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Dagnæs-Hansen J, Kristensen GH, Stroomberg HV, Sørensen SS, Røder MA. Surgical Approaches and Outcomes in Living Donor Nephrectomy: A Systematic Review and Meta-analysis. Eur Urol Focus 2022; 8:1795-1801. [PMID: 35469780 DOI: 10.1016/j.euf.2022.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/16/2022] [Accepted: 03/30/2022] [Indexed: 01/25/2023]
Abstract
CONTEXT The use of living kidney donors is increasing and there are several surgical approaches for donor nephrectomy but it remains unknown which procedure is optimal for the patient and the graft. OBJECTIVE To review different surgical techniques for living donor nephrectomy and compare complication rates, warm ischemia time, and delayed graft function. EVIDENCE ACQUISITION A systematic review of prospective studies involving surgical complications following living donor nephrectomy was conducted in the MEDLINE/PubMed and EMBASE databases according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Baseline data, perioperative and postoperative parameters, and postoperative complications are reported. Overall complication rates between surgical techniques were compared via analysis of variance with post hoc analysis. We included 35 studies involving 6398 patients and representing six different surgical procedures for living donor nephrectomy. EVIDENCE SYNTHESIS Hand-assisted laparoscopic donor nephrectomy had a significantly higher overall complication rate compared to open, laparoscopic, retroperitoneoscopic, and laparoendoscopic single-site techniques (p < 0.005). The complication rates were low and no mortality was observed. The main limitation was varying reporting of complications, with only one-third of the studies using the Clavien-Dindo classification. CONCLUSIONS No specific surgical approach seems superior in terms of complications, which were generally low. Different factors such as warm ischemia time, blood loss, and surgeon expertise define which surgical approach should be chosen. PATIENT SUMMARY We looked at the different surgical methods for removing the kidney from a living kidney donor. Overall, the different surgical techniques were similar in terms of complications and no donors died in the studies we reviewed. The choice of procedure depends on multiple factors such as the expertise of the surgeon and the surgical center.
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Affiliation(s)
- Julia Dagnæs-Hansen
- Urologic Research Unit, Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | | | - Hein V Stroomberg
- Urologic Research Unit, Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Søren Schwartz Sørensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Nephrology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Martin Andreas Røder
- Urologic Research Unit, Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Park JW, Lee HH, Lee HS, Kim YS. Reproducibility and Step-By-Step Learning Curve of Retroperitoneal Video-Assisted Mini-Laparotomy Surgery for Living Donor Nephrectomy: A Single-Center Experience. EXP CLIN TRANSPLANT 2022; 20:657-662. [DOI: 10.6002/ect.2022.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Yoon YE, Lee HH, Na JC, Han WK. Prospective assessment of urinary neutrophil gelatinase-associated lipoprotein in living kidney donors: toward understanding differences between chronic kidney diseases of surgical and medical origin. BJU Int 2018; 123:869-876. [PMID: 30347133 DOI: 10.1111/bju.14592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the clinical implications of postoperative urinary neutrophil gelatinase-associated lipoprotein (NGAL) changes and the association between urinary NGAL (uNGAL) and renal function in living kidney donors. SUBJECTS, PATIENTS AND METHODS We included 76 healthy adults who underwent donor nephrectomy between December 2013 and November 2014. Perioperative serum creatinine (sCr), uNGAL, serum NGAL (sNGAL), and urinary microalbumin were prospectively measured until 6 months postoperatively. Patients with chronic kidney disease (CKD) due to medical disorders who visited our outpatient clinic during the same period were included for comparison. RESULTS The mean (SD) preoperative uNGAL of donors was 5 (5.17) ng/mL. uNGAL (corrected for urinary creatinine) was maximal at 1-2 days postoperatively, decreased on postoperative day 3, and stabilised by 7 days after surgery. Postoperative uNGAL was not associated with sex, age, or preoperative renal function. When corrected for sNGAL to compensate for the systemic increase in NGAL with major surgery, uNGAL on days 1-3 postoperatively was negatively correlated with sCr. Postoperatively, donor uNGAL remained higher than preoperatively for up to 6 months but was significantly lower than in patients with medical CKD with similar glomerular filtration rates. CONCLUSION Acute kidney injury due to hyperfiltration of remnant kidney after donor nephrectomy was maximal within 1-2 days postoperatively. The rise in uNGAL during this period in donors was negatively correlated with postoperative sCr levels. Decreased renal function after nephrectomy differs from that of medical CKD.
