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Goto F, Sato Y, Noguchi H, Kubo S, Kaku K, Okabe Y, Nakamura M. Safety and graft outcome of right retroperitoneal laparoscopic donor nephrectomy for living donor kidney transplantation: A comparison with left retroperitoneal laparoscopic donor nephrectomy. Asian J Endosc Surg 2024; 17:e13355. [PMID: 38956792 DOI: 10.1111/ases.13355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/11/2024] [Accepted: 06/23/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION The left kidney is often preferred for living donor kidney transplantation because of its anatomical advantages. However, the right kidney may be procured due to donor conditions. Few studies have assessed the safety and graft outcome of right retroperitoneal laparoscopic donor nephrectomy (RDN). This study aimed to compare the outcomes between right and left RDN with respect to donor outcome and the graft function of recipients. METHODS This retrospective study included 230 consecutive living donor kidney transplants performed at our institution between May 2019 and March 2023. We reviewed the outcomes of kidney transplant in the right and left kidneys after RDN. RESULTS A total of 230 living donor kidney transplants were performed, with 32 donors receiving right RDN (right RDN group) and 198 donors receiving left RDN (left RDN group). The renal veins and ureters were significantly shorter in the right RDN group than in the left RDN group (both p < .001). Donor operation and warm ischemia time were significantly longer in the right RDN group than in the left RDN group (p = .012 and p < .001, respectively). None of the groups exhibited any cases of delayed graft function owing to donor-related reasons. Perioperative changes in the estimated glomerular filtration rate of recipients and death-censored graft survival were not significantly different between the two groups. CONCLUSIONS In RDN, the outcomes of right donor nephrectomy were comparable to those of left donor nephrectomy in terms of donor safety and recipient renal function.
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Affiliation(s)
- Fumika Goto
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yu Sato
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Noguchi
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinsuke Kubo
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keizo Kaku
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhiro Okabe
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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2
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Ahmadi A, Al Rashed AA, Hasan O, Awad N, Abdulaziz K, Turki B, Ebrahim SD, Jaafar H, Al Geizawi S. Laparoscopic Right Donor Nephrectomy: A Two-Center Comparative Study. Cureus 2024; 16:e59562. [PMID: 38826980 PMCID: PMC11144283 DOI: 10.7759/cureus.59562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/04/2024] Open
Abstract
Introduction As the field of laparoscopic living donor nephrectomy (LLDN) has progressed over the years, there has been a growing emphasis on optimizing surgical techniques and outcomes to ensure the safety and well-being of living kidney donors. The early experiences with right LLDN, marked by challenges and concerns such as high conversion rates to open surgery and early graft loss due to technical reasons, prompted a reevaluation of the approach toward right-sided donor nephrectomies. In this article, we aim to compare the safety and efficacy of right LLDN to left LLDN performed in our centers and to provide valuable insights that can ultimately enhance patient outcomes and ensure the well-being of living organ donors. Methods Between January 2018 and January 2022, we conducted 16 cases of right LLDN and compared them with 134 cases of left LLDN procedures done in the Kingdom of Bahrain and Jordan over the same time period. We analyzed differences in donor age, sex, operative time, warm ischemia time (WIT), graft function, complications, and conversion to open technique. Patient data and surgical outcomes were extracted from medical records and surgical databases. Statistical analysis was conducted to identify significant differences between the two groups. Categorical variables such as complications and safety outcomes were compared using chi-square tests and logistic regression analysis. The primary outcomes of interest included safety metrics such as complication rates, vascular complications, graft loss, and postoperative serum creatinine levels for the recipients. Results Our study showed similar demographics in both groups. However, the operative time was shorter for the left LLDN, with 81 minutes compared to 96 minutes for the right. Warm ischemia times (WITs) were comparable at 4.5 minutes for the left and 5.2 minutes for the right. There was less incidence of delayed graft function on the left side (none in the left group compared to one case in the right group). Both groups had similar six-month graft function in terms of serum creatinine levels (0.98 mg/dL for the left and 1.2 mg/dL for the right), hospital stays (2.5 days for the left and 2.8 days for the right), and estimated blood loss (EBL) (90 mL for the left and 50 mL for the right). Additionally, no blood transfusions were required in either group, but there was one case of conversion to open surgery in the right LLDN group. Conclusion Our data confirm the safety and efficacy of the right LLDN, consistent with the current literature. This increases the cumulative evidence supporting the use of laparoscopic retrieval on the right side when indicated.
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Affiliation(s)
| | | | - Omran Hasan
- Urology, Salmaniya Medical Complex, Manama, BHR
| | - Nader Awad
- Urology, Salmaniya Medical Complex, Manama, BHR
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Ruch B, Tsering D, Bhati C, Kumar D, Saeed M, Lee SD, Khan A, Imai D, Bruno D, Levy M, Cotterell A, Sharma A. Right versus left fully robotic live donor nephrectomy and open kidney transplantation: Does the laterality of the donor kidney really matter? Asian J Urol 2023; 10:453-460. [PMID: 38024427 PMCID: PMC10659977 DOI: 10.1016/j.ajur.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/21/2023] [Accepted: 08/16/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Robotic-assisted live donor nephrectomy (LDN) is being gradually adopted across transplant centers. The left donor kidney is preferred over right due to anatomical factors and ease of procurement. We aimed to study donor and recipient outcomes after robotic procurement and subsequent open implantation of right and left kidneys. Methods All fully robotic LDNs and their corresponding open kidney transplants performed at our center between February 2016 and December 2021 were retrospectively analyzed. Results Out of 196 robotic LDN (49 [right] vs. 147 [left]), 10 (5.1%) donors had intra-operative events (6.1% [right] vs. 4.8% [left], p=0.71). None of the LDN required conversion to open surgery. The operative times were comparable for the two groups. Nausea (13.3%) was the most common post-operative complication. There was no mortality in either LDN group. Herein, we report our outcomes on 156 recipients (39 right and 117 left allografts) excluding robotic implants, exports, and pediatric recipients. There were no significant differences between right and left kidney recipients with respect to 1-year post-transplant patient survival (100.0% vs. 98.1%, p=0.45) or graft survival (93.9% vs. 97.1%, p=0.11), or delayed graft function (7.7% vs. 5.1%, p=0.55). Conclusion Non-hand-assisted robotic live donor nephrectomies can be safely performed with excellent outcomes. Right LDN was not associated with higher incidence of complications compared to left LDN. Open implantation of robotically procured right renal allografts was not associated with higher risk of recipient complications.
