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Zemla P, Hartmann I, Hruska F, Kral M, Janeckova J, Utikal P, Vidlar A, Krejci K, Bachleda P. Robotic assisted living donor nephrectomy - the first in the Czech Republic. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2024; 168:177-180. [PMID: 37614196 DOI: 10.5507/bp.2023.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/19/2023] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION A kidney transplant is the best method for treating terminal kidney failure. Long-term results of kidney transplants from living donors are significantly better than transplants from dead donors. Living kidney donors are healthy people who undergo a major operation in order to improve the health of another person. Therefore, major emphasis is on safety, low level of invasiveness and a desirable cosmetic effect of the donor nephrectomy. Since 2012, the Department of Urology at the University Hospital in Olomouc has performed 12 kidney harvestings from living donors. The kidney harvesting was conducted using various techniques. CASE REPORT The first robotic assisted kidney harvesting in the Czech Republic was performed in June 2022. The donor was a 57-year-old man who donated his kidney to his 32-year-old daughter. The left kidney was evaluated as suitable for kidney harvesting. The operation took 174 min. The kidney's warm ischemia was 145 s. Based on the Clavien Dindo classification, no 2nd degree or high post-operative complications were recorded. The donor's pre-operative glomerular filtration was 1.63 mL/s. Six months post-operation, it went down to 1.19 mL/s. This represents a 27% decrease. The kidney recipient did not require early dialysis. Six months post-operation, the recipient's glomerular filtration was 2.03 mL/s. CONCLUSION In the hands of experienced professionals and transplantation centres, robotic assisted donor nephrectomy is a feasible and safe option for this operation. It not only provides all the advantages of a laparoscopic operation but it also adds other technical improvements and minimizes intraoperative stress on the surgeon. Currently, the global trend is moving towards increasing the ratio of robotic assisted donor nephrectomies.
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Affiliation(s)
- Pavel Zemla
- Department of Urology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Igor Hartmann
- Department of Urology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Frantisek Hruska
- Department of Urology, University Hospital Olomouc, Olomouc, Czech Republic
| | | | - Jana Janeckova
- Department of Surgery II - Vascular and Transplantation Surgery, University Hospital Olomouc, Olomouc, Czech Republic
| | - Petr Utikal
- Department of Surgery II - Vascular and Transplantation Surgery, University Hospital Olomouc, Olomouc, Czech Republic
| | - Ales Vidlar
- Department of Urology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Karel Krejci
- Department of Internal Medicine III - Nephrology, Rheumatology and Endocrinology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Petr Bachleda
- Department of Surgery II - Vascular and Transplantation Surgery, University Hospital Olomouc, Olomouc, Czech Republic
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López-Abad A, Pecoraro A, Boissier R, Piana A, Prudhomme T, Hevia V, Catucci CL, Dönmez MI, Breda A, Serni S, Territo A, Campi R. Prediction models for postoperative renal function after living donor nephrectomy: a systematic review. Minerva Urol Nephrol 2024; 76:148-156. [PMID: 38742550 DOI: 10.23736/s2724-6051.24.05556-3] [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: 05/16/2024]
Abstract
INTRODUCTION Living-donor nephrectomy (LDN) is the most valuable source of organs for kidney transplantation worldwide. The current preoperative evaluation of a potential living donor candidate does not take into account formal estimation of postoperative renal function decline after surgery using validated prediction models. The aim of this study was to summarize the available models to predict the mid- to long-term renal function following LDN, aiming to support both clinicians and patients during the decision-making process. EVIDENCE ACQUISITION A systematic review of the English-language literature was conducted following the principles highlighted by the European Association of Urology (EAU) guidelines and following the PRISMA 2020 recommendations. The protocol was registered in PROSPERO on December 10, 2022 (registration ID: CRD42022380198). In the qualitative analysis we selected the models including only preoperative variables. EVIDENCE SYNTHESIS After screening and eligibility assessment, six models from six studies met the inclusion criteria. All of them relied on retrospective patient cohorts. According to PROBAST, all studies were evaluated as high risk of bias. The models included different combinations of variables (ranging between two to four), including donor-/kidney-related factors, and preoperative laboratory tests. Donor age was the variable more often included in the models (83%), followed by history of hypertension (17%), Body Mass Index (33%), renal volume adjusted by body weight (33%) and body surface area (33%). There was significant heterogeneity in the model building strategy, the main outcome measures and the model's performance metrics. Three models were externally validated. CONCLUSIONS Few models using preoperative variables have been developed and externally validated to predict renal function after LDN. As such, the evidence is premature to recommend their use in routine clinical practice. Future research should be focused on the development and validation of user-friendly, robust prediction models, relying on granular large multicenter datasets, to support clinicians and patients during the decision-making process.