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Affiliation(s)
- Young Eun Yoon
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
| | - Hyung Ho Lee
- Department of Urology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Joon Chae Na
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Kyu Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Na JC, Park JS, Yoon MG, Lee HH, Yoon YE, Huh KH, Kim YS, Han WK. Long-term Follow-up of Living Kidney Donors With Chronic Kidney Disease at 1 Year After Nephrectomy. Transplant Proc 2018; 50:1018-1021. [PMID: 29731059 DOI: 10.1016/j.transproceed.2018.02.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/12/2018] [Accepted: 02/22/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Although renal function recovery of living kidney donors has been reported in a number of studies, many patients show poor recovery, and the long-term prognosis of these patients has not been well studied. In this investigation we explored the long-term prognosis of renal function in patients with chronic kidney disease (CKD) at 1 year after nephrectomy. METHODS Patients who underwent donor nephrectomy during the period from March 2006 to April 2014, with a follow-up creatinine study at 1 year postoperatively and more than 3 years of follow-up, were included in the study. Creatinine and estimated glomerular filtration rate (eGFR, using the Modification of Diet in Renal Disease formula) before and after surgery were studied. Age, sex, history of hypertension or diabetes, body mass index, blood pressure, complete blood count, preoperative routine serum chemistry, and urine study results were reviewed. RESULTS Among 841 patients who had donor nephrectomy, 362 were included in the study. There were 111 patients (30.6%) with eGFR <60 mL/min/1.73 m2 at 1 year postsurgery, and the median follow-up period was 62.8 months (interquartile range [IQR] 42.0-86.3 months). The maximum eGFR after 3-year follow-up was studied, and 48 patients (43.2%) never recovered eGFR to >60 mL/min/1.73 m2. Age, history of hypertension, preoperative eGFR, and eGFR at 1 year were predictive factors at univariate analysis. Multivariate analysis of these factors was studied, and age (52.5 [IQR 47-55.7] vs 47 [IQR 7-53] years, odds ratio [OR] 1.1, 95% confidence interval [CI] 1.02-1.15, P = .007), history of hypertension (16.7% vs 1.6%, OR 10.0, 95% CI 1.09-92.49, P = .042), and eGFR at 1 year (53.9 [IQR 50.3-56.0] vs 57.0 [IQR 54.2-58.4] mL/min/1.73 m2, OR 0.8, 95% CI 0.72-0.92, P = .002) remained as significant risk factors. CONCLUSION Of all living donors, 15.7% had CKD after >3 years of follow-up. Close observation is warranted when donors have CKD after 1 year follow-up, as 43.2% fail to recover renal function. Patients who are older, have a history of hypertension, and have low eGFR at 1-year follow-up are especially at risk.
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Affiliation(s)
- J C Na
- Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Seoul, Korea
| | - J S Park
- Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Seoul, Korea
| | - M-G Yoon
- Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Seoul, Korea
| | - H H Lee
- Department of Urology, National Health Insurance Service Ilsan Hospital, Goyang-si, Korea
| | - Y E Yoon
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
| | - K H Huh
- Department of Transplantation Surgery, Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Y S Kim
- Department of Transplantation Surgery, Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - W K Han
- Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Seoul, Korea; Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, Korea.
