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Glatz T, Brinkmann S, Bausch D. [Robot-assisted Living Donor Nephrectomy - Technical Aspects and Initial Evidence]. Zentralbl Chir 2021; 146:400-406. [PMID: 33782928 DOI: 10.1055/a-1346-0304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Minimally invasive donor nephrectomy has become the standard procedure in most transplant centres over the past two decades and has contributed to a reduction in postoperative morbidity for the donor. Robot-assisted technology is an alternative to conventional (hand-assisted) laparoscopic technology and will find increasing use in the future. In this review article, we address technical aspects of robotic-assisted donor nephrectomy, in accordance with our own experience and will provide an overview of the currently available literature. Robot-assisted living kidney donation is a safe procedure with a very low postoperative complication rate. The procedure offers advantages over the open surgical technique with respect to the reduction in the postoperative need for analgesia and the duration of hospital stay, with longer operating times and warm ischemia times, but without a measurable effect on transplant function. The postoperative outcome parameters are comparable to those of the laparoscopic technique, indicating a further acceleration of postoperative convalescence. The advantages of robot-assisted technology, due to the better exposure options, are most relevant in patients with a high BMI and multiple renal arteries, as well as in right-sided nephrectomies in which a longer transplant artery can be obtained. Robot-assisted living kidney donation will play a major role in the future of transplant surgery and is a serious alternative to conventional laparoscopic technology.
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Affiliation(s)
- Torben Glatz
- Chirurgische Klinik, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Herne, Deutschland
| | - Sebastian Brinkmann
- Chirurgische Klinik, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Herne, Deutschland
| | - Dirk Bausch
- Chirurgische Klinik, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Herne, Deutschland
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Ozturk SA, Yuksel Y, Erbis H, Aliosmanoglu I, Sarier M, Yayar O, Yavuz HA, Demirbas A. Laparoscopic Live Donor Nephrectomy: Experience of High-Volume Center with 2,477 Cases. Urol Int 2020; 105:100-107. [PMID: 33207353 DOI: 10.1159/000511377] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/04/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Donors' health and safety are mandatory in the living-donor kidney transplantation procedure. Laparoscopic live donor nephrectomy (LLDN) provides an increase in donor numbers with its benefits and becomes a standard of care. We aimed to explain the results, complication rates, tips, and tricks of the largest number of LLDN case series ever performed in the literature. MATERIALS AND METHODS Between August 2012 and December 2019, 2,477 live donor case files were analyzed retrospectively. Age, gender, hospitalization times, body mass index, warm ischemia times, operation times, numbers of arteries, side of the kidneys, and complications were noted. RESULTS 1,421 (57.4%) of 2,477 donors were female (p = 0.007). Operation times and warm ischemia times were found longer in right-sided LLDN and donors with multiple renal arteries (p = 0.046, <0.001, and <0.001, respectively). Obesity (BMI >30 kg/m2) did not affect warm ischemia times while prolonging the operation times (p = 0.013). Hospitalization times and numbers of complications were higher in obese donors. CONCLUSIONS LLDN seems to be a reliable solution with fewer complications and higher satisfaction rates. We hope to illuminate the way with tips and trick points for beginner transplant surgeons based on the experience obtained from 2,477 LLDN cases.
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Affiliation(s)
- Sefa Alperen Ozturk
- Department of Urology, Suleyman Demirel University School of Medicine, Isparta, Turkey,
| | - Yucel Yuksel
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - Halil Erbis
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - Ibrahim Aliosmanoglu
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - Mehmet Sarier
- Department of Urology, Istinye University Medical Faculty, Istanbul, Turkey
| | - Ozlem Yayar
- Department of Nephrology and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - Havva Asuman Yavuz
- Department of Nephrology and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - Alper Demirbas
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey
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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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He B, Mou L, De Roo R, Musk GC, Hamdorf JM. Evaluation of Three-Dimensional Versus Conventional Laparoscopy for Kidney Transplant Procedures in a Human Cadaveric Model. EXP CLIN TRANSPLANT 2017; 15:497-503. [PMID: 28447928 DOI: 10.6002/ect.2016.0177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES There are increased reports that kidney transplant can be performed by laparoscopic surgery. The further development of this technique could revolutionize human kidney transplant surgery. However, laparoscopic kidney transplant demands a high level of skill for vascular anastomoses. The emerging technology of the three-dimensional, high-definition laparoscopic system may facilitate the application of this technique. Therefore, in this study, we evaluated this system in performing kidney transplant surgery versus the two-dimensional laparoscopic system. MATERIALS AND METHODS Four fresh-frozen human cadavers were used in this study, with 2 for the 3-dimensional and 2 for the 2-dimensional system. Kidneys were retrieved by using the retroperitoneoscopic technique for living donor nephrectomy from the same cadaver. The kidney graft was transplanted at the right iliac fossa using a laparoscopic technique by extraperitoneal approach. The procedure was recorded, and the vessel anastomotic time was analyzed. RESULTS Kidney transplant procedures were conducted successfully in the 3-dimensional, high-definition and the 2-dimensional groups. We recorded no significant differences in terms of vessel anastomotic time between the 2 groups. The total surgery time was shorter in the 3-dimensional, high-definition group than in the 2-dimensional group (P = .02). CONCLUSIONS This pilot study reinforces that kidney transplant with either the 3-dimensional, high-definition or 2-dimensional laparoscopy is feasible in a human cadaveric model. The operation was the same as open kidney transplant, but the procedure was performed by a laparoscopic approach with a smaller incision.