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Affiliation(s)
- Alicia López-Abad
- Department of Urology, Virgen de la Arrixaca University Hospital, Murcia, Spain
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Romain Boissier
- Department of Urology and Renal Transplantation, La Conception University Hospital, Marseille, France
| | - Alberto Piana
- Division of Urology, Department of Oncology, University of Turin, Turin, Italy
| | - Thomas Prudhomme
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Vital Hevia
- Urology Department, Hospital Universitario Ramón y Cajal, Alcalá University, Madrid, Spain
| | - Claudia L Catucci
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Muhammet I Dönmez
- Division of Pediatric Urology, Department of Urology, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Türkiye
| | - Alberto Breda
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Angelo Territo
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy -
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Pecoraro A, Li Marzi V, Serni S, Campi R. Re: Julia Dagnæs-Hansen, Gitte Hjartbro Kristensen, Hein V. Stroomberg, Søren Schwartz Sørensen, Martin Andreas Røder. Surgical Approaches and Outcomes in Living Donor Nephrectomy: A Systematic Review and Meta-analysis. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2022.03.021. Eur Urol Focus 2023; 9:216-217. [PMID: 35798648 DOI: 10.1016/j.euf.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/28/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Vincenzo Li Marzi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
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Mankiev B, Cimen SG, Kaya IO, Cimen S, Eraslan A. Current practice of live donor nephrectomy in Turkey. World J Transplant 2022; 12:405-414. [PMID: 36570407 PMCID: PMC9782686 DOI: 10.5500/wjt.v12.i12.405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/31/2022] [Accepted: 12/06/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Over the last few years, the deceased donor organ donation rate was declined or remained stable, whereas the live donor organ donation rate has increased to compensate for the demand. Minimally invasive techniques for live donor nephrectomy (LDN) have also improved the live donor kidney donation rates. This increase has led to an interest in the surgical procedures used for LDN.
AIM To evaluate the LDN techniques performed in Turkey, the structure of surgical teams, and the training received. Additionally, the number of kidney transplantations at different centers, the surgeon experience level, differences in surgical approach during donor surgeries, and outcomes were assessed.
METHODS A questionnaire was sent to the Turkish Ministry of Health-accredited transplant centers. It inquired of the number of LDN surgeries, surgical techniques, complications, optimization protocols, the experience of surgeons, and the training. Descriptive statistics were outlined as follows: Discrete numeric variables were expressed as medians (minimum-maximum), while categorical variables were shown as numbers and percentages. As a result of the goodness-of-fit tests, if the significance of the differences between the groups in discrete numerical variables for which the parametric test statistical assumptions were not met, data were analyzed with the Mann Whitney U test and the χ2 test.
RESULTS The questionnaire was sent to 72 transplant centers, all of which replied. Five centers that reported not performing LDN procedures were excluded. Responses from the remaining 67 centers were analyzed. In 2019, the median number of kidney transplants performed was 45, and the median number of kidney transplants from living donors was 28 (1-238). Eleven (16.5%) centers performed 5-10, while 34 (50.7%) centers performed more than 100 live donor kidney transplants in 2019. While 19 (28.4%) centers performed the LDN procedures using the open technique, 48 (71.6%) centers implemented minimally invasive techniques. Among the centers preferring minimally invasive techniques for LDN, eight (16.6%) used more than one surgical technique. The most and the least common surgical techniques were transperitoneal laparoscopic (43 centers, 89.6%) and single port laparoscopic LDN (1 center, 2.1%) techniques, respectively. A positive association was found between the performance of minimally invasive techniques and the case volume of a transplant center, both in the total number and live donor kidney transplants (15 vs 55, P = 0.001 and 9 vs 42, P ≤ 0001 respectively). The most frequently reported complication was postoperative atelectasis (n = 33, 49.2%). There was no difference between the techniques concerning complications except for the chyle leak.
CONCLUSION Turkish transplant centers performed LDN surgeries successfully through various techniques. Centers implementing minimally invasive techniques had a relatively higher number of live donor kidney transplants in 2019.