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Na JC, Park JS, Yoon MG, Lee HH, Yoon YE, Huh KH, Kim YS, Han WK. Delayed Recovery of Renal Function After Donor Nephrectomy. Transplant Proc 2018; 50:1022-1024. [PMID: 29731060 DOI: 10.1016/j.transproceed.2018.01.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/22/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Many living kidney donors are still at risk of chronic kidney disease (CKD) 1 year after nephrectomy. Although some donors still experience poor renal function, many exhibit delayed recovery of renal function afterwards. We studied the factors related to delayed recovery of renal function in patients with CKD at 1 year after nephrectomy. METHODS Patients who underwent donor nephrectomy from March 2006 to April 2014 with a follow-up creatinine study at 1 month, 6 months, 1 year, and after 3 years of follow-up were included in the study. Age, sex, history of hypertension or diabetes, body mass index, blood pressure, complete blood cell count, preoperative routine serum chemistry, and urine study results were reviewed. RESULTS Among 275 donors, 83 (30.2%) who had an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 at 1 year of follow-up were included in the study, and the eGFR was observed during a median follow-up of 62.0 months (interquartile range [IQR], 48.9-83.1 months). Those who had improvements in eGFR of >5 mL/min/1.73 m2 were included in the recovery group (n = 48 [57.8%]), and those who did not were included in the nonrecovery group (n = 35 [42.2%]). The preoperative and 1-year follow-up eGFR did not differ significantly between the 2 groups, and the maximum eGFR after 3 years was higher in the recovery group (68.68 mL/min/1.73 m2 [IQR, 61.81-75.64 mL/min/1.73 m2] vs 55.63 mL/min/1.73 m2 [IQR, 51.73-58.29 mL/min/1.73 m2]; P < .001). The recovery group was more likely to have a history of hypertension (4.2% vs 20%; P = .032), a lower body mass index (24.11 kg/m2 [IQR, 22.04-25.20 kg/m2] vs 25.25 kg/m2 [IQR, 23.23-26.44 kg/m2]; P = .01), and a lower preoperative uric acid level (4.7 mg/dL [IQR, 3.8-5.4 mg/dL] vs 5.3 mg/dL [IQR, 4.4-6.2 mg/dL]; P = .031). After multivariate logistic regression analysis, history of hypertension (odds ratio, 0.131; P = .022) and uric acid level (odds ratio, 0.641; P = .036,) remained as significant factors. CONCLUSIONS Although 30.2% of donors had CKD at 1 year after nephrectomy, 57.8% reported improved renal function. Those with a history of hypertension and high preoperative uric acid levels were less likely to have improvements in renal function and required close follow-up.
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Affiliation(s)
- J C Na
- Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Seoul, Republic of Korea
| | - J S Park
- Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Seoul, Republic of Korea
| | - M-G Yoon
- Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Seoul, Republic of Korea
| | - H H Lee
- Department of Urology, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea
| | - Y E Yoon
- Department of Urology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - K H Huh
- Department of Transplantation Surgery, Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y S Kim
- Department of Transplantation Surgery, Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - W K Han
- Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Seoul, Republic of Korea; Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, Republic of Korea.
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Park JS, Ahn HK, Na J, Lee HH, Yoon YE, Yoon MG, Han WK. Cumulative sum analysis of the learning curve for video-assisted minilaparotomy donor nephrectomy in healthy kidney donors. Medicine (Baltimore) 2018; 97:e0560. [PMID: 29703043 PMCID: PMC5944565 DOI: 10.1097/md.0000000000010560] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 04/04/2018] [Indexed: 11/26/2022] Open
Abstract
Video-assisted minilaparotomy surgery (VAMS) is a hybrid of open and laparoscopic surgical techniques, so has advantages of both approaches. Here, we examined the learning curve for this procedure.We retrospectively evaluated 50 consecutive patients who underwent VAMS donor nephrectomy performed by a single surgeon (YEY) between March 2015 and March 2016. The learning curve was evaluated using the cumulative sum (CUSUM) method. Measures of surgical performance included total operation time, warm ischemic time, and estimated blood loss.The mean patient age, body mass index, and body surface area were 43.5 years, 23.8 kg/m, and 1.7 m, respectively. The mean operation time and warm ischemic time were 160.0 minutes and 124.4 seconds. The learning curve of total operation time was best modeled as a second-order polynomial with equation CUSUMOT (minutes) = -0.3802 × case number + 20.315 × case number - 41.333 (R = 0.7707). The curve included 3 unique phases: phase 1 (the initial 17 cases), which is the initial learning curve; phase 2 (the middle 23 cases), expert competence, and phase 3 (the subsequent cases), mastery. In terms of warm ischemic time and estimated blood loss, the initial learning was achieved after 16 cases and after 9 to 10 cases, one could achieve competency.The VAMS donor nephrectomy learning curve is shorter than for laparoscopic or robotic hand-assisted donor nephrectomy. Surgeons can become familiar with the procedure and perform it without complications after approximately 16 to 17 operations.
