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Jackson S, Combes A, Latif E, Tran M, Lam S, Gore N, Utsiwegota M, Mawson J, Smith L, Palma C, Laurence J, Crawford M, Pulitano C, Wyburn K, Chadban S, Leslie S, Vasilaras A. Laparoscopic donor nephrectomy-Technique and peri-operative outcomes in an Australian transplant center. Clin Transplant 2023; 37:e14945. [PMID: 36807636 DOI: 10.1111/ctr.14945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 02/21/2023]
Abstract
INTRODUCTION Demand for donor kidneys far exceeds the availability of organs from deceased donors. Living donor kidneys are an important part of addressing this shortfall, and laparoscopic nephrectomy is an important strategy to reduce donor morbidity and increase the acceptability of living donation. AIM To retrospectively review the intraoperative and postoperative safety, technique, and outcomes of patients undergoing donor nephrectomy at a single tertiary hospital in Sydney, Australia. METHOD Retrospective capture and analysis of clinical, demographic, and operative data for all living donor nephrectomies performed between 2007 and 2022 at a single University Hospital in Sydney, Australia. RESULTS Four hundred and seventy-two donor nephrectomies were performed: 471 were laparoscopic, two of which were converted from laparoscopic to open and hand-assisted nephrectomy, respectively, and one (.2%) underwent primary open nephrectomy. The mean warm ischemia time was 2.8 min (±1.3 SD, median 3 min, range 2-8 min) and the mean length of stay (LOS) was 4.1 days (±1.0 SD). The mean renal function on discharge was 103 μmol/L (±23.0 SD). Seventy-seven (16%) patients had a complication with no Clavien Dindo IV or V complications seen. Outcomes demonstrated no impact of donor age, gender, kidney side, relationship to the recipient, vascular complexity; or surgeon experience, on complication rate or LOS. CONCLUSION Laparoscopic donor nephrectomy is a safe and effective procedure with minimal morbidity and no mortality in this series.
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Affiliation(s)
- Stuart Jackson
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Alexander Combes
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Edward Latif
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Minh Tran
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Susanna Lam
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Neel Gore
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Mike Utsiwegota
- Department of Renal Medicine and Transplantation, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Jane Mawson
- Department of Renal Medicine and Transplantation, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Laura Smith
- Department of Renal Medicine and Transplantation, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Catalina Palma
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Jerome Laurence
- Department of Surgical Transplantation, Royal Prince Alfred Hospital, Camperdown, Australia.,RPA Institute of Academic Surgery, Camperdown, Australia.,The University of Sydney, Camperdown, Australia.,Chris O'Brien Lifehouse, Sydney, Australia
| | - Michael Crawford
- Department of Surgical Transplantation, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Carlo Pulitano
- Department of Surgical Transplantation, Royal Prince Alfred Hospital, Camperdown, Australia.,RPA Institute of Academic Surgery, Camperdown, Australia.,The University of Sydney, Camperdown, Australia.,Chris O'Brien Lifehouse, Sydney, Australia
| | - Kate Wyburn
- Department of Renal Medicine and Transplantation, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Steve Chadban
- Department of Renal Medicine and Transplantation, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Scott Leslie
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia.,RPA Institute of Academic Surgery, Camperdown, Australia.,The University of Sydney, Camperdown, Australia.,Chris O'Brien Lifehouse, Sydney, Australia
| | - Arthur Vasilaras
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, Australia.,Chris O'Brien Lifehouse, Sydney, Australia
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Antonelli A, Veccia A, Francavilla S, Bertolo R, Bove P, Hampton LJ, Mari A, Palumbo C, Simeone C, Minervini A, Autorino R. On-clamp versus off-clamp robotic partial nephrectomy: A systematic review and meta-analysis. Urologia 2019; 86:52-62. [PMID: 31179885 DOI: 10.1177/0391560319847847] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The debate on the pros and cons of robot-assisted partial nephrectomy performed with (on-clamp) or without (off-clamp) renal artery clamping is ongoing. The aim of this meta-analysis is to summarize the available evidence on the comparative studies assessing the outcomes of these two approaches. MATERIAL AND METHODS A systematic review of the literature on PubMed, ScienceDirect®, and Embase® was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement (PRISMA). Only comparative and case-control studies were submitted to full-text assessment and meta-analysis. RevMan 5.3 software was used. RESULTS From the initial retrieval of 1937 studies, 15 fulfilling inclusion criteria were selected and provided 2075 patients for analysis (702 off-clamp, 1373 on-clamp). Baseline tumor's features showed a significant difference in size (weighted mean difference: -0.58 cm; 95% confidence interval: [-1.06, -0.10]; p = 0.02) and R.E.N.A.L. score (weighted mean difference: -0.53; 95% confidence interval: [-0.81, -0.25]; p = 0.0002), but not in the exophytic property, the location, and the PADUA score. Pooled analysis revealed shorter operative time (p = 0.02) and higher estimated blood loss (p = 0.0002) for the off-clamp group. Overall complication and transfusion rates were similar, while higher major complication rate was observed in the on-clamp approach (5.6% vs 1.9%, p = 0.03). No differences in oncological outcomes were found. Finally, functional outcomes (assessed by estimated glomerular filtration rate at early postoperative, 3 month, 6 month, and last available follow-up) were not statistically different. CONCLUSION This meta-analysis shows that off-clamp robot-assisted partial nephrectomy is reserved to smaller renal masses. Under such conditions, no differences with the on-clamp approach emerged.
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Affiliation(s)
- Alessandro Antonelli
- 1 Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy.,2 Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Alessandro Veccia
- 1 Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy.,2 Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.,3 Division of Urology, VCU Health System, Richmond, VA, USA
| | - Simone Francavilla
- 1 Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy.,2 Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Pierluigi Bove
- 4 Urology Department, San Carlo di Nancy Hospital, Rome, Italy
| | | | - Andrea Mari
- 5 Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Carlotta Palumbo
- 1 Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy.,2 Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Claudio Simeone
- 1 Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy.,2 Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Andrea Minervini
- 5 Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
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