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Affiliation(s)
- Bulang He
- From the Western Australia Liver and Kidney Transplant Service, Sir Charles Gairdner Hospital, Perth, Australia; and the School of Surgery, The University of Western Australia, Perth, Australia
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Kashiwadate T, Tokodai K, Amada N, Haga I, Takayama T, Nakamura A, Jimbo T, Hara Y, kawagishi N, Ohuchi N. Right versus left retroperitoneoscopic living-donor nephrectomy. Int Urol Nephrol 2015; 47:1117-21. [DOI: 10.1007/s11255-015-1014-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 05/13/2015] [Indexed: 11/29/2022]
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Tokodai K, Takayama T, Amada N, Haga I, Nakamura A, Kashiwadate T. Retroperitoneoscopic Living Donor Nephrectomy: Short Learning Curve and Our Original Hybrid Technique. Urology 2013; 82:1054-8. [DOI: 10.1016/j.urology.2013.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 07/27/2013] [Accepted: 08/01/2013] [Indexed: 11/26/2022]
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Moore RB. Protecting transplant recipients and live renal donors: Facing the challenges. Can Urol Assoc J 2013; 7:46. [PMID: 23671493 DOI: 10.5489/cuaj.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ronald B Moore
- Professor Surgery & Oncology, University of Alberta, Surgical Director of Renal Transplant, Mr. Lube Chair in Uro-Oncology, Diplomat American Board of Urology, Edmonton, AB
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The Safety and Efficacy of Laparoscopic Donor Nephrectomy for Renal Transplantation: An Updated Meta-analysis. Transplant Proc 2013; 45:65-76. [DOI: 10.1016/j.transproceed.2012.07.152] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 06/21/2012] [Accepted: 07/19/2012] [Indexed: 11/18/2022]
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Stroup SP, Palazzi KL, Chang DC, Ward NT, Parsons JK. Inpatient safety trends in laparoscopic and open nephrectomy for renal tumours. BJU Int 2012; 110:1808-13. [PMID: 22471427 DOI: 10.1111/j.1464-410x.2012.11071.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
UNLABELLED Study Type--Cohort study Level of Evidence 2b. What's known on the subject? and What does the study add? Laparoscopic radical nephrectomy for renal cancer provides equivalent long-term cancer control with shorter hospital stays, less postoperative pain, and faster resumption of normal activities, but it has diffused slowly into clinical practice, perhaps as a result of perceptions about safety. Patient safety outcomes for laparoscopic and open radical nephrectomy using validated measures remain incompletely characterized. This is the first study to investigate peri-operative outcomes of radical nephrectomy using validated patient safety measures. We found a 32% decreased probability of adverse patient safety events occurring in laparoscopic compared with open radical nephrectomy. The safety benefits of laparoscopy were attained only after 10% of cases were completed laparoscopically--a proportion some have proposed as the 'tipping point' for the adoption of surgical innovations. This observation could have implications for patient safety in the setting of diffusion of new surgical techniques. OBJECTIVE • To compare peri-operative adverse patient safety events occurring in laparoscopic radical nephrectomy (LRN) with those occurring in open radical nephrectomy (ORN). METHODS • We used the US Nationwide Inpatient Sample to identify patients undergoing kidney surgery for renal tumours from 1998 to 2008. • We used patient safety indicators (PSIs), which are validated measures of preventable adverse outcomes, and multivariate regression to analyse associations of surgery type with patient safety. RESULTS • Open radical nephrectomy accounted for 235,098 (89%) cases while 28,609 (11%) cases were LRN. • Compared with ORN, LRN patients were more likely to be male (P= 0.048), have lower Charlson comorbidity scores (P < 0.001), and to undergo surgery at urban (P < 0.001) and teaching (P < 0.001) hospitals. • PSIs occurred in 18,714 (8%) of ORN and 1434 (5%) of LRN cases (P < 0.001). • On multivariate analysis, LRN was associated with a 32% decreased probability of any PSI (adjusted odds ratio 0.68, 95% confidence interval: 0.6 to 0.77, P < 0.001). Stratification by year showed that this difference was initially manifested in 2003, when the proportion of LRN cases first exceeded 10%. CONCLUSIONS • We found that LRN was associated with substantially superior peri-operative patient safety outcomes compared with ORN, but only after the national prevalence of LRN exceeded 10%. • Further study is needed to explain these patterns and promote the safe diffusion of novel surgical therapies into broad practice.