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Affiliation(s)
- Jee Soo Park
- Department of Urology, Urological Science Institute, Yonsei
University College of Medicine
| | - Hyun Kyu Ahn
- Department of Urology, Urological Science Institute, Yonsei
University College of Medicine
| | - Joonchae Na
- Department of Urology, Urological Science Institute, Yonsei
University College of Medicine
| | - Hyung Ho Lee
- Department of Urology, National Health Insurance Service
Ilsan Hospital, Goyang, Gyeonggi-do
| | - Young Eun Yoon
- Department of Urology, Hanyang University College of
Medicine
| | - Min Gee Yoon
- Department of Urology, Urological Science Institute, Yonsei
University College of Medicine
| | - Woong Kyu Han
- Department of Urology, Urological Science Institute, Yonsei
University College of Medicine
- Brain Korea 21 PLUS Project for Medical Science, Department
of Urology, Yonsei University, Seoul, Republic of Korea
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Lee HH, Kang SK, Yoon YE, Huh KH, Kim MS, Kim SI, Kim YS, Han WK. Impact of the Ratio of Visceral to Subcutaneous Adipose Tissue in Donor Nephrectomy Patients. Transplant Proc 2017; 49:940-943. [PMID: 28583563 DOI: 10.1016/j.transproceed.2017.03.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE It was reported that a metabolic syndrome affected the remaining renal function after living donor nephrectomy. However, the measurement of waist circumference is unclear because it cannot distinguish between visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). We investigate the clinical correlation between body adipose tissue and renal function recovery after living donor nephrectomy. METHODS From July 2013 to February 2015, 75 living kidney donors were enrolled. The VAT and SAT were measured by preoperative computed tomography (CT) scan. Body mass index (BMI), VAT, SAT, and VAT-to-SAT ratio were analyzed according to a postoperative renal function recovery. Receiver operating characteristic (ROC) was performed to predict estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2 at postoperative 6 months for BMI, VAT, SAT, and VAT-to-SAT ratio. RESULTS The lowest value of eGFR (57.52 ± 11.20 mL/min/1.73 m2) was measured at postoperative day 7. There was no statistically significant difference in eGFR between 1 month and 3 months. BMI, VAT, SAT, and VAT-to-SAT ratio showed a statistically significant correlation with each other (Pearson correlation, P < .05). Also, the recovery time of eGFR was correlated with VAT-to-SAT ratio; it was significant at postoperative 1, 3, and 6 months. VAT-to-SAT ratio (0.654, 95% confidence interval 0.525-0.783, P = .024) had higher predictive value in ROC. CONCLUSION We developed a new variable to predict the value of lower eGFR (less than 60 mL/min/1.73 m2) at a postoperative 6 months in living kidney donor. According to a CT scan, VAT-to-SAT ratio can predict renal function recovery.
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Affiliation(s)
- H H Lee
- Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Seoul, Korea; Department of Urology, National Health Insurance Service Ilsan Hospital, Goyang-si, Korea
| | - S K Kang
- Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Seoul, Korea
| | - Y E Yoon
- Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Seoul, Korea
| | - K H Huh
- Department of Transplantation Surgery, Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - M S Kim
- Department of Transplantation Surgery, Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - S I Kim
- Department of Transplantation Surgery, Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Y S Kim
- Department of Transplantation Surgery, Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - W K Han
- Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Seoul, Korea; Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, Korea.