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Affiliation(s)
- Brianna Ruch
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Deki Tsering
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Chandra Bhati
- Division of Transplant Surgery, University of Maryland, Baltimore, MD, USA
| | - Dhiren Kumar
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Muhammad Saeed
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Seung Duk Lee
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Aamir Khan
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Daisuke Imai
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - David Bruno
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Marlon Levy
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Adrian Cotterell
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Amit Sharma
- Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
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4
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Roll GR, Cooper M, Verbesey J, Veale JL, Ronin M, Irish W, Waterman AD, Flechner SM, Leeser DB. Risk aversion in the use of complex kidneys in paired exchange programs: Opportunities for even more transplants? Am J Transplant 2022; 22:1893-1900. [PMID: 35181991 PMCID: PMC9543328 DOI: 10.1111/ajt.17008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/02/2022] [Accepted: 02/16/2022] [Indexed: 01/25/2023]
Abstract
This retrospective review of the largest United States kidney exchange reports characteristics, utilization, and recipient outcomes of kidneys with simple compared to complex anatomy and extrapolates reluctance to accept these kidneys. Of 3105 transplants performed, only 12.8% were right kidneys and 23.1% had multiple renal arteries. 59.3% of centers used fewer right kidneys than expected and 12.1% transplanted zero right kidneys or kidneys with more than 1 artery. Five centers transplanted a third of these kidneys (35.8% of right kidneys and 36.7% of kidneys with multiple renal arteries). 22.5% and 25.5% of centers currently will not entertain a match offer for a left or right kidney with more than one artery, respectively. There were no significant differences in all-cause graft failure or death-censored graft loss for kidneys with multiple arteries, and a very small increased risk of graft failure for right kidneys versus left of limited clinical relevance for most recipients. Kidneys with complex anatomy can be used with excellent outcomes at many centers. Variation in use (lack of demand) for these kidneys reduces the number of transplants, so systems to facilitate use could increase demand. We cannot know how many donors are turned away because perceived demand is limited.
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Affiliation(s)
- Garrett R. Roll
- Department of SurgeryDivision of TransplantUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Matthew Cooper
- Medstar Georgetown Transplant InstituteGeorgetown UniversityWashingtonDistrict of ColumbiaUSA
| | - Jennifer Verbesey
- Medstar Georgetown Transplant InstituteGeorgetown UniversityWashingtonDistrict of ColumbiaUSA
| | - Jeffrey L. Veale
- Department of UrologyUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | | | - William Irish
- Department of SurgeryEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Amy D. Waterman
- Department of SurgeryJ.C. Walter Transplant CenterHoustonTexasUSA,Terasaki Institute of Biomedical InnovationLos AngelesCaliforniaUSA
| | - Stuart M. Flechner
- Glickman Urological and Kidney InstituteCleveland ClinicClevelandOhioUSA
| | - David B. Leeser
- Department of SurgeryEast Carolina UniversityGreenvilleNorth CarolinaUSA
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5
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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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6
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Ciancio G, Farag A, Gaynor JJ, Morsi M, Chen L, Burke GW. Midline Rotation of the Right Renal Hilum During Hand-Assisted Laparoscopic Living Donor Nephrectomy. JSLS 2021; 25:e2021.00018. [PMID: 34248334 PMCID: PMC8241287 DOI: 10.4293/jsls.2021.00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND/OBJECTIVES Laparoscopic living donor nephrectomy (LLDN) of the right kidney is currently considered as part of standard of care; however, dealing with the renal hilum when performing ligation/division of its renal vessels is still a main concern. Here, we describe a simple-to-perform technique, i.e., flipping the fully mobilized right kidney to the midline so that the renal artery becomes anteriorly, which offers better visualization and easier dissection of the renal vessels (achieving maximized lengths) when performing hand-assisted LLDN of the right kidney. METHODS Living donors who underwent hand-assisted LLDN of the right kidney, along with their respective renal transplant recipients, were included in this report. Donor characteristics included renal artery and vein lengths; recipient characteristics included creatinine at months 12 - 36. Graft vein and arterial anastomosis data were also reported. RESULTS Nineteen living donors and 19 recipients, with median donor and recipient ages being 39 (24 - 60) and 53 (3 - 81) years, respectively, were included. None of the 38 patients had intra- or postoperative complications. Donor renal vein was anastomosed to the right external iliac vein (n = 16), right common iliac vein (n = 2), and inferior vena cava (n = 1). Gonadal vein (n = 1) and deceased donor iliac vein (n = 2) were used to increase the right renal vein length in 3 cases. Four donor kidneys had 2 arteries reconstructed side by side. None of the recipients developed any vascular or urological complications. CONCLUSIONS The laparoscopic technique described is safe and allows better visualization of the right hilum, mainly the renal artery, and helps in stapling the renal vein and renal artery.
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Affiliation(s)
- Gaetano Ciancio
- Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL
| | - Ahmed Farag
- Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL
| | - Jeffrey J Gaynor
- Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL
| | - Mahmoud Morsi
- Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL
| | - Linda Chen
- Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL
| | - George W Burke
- Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL
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7
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Yamanaga S, Freise CE, Stock PG, Rosario A, Fernandez D, Kobayashi T, Tavakol M, Kang SM. Inferior Long-Term Graft Survival of Suboptimal Kidneys After Living Donor Kidney Transplantation. Transplant Proc 2020; 52:1734-1740. [PMID: 32446691 DOI: 10.1016/j.transproceed.2020.01.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 01/24/2020] [Accepted: 01/24/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND In living donors, if both kidneys are considered to be of equal quality, the side with favorable anatomy for transplant is usually selected. A "suboptimal kidney" is a kidney that has a significant abnormality and is chosen to maintain the principle of leaving the better kidney with the donor. We hypothesized that the long-term outcome of suboptimal kidney is inferior to that of the normal kidney. METHODS In a retrospective analysis of 1744 living donor kidney transplantations performed between 1999 and 2015 at our institution, 172 allografts were considered as a suboptimal kidney (9.9%). Median length of follow-up after living donor kidney transplantation was 59.5 months (interquartile range 26.3-100.8). This study strictly complied with the Helsinki Congress and the Istanbul Declaration regarding donor source. RESULTS The reasons for suboptimal kidneys were cysts or tumors (46.5%), arterial abnormalities (22.7%), inferior size or function (19.8%), and anatomic abnormalities (11.0%). Suboptimal kidneys showed worse long-term overall graft survival regardless of the reasons (5-year: control vs suboptimal kidney; 88.9% vs 79.3%, P = .001 and 10-year: 73.6% vs 63.5%, P = .004). Suboptimal kidneys showed a 1.6-fold higher adjusted hazard ratio (aHR) of all-cause graft loss (95% confidence interval [CI]: 1.1-2.5, P = .025) and had the same impact as older donor age (≥ 54 years old, aHR: 1.6, 95% CI: 1.1-2.4, P = .008). CONCLUSIONS The impact of suboptimal kidney should be factored into the donor selection process.