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Affiliation(s)
- Bakytbek Mankiev
- Department of General Surgery, Sağlık Bilimleri Üniversitesi, Ankara 65100, Turkey
| | - Sanem Guler Cimen
- Department of General Surgery, Sağlık Bilimleri Üniversitesi, Ankara 65100, Turkey
| | - Ismail Oskay Kaya
- Departments of Surgery, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara 65100, Turkey
| | - Sertac Cimen
- Department of Urology, Saglık Bilimleri Universitesi, Ankara 65100, Turkey
| | - Asir Eraslan
- Department of Urology, Somalia Turkish Training and Research Hospital, Mogadishu 23451, Somalia
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Radić J, Vučković M, Gelemanović A, Kolak E, Bučan Nenadić D, Begović M, Radić M. Associations between Advanced Glycation End Products, Body Composition and Mediterranean Diet Adherence in Kidney Transplant Recipients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11060. [PMID: 36078776 PMCID: PMC9518364 DOI: 10.3390/ijerph191711060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 06/15/2023]
Abstract
There is limited evidence on the associations between dietary patterns, body composition, and nonclassical predictors of worse outcomes such as advanced glycation end products (AGE) in kidney transplant recipients (KTRs). The aim of this cross-sectional study was to determine the level of AGE-determined cardiovascular (CV) risk in Dalmatian KTRs and possible associations between AGE, adherence to the Mediterranean diet (MeDi), and nutritional status. Eighty-five (85) KTRs were enrolled in this study. For each study participant, data were collected on the level of AGE, as measured by skin autofluorescence (SAF), Mediterranean Diet Serving Score (MDSS), body mass composition, anthropometric parameters, and clinical and laboratory parameters. Only 11.76% of the participants were adherent to the MeDi. Sixty-nine percent (69%) of KTRs had severe CV risk based on AGE, while 31% of KTRs had mild to moderate CV risk. The results of the LASSO regression analysis showed that age, dialysis type, dialysis vintage, presence of CV and chronic kidney disease, C- reactive protein level, urate level, percentage of muscle mass, and adherence to recommendations for nuts, meat, and sweets were identified as positive predictors of AGE. The negative predictors for AGE were calcium, phosphate, cereal adherence according to the MeDi, and trunk fat mass. These results demonstrate extremely low adherence to the MeDi and high AGE levels related CV risk in Dalmatian KTRs. Lifestyle interventions in terms of CV risk management and adherence to the MeDi of KTRs should be taken into consideration when taking care of this patient population.
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Affiliation(s)
- Josipa Radić
- Department of Nephrology and Dialysis, University Hospital of Split, Spinčićeva 1, 21 000 Split, Croatia
- Department of Internal Medicine, University of Split School of Medicine, Šoltanska 2, 21 000 Split, Croatia
| | - Marijana Vučković
- Department of Nephrology and Dialysis, University Hospital of Split, Spinčićeva 1, 21 000 Split, Croatia
| | - Andrea Gelemanović
- Mediterranean Institute for Life Sciences (MedILS), 21 000 Split, Croatia
| | - Ela Kolak
- Department of Nutrition and Dietetics, University Hospital Centre Split, 21 000 Split, Croatia
| | - Dora Bučan Nenadić
- Department of Nutrition and Dietetics, University Hospital Centre Split, 21 000 Split, Croatia
| | - Mirna Begović
- School of Medicine, University of Split, Šoltanska 2, 21 000 Split, Croatia
| | - Mislav Radić
- Department of Internal Medicine, University of Split School of Medicine, Šoltanska 2, 21 000 Split, Croatia
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University Hospital of Split, 21 000 Split, Croatia
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Li Marzi V, Pecoraro A, Gallo ML, Caroti L, Peris A, Vignolini G, Serni S, Campi R. Robot-assisted kidney transplantation: Is it getting ready for prime time? World J Transplant 2022; 12:163-174. [PMID: 36051450 PMCID: PMC9331411 DOI: 10.5500/wjt.v12.i7.163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/08/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
Kidney transplantation (KT) is the treatment of choice for patients with end-stage renal disease, providing a better survival rate and quality of life compared to dialysis. Despite the progress in the medical management of KT patients, from a purely surgical standpoint, KT has resisted innovations during the last 50 years. Recently, robot-assisted KT (RAKT) has been proposed as an alternative approach to open surgery, especially due to its potential benefits for fragile and immunocompromised recipients. It was not until 2014 that the role of RAKT has found value thanks to the pioneering Vattikuti Urology Institute-Medanta collaboration that conceptualized and developed a new surgical technique for RAKT following the Idea, Development, Exploration, Assessment, Long-term follow-up recommendations for introducing surgical innovations into real-life practice. During the last years, mirroring the Vattikuti-Medanta technique, several centers developed RAKT program worldwide, providing strong evidence about the safety and the feasibility of this procedure. However, the majority of RAKT are still performed in the living donor setting, as an “eligible” procedure, while only a few centers have realized KT through a robotic approach in the challenging scenario of cadaver donation. In addition, despite the spread of minimally-invasive (predominantly robotic) surgery worldwide, many KTs are still performed in an open fashion. Regardless of the type of incision employed by surgeons, open KT may lead to non-negligible risks of wound complications, especially among obese patients. Particularly, the assessment for KT should consider not only the added surgical technical challenges but also the higher risk of postoperative complications. In this context, robotic surgery could offer several benefits, including providing a better exposure of the surgical field and better instrument maneuverability, as well as the possibility to integrate other technological nuances, such as the use of intraoperative fluorescence vascular imaging with indocyanine green to assess the ureteral vascularization before the uretero-vesical anastomosis. Therefore, our review aims to report the more significant experiences regarding RAKT, focusing on the results and future perspectives.