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Lee H, Han W, Kang S, Huh K, Kim M, Kim S, Kim Y, Yoon Y. Usefulness of Multi-Detector Computed Tomography Scanning as a Replacement for Diethylenetriamine Pentaacetic Acid. Transplant Proc 2017; 49:1023-1026. [DOI: 10.1016/j.transproceed.2017.03.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kim BS, Kim KH, Yoo ES, Kwon TG. Hybrid Technique Using a Satinsky Clamp for Right-sided Transperitoneal Hand-assisted Laparoscopic Donor Nephrectomy: Comparison With Left-sided Standard Hand-assisted Laparoscopic Technique. Urology 2014; 84:1529-34. [DOI: 10.1016/j.urology.2014.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 08/09/2014] [Accepted: 09/08/2014] [Indexed: 11/26/2022]
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Contralateral kidney volume change as a consequence of ipsilateral parenchymal atrophy promotes overall renal function recovery after partial nephrectomy. Int Urol Nephrol 2014; 47:25-32. [DOI: 10.1007/s11255-014-0847-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 09/11/2014] [Indexed: 10/24/2022]
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Prospective Measurement of Urinary Microalbumin in Living Kidney Donor Nephrectomy: Toward Understanding the Renal Functional Recovery Period. J Urol 2014; 192:1172-7. [DOI: 10.1016/j.juro.2014.03.106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2014] [Indexed: 11/18/2022]
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Choi K, Yang S, Joo D, Kim M, Kim Y, Kim S, Han W. Clinical Assessment of Renal Function Stabilization After Living Donor Nephrectomy. Transplant Proc 2012. [DOI: 10.1016/j.transproceed.2012.05.086] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Goldstein MJ, Lubezky N, Yushkov Y, Bae C, Guarrera JV. Innovations in organ donation. ACTA ACUST UNITED AC 2012; 79:351-64. [PMID: 22678859 DOI: 10.1002/msj.21312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The growing disparity between organ availability for transplantation and the number of patients in need has challenged the donation and transplantation community of practice to develop innovative processes, ideas, and techniques to bridge the gaps. Advances in the sharing of best practices in the donation community have contributed greatly over the last 8 years. Broader sharing of updated guidelines for declaration of brain death in conjunction with improvements in deceased donor management have increased opportunities for organ donation. New techniques for organ preservation and organ resuscitation have allowed for better utilization of the potential donor pool. This review will highlight processes, ideas, and techniques in organ donation.
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Affiliation(s)
- Michael J Goldstein
- Recanati/Miller Transplantation Institute, Mount Sinai Medical Center, New York, NY, USA.
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Park JW, Choi KH, Yang SC, Han WK. Cost aspects of radical nephrectomy for the treatment of renal cell carcinoma in Korea: open, laparoscopic, robot-assisted laparoscopic, and video-assisted minilaparotomy surgeries. Korean J Urol 2012; 53:519-23. [PMID: 22949994 PMCID: PMC3427834 DOI: 10.4111/kju.2012.53.8.519] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 05/14/2012] [Indexed: 11/18/2022] Open
Abstract
Purpose This study aimed to comparatively evaluate the cost-effectiveness of four different types of radical nephrectomy (RN) techniques: open, laparoscopic, robot-assisted laparoscopic, and video-assisted minilaparotomy surgery (VAMS). Materials and Methods Among patients who were diagnosed with renal cell carcinoma and underwent RN, 20 patients were selected who received open, laparoscopic, robot-assisted laparoscopic, or VAMS RN between January 2008 and December 2010. Their medical fees were divided into four categories: procedure and operation, anesthesia, laboratory test, and medical supply fees. The medical costs of the patients were also divided into insured and uninsured costs. Results The total direct cost of VAMS, open, laparoscopic, and robot-assisted laparoscopic RN were 2,023,791±240,757, 2,024,246±674,859 (p=0.998), 3,603,557±870,333 (p<0.01), and 8,021,902±330,157 (p<0.01) Korean Won (KRW, the currency of South Koea), respectively. The total insured cost of VAMS, open, laparoscopic, and robot-assisted laparoscopic RN was 1,904,627±231,957, 1,798,127±645,602 (p=0.634), 3,039,769±711,792 (p<0.01), and 899,668±323,508 (p<0.01) KRW, respectively. The total uninsured cost of VAMS, open, laparoscopic, and robot-assisted laparoscopic RN was 119,163±24,581, 226,119±215,009, 563,788±487,798 (p<0.01), and 7,122,234±56,117 (p<0.01) KRW, respectively. Medical supply fees accounted for the largest portion of the costs and amounted to 33.43% of the VAMS cost. Conclusions VAMS RN is as cost-effective as open surgery. Furthermore, it is comparatively more cost-effective than laparoscopic and robot-assisted laparoscopic RN.
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Affiliation(s)
- Jae Won Park
- Department of Urology, Urological Science Institute, Yonsei University Health System, Seoul, Korea
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