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Affiliation(s)
- Shigeyoshi Yamanaga
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA; Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan; Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Chris E Freise
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Peter G Stock
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Angel Rosario
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Danny Fernandez
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Takaaki Kobayashi
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Mehdi Tavakol
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Sang-Mo Kang
- Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA.
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8
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Broudeur L, Karam G, Chelghaf I, De Vergie S, Rigaud J, Perrouin Verbe MA, Branchereau J. Feasibility and safety of laparoscopic living donor nephrectomy in case of right kidney and multiple-renal artery kidney: a systematic review of the literature. World J Urol 2019; 38:919-927. [PMID: 31129713 DOI: 10.1007/s00345-019-02821-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 05/21/2019] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To access the current status of the security and feasibility of right kidney (RK) and multiple-renal artery (MRA) laparoscopic living donor nephrectomy (LLDN) which are more challenging compared to left kidney (LK) and single renal artery (SRA) because of a shorter renal vein and more complex vascular anatomy. METHODS We did a systematic review of the literature according to the PRISMA recommendations, reporting RK or MRA donor nephrectomy performed with a laparoscopic technique compared to LK or SRA kidney LLDN. The identified and analyzed primary outcomes of interest were operating time (OT), warm ischemia time (WIT), rate of conversion and transfusion, donor length of stay (LOS), delayed graft function (DGF) and rate of graft loss (GL). RESULTS 16 comparative studies (1397 cases) of RK-LLDN and 12 comparative studies including 15 series (993 cases) of MRA-LLDN were selected. For RK-LLDN review, conversion rate was 0.8% and blood transfusion rate 0.2%, only one case of graft venous thrombosis was reported, OT was shorter in four studies and there was no any difference of DGF and GL rate compared to LK-LLDN. For MRA-LLDN review, conversion rate was 1.3% and blood transfusion rate 1.1%, OT and WIT were longer compared to SRA-LLDN, there were more ureteral complications in two studies, and no difference in terms of vascular complications and graft loss rate. CONCLUSION RK-LLDN and MRA-LLDN would be similar to LK-LLDN and SRA-LLDN in terms of feasibility and safety for the donor as well as graft function results for RK-LLDN.
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Affiliation(s)
- L Broudeur
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - G Karam
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - I Chelghaf
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - S De Vergie
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - J Rigaud
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - M A Perrouin Verbe
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - Julien Branchereau
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France. .,Centre de Recherche en Transplantation et Immunologie (ou CRTI), Inserm, Nantes University, Nantes, France. .,Institut de Transplantation Urologie Néphrologie (ou ITUN), CHU Nantes, Nantes, France.
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9
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Yamanaga S, Rosario A, Fernandez D, Kobayashi T, Tavakol M, Stock PG, Kang SM. Inferior long-term graft survival after end-to-side reconstruction for two renal arteries in living donor renal transplantation. PLoS One 2018; 13:e0199629. [PMID: 29995911 PMCID: PMC6040747 DOI: 10.1371/journal.pone.0199629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/11/2018] [Indexed: 12/26/2022] Open
Abstract
Living donor kidneys with two arteries can be revascularized using various techniques depending on anatomy. We hypothesized that the revascularization technique could impact long-term outcomes. We retrospectively analyzed 1714 living donor renal transplants at our institution between 1999 and 2015. Three hundred and eleven kidneys had dual arteries, and these were categorized into 5 groups; end-to-side (n = 18), inferior epigastric artery (n = 21), direct anastomosis (n = 65), side-to-side (n = 126) and ligated (n = 81). We then compared the outcomes with that of a control group (single artery, n = 1403) using Kaplan-Meier and Cox regression analyses. Cox regression was adjusted by age, sex and race/ethnicity of donor and recipient, side of kidney, transplant period and recipient surgeon. Compared to the control group, the end-to-side group had increased all-cause graft loss (10 years: 77.2% vs 24.5%, adjusted hazard ratio [aHR] 3.02, 95% confidence interval [CI] 1.30–7.03, p = 0.010) and death-censored graft loss (10 years: 82.0% vs 55.9%, aHR 4.17, 95% CI 1.63–10.68, p = 0.003), whereas the other groups did not. Our study shows that 10-year overall survival and death-censored graft survival were significantly worse for end-to-side arterial reconstruction than for other techniques. Alternative techniques to the end-to-side method should be used for accessory arteries that require revascularization.
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Affiliation(s)
- Shigeyoshi Yamanaga
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, United States of America
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Angel Rosario
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, United States of America
| | - Danny Fernandez
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, United States of America
| | - Takaaki Kobayashi
- Department of Renal Transplant Surgery, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Mehdi Tavakol
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, United States of America
| | - Peter G. Stock
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, United States of America
| | - Sang-Mo Kang
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, United States of America
- * E-mail:
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10
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Margreiter C, Gummerer M, Gallotta V, Scheidl S, Öfner D, Kienzl-Wagner K, Maier HT, Oberhuber R, Margreiter R, Schneeberger S. Open Management of the Renal Vein Is a Safe Modification in Right-Sided Laparoscopic Living Donor Nephrectomy to Maximize Graft Vein Length. Transplant Proc 2018; 50:3199-3203. [PMID: 30577185 DOI: 10.1016/j.transproceed.2018.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 06/19/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The primary objective in living donor kidney transplantation is donor safety. In laparoscopic living donor nephrectomy, most centers prefer the left kidney for donation given the shorter renal vein, higher rate of thromboses, and more difficult surgical procedure for right kidney retrieval. The goal of this study was to demonstrate the feasibility of a hybrid technique using a Satinsky clamp in right-sided living donor nephrectomy to obtain maximal renal vein and to compare the outcome with standard left-sided laparoscopic donor nephrectomies. MATERIAL AND METHODS Between 2005 and 2013, 77 patients underwent a left (group L) and 54 a right (group R) living donor nephrectomy. In group R, after laparoscopic dissection and mobilization of the right kidney, two 12-mm trocar incisions in the right upper quadrant were connected in a 5-7 cm subcostal incision. The caval vein was partially clamped under direct vision prior to dissection of the renal vein. The venotomy was then closed with a running 4-0 Prolene suture. The two groups were compared with regard to surgical complications, graft function, and graft survival. RESULTS Using this technique, no significant difference with regard to complications or graft function was observed. Serum creatinine at discharge in donor group L was 1.23 (±0.43) mg/dL and in donor group R 1.21 (±0.37) mg/dL (P = .71). Graft survival at one year was 100% in both groups. CONCLUSION Open management of the renal vein is a safe alternative in laparoscopic right-sided donor nephrectomy and ensures maximal length of the vein.