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Affiliation(s)
- Sean P Stroup
- UC San Diego Medical Center, Division of Urology VA San Diego Medical Center Moores UCSD Cancer Center, San Diego, CA 92103, USA
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Ungbhakorn P, Kongchareonsombat W, Leenanupan C, Kijvikai K, Wisetsingh W, Patcharatrakul S, Jirasiritam S. Comparative Outcomes of Open Nephrectomy, Hand-Assisted Laparoscopic Nephrectomy, and Full Laparoscopic Nephrectomy for Living Donors. Transplant Proc 2012; 44:22-5. [DOI: 10.1016/j.transproceed.2011.12.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Grills R, Kearns P, Corcoran NM. The Impact of Laparoscopic Nephrectomy on Patient Outcome: A Community Perspective. J Endourol 2011; 25:781-6. [DOI: 10.1089/end.2010.0202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Richard Grills
- Department of Urology, Geelong Hospital, Geelong, Victoria, Australia
- Deakin University School of Medicine, Geelong, Victoria, Australia
| | - Paul Kearns
- Department of Urology, Geelong Hospital, Geelong, Victoria, Australia
| | - Niall M. Corcoran
- Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
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Altinel M, Akinci S, Gunes Z, Olcucuoglu E, Gonenc F, Yazicioglu A. Open Versus Laparoscopic Donor Nephrectomy: Perioperative Parameters and Graft Functions. Transplant Proc 2011; 43:781-6. [DOI: 10.1016/j.transproceed.2011.01.113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kohei N, Kazuya O, Hirai T, Miyauchi Y, Iida S, Shirakawa H, Shimizu T, Ishida H, Tanabe K. Retroperitoneoscopic Living Donor Nephrectomy: Experience of 425 Cases at a Single Center. J Endourol 2010; 24:1783-7. [DOI: 10.1089/end.2009.0493] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Naoki Kohei
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Omoto Kazuya
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshihito Hirai
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuki Miyauchi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shoichi Iida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroki Shirakawa
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tomokazu Shimizu
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
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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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Kanashiro H, Falci R, Piovisan AC, Saito F, Torricelli FCM, Nahas WC. Subcostal mini incision: a good option for donor nephrectomy. Clinics (Sao Paulo) 2010; 65:507-10. [PMID: 20535369 PMCID: PMC2882545 DOI: 10.1590/s1807-59322010000500008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 02/22/2010] [Accepted: 03/01/2010] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES We describe the results of over one hundred nephrectomies performed using a subcostal mini incision. INTRODUCTION A major effort has been undertaken to encourage living donor renal transplantation. New techniques that use minimally invasive approaches to perform donor nephrectomy have been progressively accepted. Among these new procedures is the mini-incision approach. METHODS We prospectively analyzed one hundred and seventeen consecutive donors that were subjected to subcostal mini-incision nephrectomy at a single center. Surgical time, warm and cold ischemia time, intraoperative complications, time until hospital discharge, presence of infection, bleeding, the need for a second operation, and death were analyzed. Eventual loss of donor renal function was indicated by increases in serum creatinine and proteinuria. RESULTS The mean time of surgery was 180.5 +/- 26.2 minutes. The mean warm ischemia time was 93 +/-8.3 seconds, while the mean cold ischemia time was 85.9 (+/-23.5) minutes. We had one case with an intraoperative complication, and only two patients required another operation. An intra-abdominal abscess occurred in one patient (0.85%), proteinuria occurred in one patient (0.85%), and a transitory increase of creatinine levels occurred in two patients (1.7%). DISCUSSION Reducing the length of the abdominal incision did not influence surgical time or result in an increase in intraoperative complications relative to our historical data or literature reports. Organ preparation was accomplished successfully with a brief warm ischemia time. Additionally, the mean hospital stay was short, and few surgical complications occurred. CONCLUSION The use of a subcostal mini incision is both safe and similar to conventional techniques previously described in the literature.
