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Chavan AS, Bale CB, Wakhare PS, Shinde N, Kulkarni AR, Sajgure AD, Dighe TA. Measured Glomerular Filtration Rate in Live Related Kidney Donors Three Months Post-Kidney Donation: A Single-Center Experience From Western India. Cureus 2023; 15:e45103. [PMID: 37842396 PMCID: PMC10569230 DOI: 10.7759/cureus.45103] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
Background Glomerular filtration rate (GFR) estimation is pivotal in the evaluation of kidney donors. There are various methods available for assessing GFR, but there has been a lack of consensus on the measurement of GFR and the frequency of renal evaluation after kidney donation. Our study aims to analyze the measured GFR (m-GFR) before and three months after kidney donation and note the compensatory abilities of the remnant kidney in live related kidney donors. Methods This prospective observational study was conducted at the Department of Nephrology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, from April 2021 to December 2022. The study included 30 donors from both genders aged between 23 and 73 years. The measured GFR was calculated using a technetium-99m diethylene triamine pentaacetic acid (Tc-99m DTPA) scan. We analyzed donor characteristics and various parameters that included demography, anthropometry, blood pressure, and serum creatinine and measured GFR (m-GFR) using a Tc-99m DTPA scan, which was compared before and three months after donor nephrectomy. Results Of the 30 donors, 25 (83.3%) were females and five (16.7%) were males. The mean age of donors was 49.23 ± 12.29 years. The mean body mass index (BMI) was noted to be 24.73 ± 5.58 kg/m2, whereas the mean body surface area (BSA) was 1.59 ± 0.12 m2. In terms of the measured GFR by DTPA scan, pre-donation and post-donation, the average GFR for our population was 103.83 ± 10.07 mL/minute/1.73 m2 and 60.47±6.57 mL/minute/1.73 m2, respectively. The mean measured GFR of remnant kidney increased by 9.21 ± 4.39 mL/minute/1.73 m2 in 28 donors, while two donors had a fall in the mean measured GFR by 6.8 ± 1.69 mL/minute/1.73 m2. Conclusions To safeguard donor health, accurate measurement of GFR at various timelines after kidney donation should be considered as there are various limitations associated with the use of serum creatinine-based GFR estimating equations for solitary kidneys. However, long-term studies are required to analyze the changes in GFR after nephrectomy and determine the adequacy of compensatory changes in the remnant kidney post-kidney donation.
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Affiliation(s)
- Abhijit S Chavan
- Nephrology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Charan B Bale
- Nephrology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Pavan S Wakhare
- Nephrology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Nilesh Shinde
- Nephrology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Akshay R Kulkarni
- Nephrology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Atul D Sajgure
- Nephrology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Tushar A Dighe
- Nephrology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
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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 2023. [PMID: 37614196 DOI: 10.5507/bp.2023.034] [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] [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, Czech Republic
| | - Igor Hartmann
- Department of Urology, University Hospital Olomouc, Czech Republic
| | - Frantisek Hruska
- Department of Urology, University Hospital Olomouc, Czech Republic
| | | | - Jana Janeckova
- Department of Surgery II - Vascular and Transplantation Surgery, University Hospital Olomouc, Czech Republic
| | - Petr Utikal
- Department of Surgery II - Vascular and Transplantation Surgery, University Hospital Olomouc, Czech Republic
| | - Ales Vidlar
- Department of Urology, University Hospital Olomouc, Czech Republic
| | - Karel Krejci
- Department of Internal Medicine III - Nephrology, Rheumatology and Endocrinology, University Hospital Olomouc, Czech Republic
| | - Petr Bachleda
- Department of Surgery II - Vascular and Transplantation Surgery, University Hospital Olomouc, Czech Republic
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Prudhomme T, Roumiguie M, Timsit MO. Estimation of Donor Renal Function After Living Donor Nephrectomy: The Value of the Toulouse-Rangueil Predictive Model. Transpl Int 2023; 36:11393. [PMID: 37275463 PMCID: PMC10235441 DOI: 10.3389/ti.2023.11393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/11/2023] [Indexed: 06/07/2023]
Affiliation(s)
- Thomas Prudhomme
- Department of Urology and Kidney Transplantation, Toulouse-Rangueil University Hospital, Toulouse, France
- Center for Research in Transplantation and Translational Immunology, Nantes University, INSERM, UMR 1064, Nantes, France
| | - Mathieu Roumiguie