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Affiliation(s)
- C Margreiter
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria.
| | - M Gummerer
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria; Department of Vascular Surgery, Medical University of Innsbruck, Austria
| | - V Gallotta
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria; Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - S Scheidl
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - D Öfner
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - K Kienzl-Wagner
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - H T Maier
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - R Oberhuber
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - R Margreiter
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - S Schneeberger
- Department of Visceral, Transplant, and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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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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Abstract
Background The lengths of right renal veins are shorter when compared to their left counterparts. Since the implantation of kidneys with short renal veins is considered more challenging, many surgeons prefer left kidneys for transplantation. Therefore, our hypothesis is that the implantation of right kidneys from living and deceased donors is associated with more technical graft failures as compared to left kidneys. Methods Two consecutive cohorts of adult renal allograft recipients of living (n = 4.372) and deceased (n = 5.346) donor kidneys between January 1, 2000 and January 1, 2013 were analyzed. Data were obtained from the prospectively maintained electronic database of the Dutch Organ Transplant Registry. Technical graft failure was defined as failure of the renal allograft within 10 days after renal transplantation without signs of acute rejection. Results In the living donor kidney transplantation cohort, the implantation of right donor kidneys was associated with a higher incidence of technical graft failure (multivariate analysis p = 0.03). For recipients of deceased donor kidneys, the implantation of right kidneys was not significantly associated with technique-related graft failure (multivariate analysis p = 0.16). Conclusions Our data show that the implantation of right kidneys from living donors is associated with a higher incidence of technique-related graft failure as compared to left kidneys.
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Di Carlo HN, Darras FS. Urologic considerations and complications in kidney transplant recipients. Adv Chronic Kidney Dis 2015; 22:306-11. [PMID: 26088075 DOI: 10.1053/j.ackd.2015.04.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/03/2015] [Accepted: 04/08/2015] [Indexed: 01/05/2023]
Abstract
Urologic considerations during the kidney transplantation process, starting with initial recipient evaluation and continuing through the post-transplant, long-term follow-up, are critical for minimizing urologic complications and improving graft survival. Appropriate, targeted, preoperative urologic evaluation of the recipient allows for an optimized urinary tract to accept the graft, whereas post-transplant urologic follow-up and monitoring decrease the risk of graft lost secondary to a urologic cause, particularly in patients with a urologic reason for their kidney failure and in those patients with concomitant urologic diagnoses. Urologic complications comprise the second most common adverse post-transplant event, occurring in 2.5% to 14% of patients and are associated with high morbidity, graft loss, and mortality. Early and late urologic complications, including hematuria, hematoma, lymphocele, urine leak, ureteral stricture, nephrolithiasis, and vesicoureteral reflux, and their causes and treatment options are explored. A multidisciplinary team approach to kidney transplantation, including transplant surgery, urology, and nephrology, optimizes outcomes and graft survival. Although the current role of the urologist in kidney transplantation varies greatly by institution, appropriate consultation, participation, and monitoring in select patients is essential.
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14
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Yoon YE, Han WK, Choi KH, Yang SC, Kim YS, Kang DR, Huh KH, Kim MS, Kim SI, Joo DJ. Graft Survival After Video-assisted Minilaparotomy Living-donor Nephrectomy or Conventional Open Nephrectomy: Do Left and Right Allografts Differ? Urology 2014; 84:832-7. [DOI: 10.1016/j.urology.2014.06.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 06/17/2014] [Accepted: 06/21/2014] [Indexed: 11/16/2022]
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15
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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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16
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Klop KWJ, Kok NFM, Dols LFC, Dor FJMF, Tran KTC, Terkivatan T, Weimar W, Ijzermans JNM. Can right-sided hand-assisted retroperitoneoscopic donor nephrectomy be advocated above standard laparoscopic donor nephrectomy: a randomized pilot study. Transpl Int 2013; 27:162-9. [PMID: 24268098 DOI: 10.1111/tri.12226] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 09/15/2013] [Accepted: 10/27/2013] [Indexed: 12/01/2022]
Abstract
Endoscopic techniques have contributed to early recovery and increased quality of life (QOL) of live kidney donors. However, laparoscopic donor nephrectomy (LDN) may have its limitations, and hand-assisted retroperitoneoscopic donor nephrectomy (HARP) has been introduced, mainly as a potentially safer alternative. In a randomized fashion, we explored the feasibility and potential benefits of HARP for right-sided donor nephrectomy in a referral center with longstanding expertise on the standard laparoscopic approach. Forty donors were randomly assigned to either LDN or HARP. Primary outcome was operating time, and secondary outcomes included QOL, complications, pain, morphine requirement, blood loss, warm ischemia time, and hospital stay. Follow-up time was 1 year. Skin-to-skin time did not significantly differ between both groups (162 vs. 158 min, P = 0.98). As compared to LDN, HARP resulted in a shorter warm ischemia time (2.8 vs. 3.9 min, P < 0.001) and increased blood loss (187 vs. 50 ml, P < 0.001). QOL, complication rate, pain, or hospital stay was not significantly different between the groups. Right-sided HARP is feasible but does not confer clear benefits over standard right-sided LDN yet. Further studies should explore the value of HARP in difficult cases such as the obese donor and the value of HARP for transplantation centers starting a live kidney donation program (Dutch Trial Register number: NTR3096). Nevertheless, HARP is a valuable addition to the surgical armamentarium in live donor surgery.
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Affiliation(s)
- Karel W J Klop
- Division of Transplant Surgery, Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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17
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Retrocaval Renal Artery Bifurcation Is Not a Contraindication to Laparoscopic Right Donor Nephrectomy. J Am Coll Surg 2013; 217:406-11. [DOI: 10.1016/j.jamcollsurg.2013.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 03/22/2013] [Accepted: 03/22/2013] [Indexed: 11/22/2022]
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Bagul A, Frost JH, Mathuram Thiyagarajan U, Mohamed IH, Nicholson ML. Extending Anatomic Barriers to Right Laparoscopic Live Donor Nephrectomy. Urology 2012; 79:465-9. [DOI: 10.1016/j.urology.2011.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 09/28/2011] [Accepted: 10/05/2011] [Indexed: 11/26/2022]
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Abstract
Historically, urologists were the primary surgeons in renal transplantation. Specialization and increased complexity of the field of transplantation, coupled with a de-emphasis of vascular surgical training in urology, has created a situation where many renal transplants are carried out by surgeons with a general surgery background. Because of its genitourinary nature, however, urological input in renal transplantation is still vital. For living donors, a urologist should be involved to help evaluate and prepare certain patients for eventual donation. This could involve both medical and surgical intervention. Additionally, urologists who carry out living donor nephrectomy maintain a sense of ownership in the renal transplant process and provide a unique opportunity to the trainees of that particular program. For renal transplant recipients, preoperative evaluation of voiding dysfunction and other genitourinary anomalies might be necessary before the transplant. Also, occasional surgical intervention to prepare a patient for renal transplant might be necessary, such as in a patient with a small renal mass that is detected by a screening pretransplant ultrasound. Intraoperatively, for patients with complex urological reconstructions that might be related to the etiology of the renal failure (urinary diversion, bladder augmentation), a urologist who is familiar with the anatomy should be available. Postoperatively, urological evaluation and intervention might be necessary for patients who had a pre-existing urological condition or who might have developed something de novo after the transplant. Although renal transplant programs could consult an on-call urologist for particular issues on an as-needed basis, having a urologist, who has repeated exposure to the particular issues and procedures that are involved with renal transplantation, and who is part of a dedicated multidisciplinary renal transplant team, provides optimal quality of care to these complex patients.