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Affiliation(s)
- Hideki Kanashiro
- Department of Urology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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Percegona L, Bignelli A, Adamy A, Pilz F, Chin E, Meyer F, Hokazono S, Riella M, Machado C. Hand-Assisted Laparoscopic Donor Nephrectomy: Comparison to Pure Laparoscopic Donor Nephrectomy. Transplant Proc 2008; 40:687-8. [PMID: 18454987 DOI: 10.1016/j.transproceed.2008.03.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shokeir AA. Open versus laparoscopic live donor nephrectomy: a focus on the safety of donors and the need for a donor registry. J Urol 2007; 178:1860-6. [PMID: 17868736 DOI: 10.1016/j.juro.2007.07.008] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2006] [Indexed: 01/03/2023]
Abstract
PURPOSE A review of the existing literature showed that the subject of live donor nephrectomy is a seat of underreporting and underestimation of complications. We provide a systematic comparison between laparoscopic and open live donor nephrectomy with special emphasis on the safety of donors and grafts. MATERIALS AND METHODS The PubMed literature database was searched from inception to October 2006. A comparison was made between laparoscopic and open live donor nephrectomy regarding donor safety and graft efficacy. RESULTS The review included 69 studies. There were 7 randomized controlled trials, 5 prospective nonrandomized studies, 22 retrospective controlled studies, 26 large (greater than 100 donors), retrospective, noncontrolled studies, 8 case reports and 1 experimental study. Most investigators concluded that, compared to open live donor nephrectomy, laparoscopic live donor nephrectomy provides equal graft function, an equal rejection rate, equal urological complications, and equal patient and graft survival. Analgesic requirements, pain data, hospital stay and time to return to work are significantly in favor of the laparoscopic procedure. On the other hand, laparoscopic live donor nephrectomy has the disadvantages of increased operative time, increased warm ischemia time and increased major complications requiring reoperation. In terms of donor safety at least 8 perioperative deaths were recorded after laparoscopic live donor nephrectomy. These perioperative deaths were not documented in recent review articles. Ten perioperative deaths were reported with open live donor nephrectomy by 1991. No perioperative mortalities have been recorded following open live donor nephrectomy since 1991. Regarding graft safety, at least 15 graft losses directly related to the surgical technique of laparoscopic live donor nephrectomy were found but none was emphasized in recent review articles. The incidence of graft loss due to technical reasons in the early reports of open live donor nephrectomy was not properly documented in the literature. CONCLUSIONS We are in need of a live organ donor registry to determine the combined experience of complications and long-term outcomes, rather than short-term reports from single institutions. Like all other new techniques, laparoscopic live donor nephrectomy should be developed and improved at a few centers of excellence to avoid the loss of a donor or a graft.
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Affiliation(s)
- Ahmed A Shokeir
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
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Mekeel KL, Mazur MJ, Reddy KS, Mulligan DC, Heilman RL, Chakkera HA, Andrews PE, Moss AA. Diffuse parenchymal urine leak after kidney transplantation following degloving injury during donor nephrectomy. Am J Transplant 2007; 7:2039-41. [PMID: 17578504 DOI: 10.1111/j.1600-6143.2007.01870.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Laparoscopic donor nephrectomy can result in trauma to the kidney which may affect recipient graft function. In this case, the kidney sustained a complete degloving of the capsule during extraction. The kidney was transplanted and had immediate, good renal function, but postoperative course was complicated by a large urinoma that drained through the wound. Exploration was negative for a defined urine leak, but the surface of the denuded kidney was leaking a significant amount of unconcentrated urine. The patient was successfully treated with tissue glue treatment to the kidney surface and peritoneal window.
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Affiliation(s)
- K L Mekeel
- Department of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA.
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