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Affiliation(s)
- Vincenzo Li Marzi
- Department of Minimally Invasive and Robotic Urologic Surgery, Careggi University Hospital, University of Florence, Florence 50134, Italy
| | - Alessio Pecoraro
- Department of Minimally Invasive and Robotic Urologic Surgery, Careggi University Hospital, University of Florence, Florence 50134, Italy
| | - Maria Lucia Gallo
- Department of Minimally Invasive and Robotic Urologic Surgery, Careggi University Hospital, University of Florence, Florence 50134, Italy
| | | | - Adriano Peris
- Intensive Care Unit and Regional ECMO Referral Centre, Careggi Hospital, Florence 50134, Italy
| | - Graziano Vignolini
- Department of Minimally Invasive and Robotic Urologic Surgery, Careggi University Hospital, University of Florence, Florence 50134, Italy
| | - Sergio Serni
- Department of Minimally Invasive and Robotic Urologic Surgery, University of Florence, Florence 50134, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Riccardo Campi
- Department of Minimally Invasive and Robotic Urologic Surgery, Careggi University Hospital, University of Florence, Florence 50134, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
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Rysmakhanov M, Yelemessov A, Mussin N, Yessenbayev D, Saparbayev S, Zhakiyev B, Sultangereyev Y. Two- and three-dimensional laparoscopic donor nephrectomy: a comparative study of a single-center experience. KOREAN JOURNAL OF TRANSPLANTATION 2022; 36:104-110. [PMID: 35919198 PMCID: PMC9296978 DOI: 10.4285/kjt.22.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 12/05/2022] Open
Abstract
Background This is the first report on three-dimensional (3D) laparoscopic donor nephrectomy performed in the Central Asian region and Commonwealth of Independent States countries. This study presents the results of our initial experiences of 3D hand-assisted laparoscopic donor nephrectomy (3D-HALDN) in comparison with the outcomes of two-dimensional hand-assisted laparoscopic donor nephrectomy (2D-HALDN) at a single center. Methods From 2015 to 2019, 19 3D-HALDN and 19 2D-HALDN procedures were performed at the same center by two surgeons. All 38 procedures used identical techniques. Between-group differences were considered statistically significant at P<0.05. Results The baseline characteristics in both groups were statistically comparable (P>0.05). All donors underwent left nephrectomy. Donors who underwent 3D-HALDN had better outcomes than those who underwent 2D-HALDN, as shown by a shorter warm ischemic time (P<0.05), a shorter operative time (P<0.05), and less blood loss (P<0.05). There were no conversions or major complications (according to the Clavien-Dindo classification) in either group. The average drainage duration and postoperative hospitalization were significantly shorter in the 3D-HALDN group (P<0.05). The between-group differences in the mean postoperative creatinine level and glomerular filtration rate were not significant. Conclusions The 3D-HALDN approach is more beneficial than traditional 2D-HALDN by providing a shorter warm ischemic time, less blood loss, and shorter durations of drainage and postoperative hospitalization. Postoperative complications and the functional condition of the kidney in donors in the early and late postoperative periods did not depend on the type of laparoscopic donor nephrectomy.