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Affiliation(s)
- Daniel D Sackett
- Department of Urology, Division of Nephrology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA
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21
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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]
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22
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Crane C, Lam VWT, Alsakran A, Vasilaras A, Lau H, Ryan B, Pleass HCC, Allen RDM. Are there anatomical barriers to laparoscopic donor nephrectomy? ANZ J Surg 2010; 80:781-5. [DOI: 10.1111/j.1445-2197.2010.05439.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Testa G, Angelos P, Crowley-Matoka M, Siegler M. Elective surgical patients as living organ donors: a clinical and ethical innovation. Am J Transplant 2009; 9:2400-5. [PMID: 19663888 DOI: 10.1111/j.1600-6143.2009.02773.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We propose a new model for living organ donation that would invite elective laparoscopic cholecystectomy patients to become volunteer, unrelated living kidney donors. Such donors would be surgical patients first and living donors second, in contrast to the current system, which 'creates' a surgical patient by operating on a healthy individual. Elective surgery patients have accepted the risks of anesthesia and surgery for their own surgical needs but would face additional surgical risks when a donor nephrectomy is combined with their cholecystectomy procedure. Because these two procedures have never been performed together, the precise level of additional risk entailed in such a combined approach is unknown and will require further study. However, considering the large number of elective cholecystectomies performed each year in the United States, if as few as 5% of elective cholecystectomy patients agreed to also serve as living kidney donors, the number of living kidney donors would increase substantially. If this proposal is accepted by a minority of patients and surgeons, and proves safe and effective in a protocol study, it could be applied to other elective abdominal surgery procedures and used to obtain other abdominal donor organs (e.g. liver and intestinal segments) for transplantation.
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Affiliation(s)
- G Testa
- Department of Surgery, Director of Liver Transplantation and Hepatobiliary Surgery, The University of Chicago, Chicago, IL, USA.
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24
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Flechner SM. Editorial comment. Urology 2009; 74:68; author reply 68. [PMID: 19567290 DOI: 10.1016/j.urology.2009.01.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2009] [Revised: 01/18/2009] [Accepted: 01/20/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Stuart M Flechner
- Glickman Urological and Kidney Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
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25
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Abstract
BACKGROUND Laparoscopic donor nephrectomy (LDN) has become the preferred procedure for live donor nephrectomy. Most transplant surgeons are reluctant toward right-sided LDN (R-LDN) fearing short vessels and renal vein thrombosis. METHODS In our institution, selection of the appropriate kidney for donation was based on the same criteria that traditionally governed open donor nephrectomy. All intraoperative and postoperative data were prospectively recorded. RESULTS One hundred fifty-nine R-LDNs (56%) and 124 left-sided LDNs (L-LDN, 44%) were performed. Demographics did not significantly differ. Complications occurred in 10 (6%) vs. 23 (19%) procedures (R-LDN vs. L-LDN, P=0.002), resulting in 2 and 11 conversions, respectively. Right-sided kidney donation was the only independent preventative factor for complications in multivariate analysis (P=0.008, Odds ratio 0.33). R-LDN was associated with shorter operation time (mean 202 vs. 247 min, P<0.001) and less blood loss (139 vs. 294 mL, P<0.001). Hospital stay was 3 days in both groups. With regard to the recipients, the second warm ischemia time was similar (29 vs. 28 min, P=0.699). CONCLUSIONS R-LDN is faster and safer than L-LDN and does not adversely affect graft function. R-LDN may be advocated to allow donors to benefit from the advantages of laparoscopic surgery.
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26
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de Andrade Andrade RJ, Arana Castro DS, Arana García DE, Córdova Melo JC. [Experience initial right side laparoscopic live donor]. Actas Urol Esp 2009; 33:188-91. [PMID: 19418844 DOI: 10.1016/s0210-4806(09)74121-x] [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: 11/29/2022]
Abstract
UNLABELLED Live donor nephrectomy laparoscopic technique is now standard. However, the right side is controversial because of the short length of the renal vein and the incidence of venous thrombosis. METHODS A prospective study of patients live donors since May 2006 to September 2008 in which right nephrectomy was performed by laparoscopic live donor. The placement of trocares was usual and the transperitoneal approach. Incision was used for the extraction of Gibson. RESULTS Of the 10 selected patients, 1 was excluded due to conversion to open technique. The criteria for lateralization were sex, renal volume and complex vascular anatomy. 6 patients had made back-table reconstruction surgery with prosthetic vascular due to the length of the renal vein. The average operative time was 158.3 minutes and the bleeding averaged 272 cc. Warm ischemia time averaged 3.2 minutes. The average hospital stay was 1.6 days. 1 recipient presenting delayed graft dysfunction. CONCLUSIONS Laparoscopic live donor right nephrectomy offers an excellent quality of graft, being a technique feasible and safe, maintaining the principle of leaving the best kidney donor.
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27
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Keller JE, Dolce CJ, Griffin D, Heniford BT, Kercher KW. Maximizing the donor pool: use of right kidneys and kidneys with multiple arteries for live donor transplantation. Surg Endosc 2009; 23:2327-31. [PMID: 19263162 DOI: 10.1007/s00464-009-0330-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Revised: 11/16/2008] [Accepted: 12/16/2008] [Indexed: 01/03/2023]
Abstract
BACKGROUND Studies have shown donor and recipient outcomes to be equivalent for laparoscopic donor nephrectomy (LDN) and open donor nephrectomy. In the past, LDN has been avoided in the procurement of the right kidney or organs with multiple arteries. This study compares procurement of right and left kidneys as well as procurement of single- and multiple artery organs. METHODS A review of all LDNs at a single institution between August 2000 and December 2007 was performed. The data included estimated blood loss (EBL), need for transfusion, operative time, warm ischemia time, length of hospital stay (LOS), and delayed graft function. Arterial supply was assessed using renal arteriogram or computed tomographic (CT) angiography. Outcomes for multiple versus single artery and left versus right LDN were compared. Student's t-test and chi-square test were used for statistical comparison. RESULTS A total of 230 LDNs were performed. Multiple arteries were present in 37 donors. The right kidney was procured from 36 donors. No significant difference in EBL, transfusions, operative time, or LOS was noted between multiple and single or right and left LDNs. Warm ischemia time was significantly longer for multiple arteries (mean, 83 s) than for single arteries (mean, 63 s; p = 0.007), and for right kidneys (mean, 86 s) than for left kidneys (mean, 62 s; p = 0.001). No significant difference in delayed graft function was seen in the comparison of multiple (21.6%) and single (11.4%) artery organs (p = 0.11) or of right (13.9%) and left (12.9%) kidneys (p = 0.79). CONCLUSIONS The presence of multiple arteries or the need to procure the right kidney does not affect the operative outcome of laparoscopic donor nephrectomy. Warm ischemia time may be greater for these groups, but this does not result in delayed allograft function. The laparoscopic approach should be the standard of care even when expansion of the donor pool includes organs with multiple arteries and procurement of the right kidney.
