the EAU Section of Transplantation Urology (ESTU), Coimbra, Portugal
- Department of Urology and Kidney Transplantation, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Victoria Gómez Dos Santos
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
- Board of the EAU Section of Transplantation Urology (ESTU), Coimbra, Portugal
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Ng ZQ, Musk G, Rea A, He B. Transition from laparoscopic to retroperitoneoscopic approach for live donor nephrectomy. Surg Endosc 2017; 32:2793-2799. [PMID: 29218666 DOI: 10.1007/s00464-017-5981-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/05/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Laparoscopic donor nephrectomy has become the standard of care due to multiple benefits. Currently, there are various techniques employed with two different approaches: transperitoneal (TLDN) or retroperitoneoscopic (RLDN) approach. There is a lack of data to determine which technique is superior, although the RLDN offers an anatomical advantage by avoidance of manipulation of the intraperitoneal organs. The aims of this study were to explore the merits of RLDN to TLDN and assess the learning curve of transition from TLDN to RLDN. METHODS From January 2010 to February 2017, 106 live donor nephrectomies were performed: 56 by TLDN and 50 by RLDN. Data on patient demographics, perioperative parameters, analgesic consumption, pain scores, and kidney graft function were collected and analysed. Data were compared with a Student's t test or Mann-Whitney test. A CUSUM analysis was performed to investigate the learning curve. RESULTS All live donor nephrectomies were successful with no conversion to open surgery. There was no blood transfusion, readmission, or mortality. No postoperative complications were graded over Clavien II. Kidney function was comparable in both groups. The follow-up period ranged from 3 to 78 months. CONCLUSION Retroperitoneoscopic live donor nephrectomy is a safe approach with comparable results to TLDN. RLDN has an anatomical advantage as it avoids manipulating the intraperitoneal organs and retains a virgin abdomen and hence translates to a lower perioperative complication risk.
Collapse
Affiliation(s)
- Zi Qin Ng
- WA Liver and Kidney Transplant Service, Sir Charles Gairdner Hospital, Perth, WA, Australia. .,WA Liver and Kidney Transplant Service, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia.
| | - Gabrielle Musk
- Animal Care Services, University of Western Australia, Perth, WA, Australia
| | - Alethea Rea
- Centre for Applied Statistics, University of Western Australia, Perth, WA, Australia
| | - Bulang He
- WA Liver and Kidney Transplant Service, Sir Charles Gairdner Hospital, Perth, WA, Australia. .,School of Surgery, University of Western Australia, Perth, WA, Australia. .,WA Liver and Kidney Transplant Service, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia.
| |
Collapse
|
5
|
Nashan B, Abbud-Filho M, Citterio F. Prediction, prevention, and management of delayed graft function: where are we now? Clin Transplant 2016; 30:1198-1208. [PMID: 27543840 DOI: 10.1111/ctr.12832] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2016] [Indexed: 12/28/2022]
Abstract
Delayed graft function (DGF) remains a major barrier to improved outcomes after kidney transplantation. High-risk transplant recipients can be identified, but no definitive prediction model exists. Novel biomarkers to predict DGF in the first hours post-transplant, such as neutrophil gelatinase-associated lipocalin (NGAL), are under investigation. Donor management to minimize the profound physiological consequences of brain death is highly complex. A hormonal resuscitation package to manage the catecholamine "storm" that follows brain death is recommended. Donor pretreatment with dopamine prior to procurement lowers the rate of DGF. Hypothermic machine perfusion may offer a significant reduction in the rate of DGF vs simple cold storage, but costs need to be evaluated. Surgically, reducing warm ischemia time may be advantageous. Research into recipient preconditioning options has so far not generated clinically helpful interventions. Diagnostic criteria for DGF vary, but requirement for dialysis and/or persistent high serum creatinine is likely to remain key to diagnosis until current work on early biomarkers has progressed further. Management centers on close monitoring of graft (non)function and physiological parameters. With so many unanswered questions, substantial reductions in the toll of DGF in the near future seem unlikely but concentrated research on many levels offers long-term promise.
Collapse
Affiliation(s)
- Björn Nashan
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Mario Abbud-Filho
- Department of Nephrology, Medical School FAMERP, Director Organ Transplantation Center Foundation FUNFARME, São José do Rio Preto, SP, Brazil
| | - Franco Citterio
- Department of Surgery, Renal Transplantation, Catholic University, Rome, Italy
| |
Collapse
|
6
|
Kashiwadate T, Tokodai K, Amada N, Haga I, Takayama T, Nakamura A, Jimbo T, Hara Y, kawagishi N, Ohuchi N. Right versus left retroperitoneoscopic living-donor nephrectomy. Int Urol Nephrol 2015; 47:1117-21. [DOI: 10.1007/s11255-015-1014-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 05/13/2015] [Indexed: 11/29/2022]
|
7
|
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]
|
8
|
Capolicchio JP, Saemi A, Trotter S, Plante MK. Retroperitoneoscopic Nephrectomy With a Modified Hand-assisted Approach. Urology 2011; 77:607-11. [PMID: 20708224 DOI: 10.1016/j.urology.2010.05.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 05/04/2010] [Accepted: 05/25/2010] [Indexed: 11/19/2022]
Affiliation(s)
- John-Paul Capolicchio
- Division of Urology, University of Vermont College of Medicine, Burlington, Vermont, USA.
| | | | | | | |
Collapse
|
9
|
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]
|
10
|
Laparoscopic Living-Donor Nephrectomy: Analysis of the Existing Literature. Eur Urol 2010; 58:498-509. [DOI: 10.1016/j.eururo.2010.04.003] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 04/07/2010] [Indexed: 01/10/2023]
|
11
|
The Transition From Laparoscopic to Retroperitoneoscopic Live Donor Nephrectomy: A Matched Pair Pilot Study. Transplantation 2010; 89:858-63. [DOI: 10.1097/tp.0b013e3181ca570f] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
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]
|
13
|
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]
|
14
|
Yashi M, Yagisawa T, Nukui A, Ishikawa N, Miyamoto N, Sakuma Y, Fujiwara T, Muraishi O. Strategic Hand Assistance for Effective and Safe Retroperitoneoscopic Live Donor Nephrectomy. Transplant Proc 2009; 41:88-90. [DOI: 10.1016/j.transproceed.2008.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 10/23/2008] [Accepted: 11/05/2008] [Indexed: 12/01/2022]
|