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Affiliation(s)
- Myltykbay Rysmakhanov
- Department of Surgery No. 2, West Kazakhstan Medical University, Aktobe, Kazakhstan
- Department of Surgery and Organ Transplantation, Aktobe Medical Center, Aktobe, Kazakhstan
| | - Asset Yelemessov
- Department of Surgery No. 2, West Kazakhstan Medical University, Aktobe, Kazakhstan
- Department of Surgery and Organ Transplantation, Aktobe Medical Center, Aktobe, Kazakhstan
| | - Nadiar Mussin
- Department of Surgery No. 2, West Kazakhstan Medical University, Aktobe, Kazakhstan
| | - Daulet Yessenbayev
- Department of Surgical Disease, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Samat Saparbayev
- Department of Surgery No. 2, West Kazakhstan Medical University, Aktobe, Kazakhstan
| | - Bazylbek Zhakiyev
- Department of Surgery No. 2, West Kazakhstan Medical University, Aktobe, Kazakhstan
| | - Yerlan Sultangereyev
- Department of Surgery and Organ Transplantation, Aktobe Medical Center, Aktobe, Kazakhstan
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Robot-Assisted Autonomous Reduction of a Displaced Pelvic Fracture: A Case Report and Brief Literature Review. J Clin Med 2022; 11:jcm11061598. [PMID: 35329924 PMCID: PMC8950953 DOI: 10.3390/jcm11061598] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 12/04/2022] Open
Abstract
Displaced pelvic fracture is among the most complicated fractures in traumatic orthopedics, with high mortality and morbidity. Reduction is considered a complex procedure as well as a key part in surgical treatment. However, few robotic techniques have been employed in the reduction of pelvic fracture, despite the rapid advancement of technologies. Recently, we designed a robot surgery system specialized in the autonomous reduction of displaced pelvic fracture and applied it in the true patient for the first time. In this paper, we report its successful clinical debut in the surgery of a displaced pelvic fracture. Total surgery time was 110 min and an anatomic reduction was achieved. We then present a brief overview of the literature about reduction techniques in pelvic fracture and introduce related principles involved in our robot-assisted reduction system.
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The Evolution of Living Donor Nephrectomy Program at A Hellenic Transplant Center. Laparoscopic vs. Open Donor Nephrectomy: Single-Center Experience. J Clin Med 2021; 10:jcm10061195. [PMID: 33809339 PMCID: PMC8001196 DOI: 10.3390/jcm10061195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/27/2021] [Accepted: 03/05/2021] [Indexed: 01/11/2023] Open
Abstract
Since its introduction in 1995, laparoscopic nephrectomy has emerged as the preferred surgical approach for living donor nephrectomy. Given the ubiquity of the surgical procedure and the need for favorable outcomes, as it is an elective operation on otherwise healthy individuals, it is imperative to ensure appropriate preoperative risk stratification and anticipate intraoperative challenges. The aim of the present study was to compare peri-and postoperative outcomes of living kidney donors (LD), who had undergone laparoscopic nephrectomy (LDN), with a control group of those who had undergone open nephrectomy (ODN). Health-related quality of life (QoL) was also assessed using the validated SF-36 questionnaire. Data from 252 LD from a single transplant center from March 2015 to December 2020 were analyzed retrospectively. In total, 117 donors in the LDN and 135 in the ODN groups were assessed. Demographics, type of transplantation, BMI, duration of surgery, length of hospital stay, peri- and postoperative complications, renal function at discharge and QoL were recorded and compared between the two groups using Stata 13.0 software. There was no difference in baseline characteristics, nor in the prevalence of peri-and postoperative complications, with a total complication rate of 16% (mostly minor, Clavien–Dindo grade II) in both groups, while a different pattern of surgical complications was noticed between them. Duration of surgery was significantly longer in the ODN group (median 240 min vs. 160 min in LDN, p < 0.01), warm ischemia time was longer in the LDN group (median 6 min vs.2 min in ODN, p < 0.01) and length of hospital stay shorter in the LDN group (median 3 days vs. 7 days in ODN). Conversion rate from laparoscopic to open surgery was 2.5%. There was a drop in estimated glomerular filtration rate (eGFR) at discharge of 36 mL/min in the LDN and 32 mL/min in the ODN groups, respectively (p = 0.03). No death, readmission or reoperation were recorded. There was a significant difference in favor of LDN group for each one of the eight items of the questionnaire (SF1–SF8). As for the two summary scores, while the total physical component summary (PCS) score was comparable between the two groups (57.87 in the LDN group and 57.07 in the ODN group), the mental component summary (MCS) score was significantly higher (62.14 vs. 45.22, p < 0.001) in the LDN group. This study provides evidence that minimally invasive surgery can be performed safely, with very good short-term outcomes, providing several benefits for the living kidney donor, thereby contributing to expanding the living donor pool, which is essential, especially in countries with deceased-donor organ shortage.
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