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Affiliation(s)
- Jennifer E Keller
- Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, 1000 Blythe Blvd, MEB #601, Charlotte, NC 28203, USA.
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Ko EY, Castle EP, Desai PJ, Moss AA, Reddy KS, Mekeel KL, Mulligan DC, Andrews PE. Utility of the Endovascular Stapler for Right-Sided Laparoscopic Donor Nephrectomy: A 7-Year Experience at Mayo Clinic. J Am Coll Surg 2008; 207:896-903. [PMID: 19183537 DOI: 10.1016/j.jamcollsurg.2008.07.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Revised: 07/18/2008] [Accepted: 07/21/2008] [Indexed: 10/21/2022]
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Is right laparoscopic donor nephrectomy right? Surg Endosc 2008; 23:1321-5. [DOI: 10.1007/s00464-008-0158-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Accepted: 07/08/2008] [Indexed: 10/21/2022]
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30
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Simforoosh N. REPLY. BJU Int 2008. [DOI: 10.1111/j.1464-410x.2008.07609_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Maciel RF. Hand-assisted laparoscopic live donor nephrectomy (right-sided approach): experience obtained from 31 cases. Transplant Proc 2007; 39:2476-7. [PMID: 17954151 DOI: 10.1016/j.transproceed.2007.07.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The removal of a donor kidney by laparoscopic nephrectomy is a safe method that is widely used, mainly in left donor nephrectomy. However, for right donor nephrectomy where the right renal vein is short, open surgery has been more frequently described in the literature. OBJECTIVE Our objective was to describe our experience with 31 renal transplantations using 2 different techniques in right donor nephrectomy. METHOD In the period ranging from February 2002 to June 2005, we performed, 31 hand-assisted laparoscopic right donor nephrectomies. Twenty-five were performed by the method where the assistant used his hand to assist the surgery and 6 were by the laparoscopic method assisted by the first surgeon. RESULTS The right donor nephrectomies assisted either by the hand of the assistant or the surgeon showed similar results. All recipients displayed diuresis in the immediate postoperative period. The serum creatinine level at 1 week after transplantation was 1.90 mg/dL (+/-1.55). CONCLUSION Although the handling techniques are similar, we concluded that laparoscopic nephrectomy assisted by the surgeon is more adequate for right kidney extraction. It can be performed either by a resident doctor or a surgeon of the transplantation team, with or without experience in nephrectomy for transplantation.
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Affiliation(s)
- R F Maciel
- Central de Transplantes do Agreste, Casa de Saude Santa Efigênia, Caruaru, Pernambuco, CEP 54400-010 Brazil.
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El-Galley R. Novel Technique for Hand Assisted Laparoscopic Right Donor Nephrectomy. J Urol 2007; 178:2062-6. [PMID: 17869293 DOI: 10.1016/j.juro.2007.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Indexed: 11/24/2022]
Abstract
PURPOSE Most surgeons divide the renal vein with a laparoscopic stapler during laparoscopic donor nephrectomy. The right renal vein is usually shorter than the left one and using the stapler on the right side can result in a higher incidence of vascular complications for right kidney recipients. We present our experience with a new technique for hand assisted laparoscopic right donor nephrectomy. MATERIALS AND METHODS We designed a new vascular clamp to be completely inserted into the peritoneal cavity through the hand port incision in hand assisted laparoscopy. The renal vein with a cuff of the inferior vena cava was then excised. The defect in the inferior vena cava was sutured intracorporeally. RESULTS A total of 80 kidney donors underwent hand assisted laparoscopic right donor nephrectomy using the new technique. Mean +/- SD operative time was 184 +/- 36 minutes. Operative time was decreased in the last 30 patients to 152 +/- 22 minutes. Intracorporeal suture time on the inferior vena cava was 16 +/- 3 minutes. No intraoperative complications were noted and there was no partial or total graft loss. Mean blood loss was 50 +/- 35 cc. Mean warm ischemia time was 4 +/- 2 minutes. Hospital discharge was on postoperative day 1 or 2 in 81% of patients. Graft function was normal in 78 recipients with a day 5 postoperative serum creatinine of 1.6 +/- 0.9 mg/dl. Two recipients showed delayed graft function and were treated medically. CONCLUSIONS This technique for hand assisted laparoscopic right donor nephrectomy has proved to be safe and reproducible. We recommend practicing laparoscopic inferior vena cava suturing in the animal laboratory before performing it in humans.
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Affiliation(s)
- Rizk El-Galley
- Division of Urology, Department of Surgery, University of Alabama, Birmingham, Alabama 35294, USA
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Simforoosh N, Aminsharifi A, Tabibi A, Fattahi M, Mahmoodi H, Tavakoli M. Right laparoscopic donor nephrectomy and the use of inverted kidney transplantation: an alternative technique. BJU Int 2007; 100:1347-50. [PMID: 17850376 DOI: 10.1111/j.1464-410x.2007.07134.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To report a novel approach to overcome the problems associated with a short right renal vein harvested by clipping the vein during right laparoscopic donor nephrectomy (RLDN). PATIENTS AND METHODS This prospective study included 32 donors and their recipients; all donors had transperitoneal RLDN. The right renal artery and vein were ligated by Hem-o-lok and titanium clips, which resulted in a very short renal vein (<1.5 cm). When the kidney was positioned inverted in the recipient, the renal vein was placed posteriorly, adjacent to the external iliac vein, making a safe and simple venous anastomosis possible. RESULTS All RLDN were completed with no conversion or re-operation. The mean (range) warm ischaemia time was 9.59 (3-17) min and there was no malfunction of the vascular clips on the major vessels. After a mean follow-up of 14 months the recipient survival rate was 97%. Graft function was excellent, with a mean (sd) serum creatinine level of 1.35 (0.31) mg/dL at 3 months after surgery, and there was no renal artery or vein thrombosis in any of the grafts. There were two ureteric complications (6%), i.e. one ureterocutaneous fistula resolved by secondary ureteroureterostomy, and one stricture at the site of ureteric anastomosis, which was managed by ureteroneocystostomy. CONCLUSION The right renal vein obtained by LDN, after clipping the renal vein, is quite short, but by placing the kidney upside-down in the right iliac fossa transplantation is possible with no increased incidence of vascular thrombosis. This simple modification might obviate the need for removing a patch from the inferior vena cava, which is a challenging procedure for laparoscopic surgeons during RLDN.
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Affiliation(s)
- Nasser Simforoosh
- Urology Nephrology Research Center, Shaheed Labbafinejad Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
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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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Lee KS, Hong JH, Jeon SS, Choi HY, Kim SJ, Lee SW. Comparison of Graft Survival in Live Donor Nephrectomy: Hand-Assisted Laparoscopic v Open Procedures. J Endourol 2007; 21:866-71. [PMID: 17867943 DOI: 10.1089/end.2006.0463] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Laparoscopic donor nephrectomy is associated with decreased morbidity while maintaining similar graft function in short-term follow-up compared with open surgery. We investigated hand-assisted laparoscopic donor nephrectomy (HALDN) in comparison with standard open donor nephrectomy (ODN) in living donors. PATIENTS AND METHODS Two hundred patients who received a living-donor kidney and were followed up for more than 1 year were enrolled. The procedure was performed exclusively on the left kidney through either HALDN or ODN from January 2001 to July 2004. The probability of graft survival was determined using the Kaplan-Meier method. Multivariate analysis using a Cox regression hazard model was performed to identify the predictors of graft survival. RESULTS The mean operative time, estimated blood loss, warm ischemic time, and operation-related complications were compared. There was no difference in graft function. The cumulative graft survival at 1 and 3 years was similar in the two groups: 98% and 97%. Episodes of acute rejection were an independent predictor of graft survival. CONCLUSIONS Hand-assisted laparoscopic nephrectomy in living donors is safe and effective with results similar to those of open nephrectomy with regard to graft function.
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Affiliation(s)
- Kyu-Sung Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Saad S, Paul A, Treckmann J, Nagelschmidt M, Heiss M, Arns W. Laparoscopic live donor nephrectomy for right kidneys: Experience in a German community hospital. Surg Endosc 2007; 22:674-8. [PMID: 17623244 DOI: 10.1007/s00464-007-9459-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Laparoscopic live donor nephrectomy has become the new gold standard for kidney procurement in many high-volume transplant centres worldwide, but it is often limited to left-sided donor kidneys. Concerns about adequate anatomical renal vessel length and sufficient surgical exposure are the main obstacles to the use of the laparoscopic approach for right kidney live donors as well. MATERIAL AND METHODS From 1998 to 2006 we performed laparoscopic kidney procurement in 73 live kidney donors on an intention-to-treat basis, harvesting a total of 48 left (LKG) and 25 right kidneys (RKG) for transplantation. We compared these two groups with respect to operating time, conversion rate, complications, hospital stay, and recipient outcome. RESULTS There were no differences in outcome of donor patients after left (D-LKG) or right laparoscopic donor nephrectomy (D-RKG). Operating time was 160 min in D-RKG versus 164 min in D-LKG. Warm ischemia was below 150 s in both groups. Hospital stay was 7.0 (D-RKG) versus 6.7 days (D-LKG). Negative events on the donor site were one temporary nerve irritation in each group and one postoperative retroperitoneal hematoma in the left kidney group. Reasons to convert to open nephrectomy were bleeding in two patients in the left kidney group and adhesions in one patient in the right kidney group. The outcome of the recipients after left (R-LKG) or right kidney (R-RKG) transplantation was similar. One kidney was lost due to renal vein thrombosis (R-LKG). Postoperative ureter complications occurred in one patient of each group. One patient of the R-RKG and two patients of the R-LKG required lymphocele fenestration. All other kidney transplants worked without problems. CONCLUSION Laparoscopic donor nephrectomy is a safe procedure and has been established as the method of choice for live kidney donation in our clinic. Laparoscopic procurement of right and left kidneys can be performed with comparable quality and outcome for donors and recipients.
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Affiliation(s)
- S Saad
- Department for Visceral, Vascular and Transplantation Surgery, Clinic Cologne-Merheim, Cologne, Germany.
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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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Abstract
BACKGROUND The increasing number of live kidney donors in the last decade has stimulated interest in the surgical technique of donor nephrectomy. In this study, we evaluated the current status of the surgical approach in European transplant centers. METHODS A questionnaire was sent to 131 centers in 12 European countries. Questions included the number of donors, the technique used, and the inclusion and exclusion criteria for a technique. RESULTS Ninety-two replies (70%) were included. In the responding centers, approximately 1450 live donor nephrectomies were performed in 2004 (more than 80% of all live kidney donations in these countries). The number of living donors ranged from 0 to 95 per center. Nineteen institutions (21%) removed kidneys using endoscopic techniques only. Twenty-two centers (24%) performed both open and laparoscopic donor nephrectomy. Vessel length, difficult anatomy and right-sided donor nephrectomy were common reasons to choose an open technique. Twelve centers had performed laparoscopic donor nephrectomy but quit their program for various reasons. In 51 centers (55%), only open donor nephrectomy was carried out. Lack of evidence that endoscopic techniques provide better results was the main reason for these centers to stick to an open approach. Incisional hernias occurred after all types of open surgery in up to 30% of the donors per center. Twenty-nine clinics still carry out the classic flank incision. CONCLUSION The surgical technique of live donor nephrectomy varies greatly between transplant centers in European countries. To define the optimal surgical approach a European registration of donor nephrectomies would be helpful.
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Affiliation(s)
- Niels F M Kok
- Department of Surgery, Erasmus MC, Rotterdam, the Netherlands
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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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Gorodner V, Horgan S, Galvani C, Manzelli A, Oberholzer J, Sankary H, Testa G, Benedetti E. Routine left robotic-assisted laparoscopic donor nephrectomy is safe and effective regardless of the presence of vascular anomalies. Transpl Int 2006; 19:636-40. [PMID: 16827680 DOI: 10.1111/j.1432-2277.2006.00315.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The classic approach to donor nephrectomy consists of preferential procurement of the kidney without vascular anomalies. We studied the effect of routine procurement of the left kidney regardless the presence of multiple arteries on the outcomes of robotic-assisted laparoscopic living donor nephrectomy (LLDN) with particular reference to the incidence of urological complications. From August 2000 to July 2005, 209 left LLDNs were performed. We analyzed the outcomes of donors and recipients in relation to the presence of multiple vessels versus normal anatomy. We divided the patients into two groups: group A (n = 148) with normal vascular anatomy and group B (n = 61) with vascular anomalies. In the donors, no significant difference in conversion to open surgery rate, blood loss, length of stay, was noted between the two groups; operative time and warm ischemia time were slightly higher in group B. One-year patient survival was 98% in both groups while the 1-year graft survival was 96.6% in group A and 96% in group B. Only one urological complication was noted in the group with normal anatomy (0.7%) versus none in the group with multiple arteries. Left kidney procurement using robotic-assisted laparoscopic technique is safe and effective, even in the presence of vascular anomalies.
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Affiliation(s)
- Verónica Gorodner
- Division of General Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA
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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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Sudhindran S, Bhat S, Sanjeevan KV, Sayeed CS. Laparoscopic Right Donor Nephrectomy: Is There a Right Way? J Endourol 2006; 20:309-11. [PMID: 16724900 DOI: 10.1089/end.2006.20.309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE There is a continuing reluctance among transplant surgeons to procure a right-kidney allograft laparoscopically. We describe our experience with right laparoscopic donor nephrectomy (RLDN) by three techniques. PATIENTS AND METHODS We retrospectively analyzed all seven RLDNs performed at our center from January 2002 to June 2005. The technique used in a particular case depended on the anatomy of the renal vasculature and included transperitoneal (N = 1), retroperitoneoscopic (N = 4), and retroperitoneoscopy-assisted approaches without the use of hand port or other assist devices (N = 2). No stapling or manual-assist devices were used in the last four cases for division of the renal vessels. RESULTS The mean blood loss, operating time, hospital stay, and serum creatinine concentration on day 7 were 94.3 +/- 46.9 mL (SD), 212.8 +/- 66 minutes, 4.9 +/- 1.9 days, and 1.1 +/- 0.2 mg/dL, respectively. The overall warm ischemia time was 217 +/- 116 seconds. Our preferred technique currently is to go for a total retroperitoneoscopic approach to the right kidney initially. If the renal vein appears short, we make a small subcostal incision to retrieve the kidney openly at this stage (retroperitoneoscopy-assisted approach) with minimal risks to the donor and recipient. CONCLUSIONS Retroperitoneoscopic RLDN performed without hand-assist or stapling devices is safe and cost-effective and yields kidneys with excellent function. Rather than have a fixed approach to RLDN, we suggest a choice depending on the length of the renal vessels observed during surgery.
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Affiliation(s)
- Surendran Sudhindran
- Solid Organ Transplant Department, Amrita Institute of Medical Science, Edappally Kochi, India.
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Fuller TF, Liefeldt L, Dragun D, Tüllmann M, Loening SA, Giessing M. Urologische Betreuung von Patienten vor und nach Nierentransplantation. Urologe A 2006; 45:53-9. [PMID: 16292480 DOI: 10.1007/s00120-005-0964-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Patients with end-stage renal disease awaiting kidney transplantation require regular urological evaluation. The urologist's main task is early diagnosis and treatment of genitourinary malignancies and evaluation of the lower urinary tract. Furthermore, urologists are often confronted with the question of whether or not to perform pretransplant urological surgery, i.e., native nephrectomy for polycystic kidney disease. Urological care after kidney transplantation involves diagnosis and treatment of ureteral complications, malignancies, lower urinary tract symptoms, and last but not least erectile dysfunction, which has a prevalence of 20-50% among kidney transplant recipients. For the evaluation and follow-up of the living kidney donor, international guidelines have been developed in recent years to also help the urologist to perform a correct evaluation and follow-up of the kidney donor.
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Affiliation(s)
- T F Fuller
- Klinik für Urologie, Campus Mitte, Charité, Universitätsmedizin, Schumannstrasse 20-21, 10017 Berlin.
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Brook NR, Wilson CH, Nicholson ML. Current status of live-donor renal transplantation. ACTA ACUST UNITED AC 2005. [DOI: 10.2217/14750708.2.6.909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
PURPOSE OF REVIEW Laparoscopic donor nephrectomy is considered the gold standard for renal donation. In the hands of experienced laparoscopists it provides a safe and equally effective alternative to open nephrectomy, and recipient graft function has been shown to be equivalent regardless of the procurement method utilized. Complication rates and postoperative donor renal function are equivalent to that of open nephrectomy, whereas recovery time is significantly shorter and surgical scars more cosmetic with the laparoscopic approach. RECENT FINDINGS Advances in preoperative imaging and laparoscopic technique have enabled surgeons to broaden the patient population considered for donor nephrectomy. Improved three-dimensional imaging facilitates operative planning and intraoperative dissection, and the retroperitoneoscopic approach has decreased operative time. Acquisition of laparoscopic skills has also enabled surgeons to perform donor nephrectomies on kidneys that previously would have been considered less desirable for donation (e.g. right-sided or with anomalous vasculature). SUMMARY End-stage renal disease and the need for renal transplantation continue to be major medical concerns in the United States and worldwide. Advances in donor nephrectomy have reduced the demand for organs by increasing the potential organ pool while limiting risk to donors. As imaging and laparoscopic techniques continue to advance, it is anticipated that minimally invasive donor nephrectomy will continue to evolve. This review summarizes the developments to date.
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Affiliation(s)
- Kathleen Kieran
- University of Michigan Urology Center, Ann Arbor, Michigan 48109, USA.
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Affiliation(s)
- J Brantley Thrasher
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA
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Carter JT, Freise CE, McTaggart RA, Mahanty HD, Kang SM, Chan SH, Feng S, Roberts JP, Posselt AM. Laparoscopic procurement of kidneys with multiple renal arteries is associated with increased ureteral complications in the recipient. Am J Transplant 2005; 5:1312-8. [PMID: 15888035 DOI: 10.1111/j.1600-6143.2005.00859.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This study investigates the effect of renal artery multiplicity on donor and recipient outcomes after laparoscopic donor nephrectomy. Three-hundred and sixty-one sequential procedures were performed over a 4-year period. Forty-nine involved accessory renal arteries; of these, 36 required revascularization and 13 were small polar vessels and ligated. The 312 remaining kidneys with single arteries served as controls. Study variables included operative times, blood loss, hospital stay, graft function and donor and recipient complications. Kidneys with multiple revascularized arteries had a longer mean warm ischemia time (35.3 vs. 29.2 min, p = 0.0003), and more ureteral complications (6/36 vs. 10/312, p = 0.0013) than single-artery controls. In contrast, ligation of a small superior accessory artery had no significant effect on donor operative time, blood loss, or complication rate while providing similar recipient graft function compared to single-artery controls. Renal artery number is important in selecting the appropriate kidney for laparoscopic procurement. Given the current excellent results with right-sided donor nephrectomy, kidneys with single arteries should be preferentially procured, irrespective of side.
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Affiliation(s)
- Jonathan T Carter
- Division of Transplantation Surgery, University of California - San Francisco, USA
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LiteratureWatch, July-December 2004. J Endourol 2005; 19:253-63. [PMID: 15798428 DOI: 10.1089/end.2005.19.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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