- Department of Urology and Kidney Transplantation, Toulouse-Rangueil University Hospital, Toulouse, France
| | - Marc Olivier Timsit
- Department of Urology and Transplant Surgery, AP-HP, Necker Hospital and European Hospital Georges Pompidou, Paris, France
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Park JH, Kim SY, Cho JS, Shin D, Ham SY, Kim H, Kwak YL. Association of Pre- and Post-Donation Renal Function with Midterm Estimated Glomerular Filtration Rate in Living Kidney Donors: A Retrospective Study. Yonsei Med J 2023; 64:221-227. [PMID: 36825349 PMCID: PMC9971441 DOI: 10.3349/ymj.2022.0541] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/25/2023] Open
Abstract
PURPOSE The estimated glomerular filtration rate (eGFR) at 6 months after donation (eGFR6m) is strongly associated with the risk of end-stage renal disease in living kidney donors. This study aimed to investigate the incidence of eGFR6m <60 mL/min/1.73 m² (eGFR6m <60) and identify the risk factors that can predict the occurrence of eGFR6m <60 in living kidney donors. MATERIALS AND METHODS Living kidney donors who underwent nephrectomy at Severance Hospital between January 2009 and December 2019 were identified. We excluded 94 of 1233 donors whose creatinine values at 6 months after donation were missing. The risk factors for eGFR6m <60 were assessed using multivariate regression analysis. The optimal cutoff points for candidate risk factors for predicting eGFR6m <60 occurrence were determined using the Youden index. RESULTS The eGFR6m <60 occurred in 17.3% of the participants. Older age (≥44 years), history of hypertension, lower preoperative eGFR (<101 mL/min/1.73 m²), and degree of increase in creatinine levels on postoperative day 2 compared to those before surgery (ΔCr2_pre) (≥0.39 mg/dL) increased the risk of eGFR6m <60. The addition of ΔCr2_pre to preoperative eGFR yielded a higher predictive accuracy for predicting eGFR6m <60 than that with preoperative eGFR alone {area under the receiver operating characteristic curve=0.886 [95% confidence interval (CI), 0.863-0.908] vs. 0.862 (95% CI, 0.838-0.887), p<0.001}. CONCLUSION The incidence of eGFR6m <60 was 17.3%. Older age, lower preoperative eGFR, history of hypertension, and greater ΔCr2_pre were associated with the occurrence of eGFR6m <60 after living donor nephrectomy. The combination of preoperative eGFR and ΔCr2_pre showed the highest predictive power for eGFR6m <60.
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Affiliation(s)
- Jin Ha Park
- Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - So Yeon Kim
- Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Sun Cho
- Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dongkwan Shin
- Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Yeon Ham
- Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyesu Kim
- Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Lan Kwak
- Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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Mohammed N, Zarzour MA, Abdelgawad AM, Ibrahim HM, Fornara P, Ahmed Gadelkareem R. Does the Inverted Kidney Transplantation Technique Promote the Feasibility and Safety of Right Living Donor Nephrectomy? Turk J Urol 2022; 48:303-308. [PMID: 35913447 PMCID: PMC9612694 DOI: 10.5152/tud.2022.22108] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this study is to compare the outcomes of right- and left-sided live donor nephrectomies using the inverted kidney transplantation technique for right live donor nephrectomy on transplantation. MATERIAL AND METHODS A retrospective review was done for the cases of live donor nephrectomy, either as open donor nephrectomy or laparoscopic donor nephrectomy between 2004 and 2019. Inverted kidney transplantation was used with right-sided grafts. The variables of the right- and left-sided live donor nephrectomies were compared. RESULTS There were 202 live donor nephrectomies including 71 (35.1%) open donor nephrectomies and 131 (64.9%) laparoscopic donor nephrectomies with 4 cases of conversion to open donor nephrectomy. There were 119 (58.9%) right-sided and 83 (41.1%) left-sided live donor nephrectomies with insignificantly different mean operative time (123 and 127 minutes; P=.09), mean warm ischemia time (82.3 and 84.5 seconds; P=.32), and mean blood loss (73 and 78 mL; P=.18), respectively. Inverted kidney transplantation was performed for 86% of grafts from right live donor nephrectomies. Discharge from hospital was on an average of 4.3 days postoperatively. There were only 3 complications (1 in right live donor nephrectomy and 2 in left live donor nephrectomies) with grade 2 according to Clavien-Dindo Classification. Incidence of delayed graft function (P=.09), transplant vein thrombosis (1 case in each group), 1-year graft survival rate (93.2% vs. 94.8%; P=.12), and 1-year serum creatinine levels (1.4 ± 0.3 vs. 1.3 ± 0.2; P=.09) revealed statistically insignificant differences. CONCLUSION Regardless of the surgical technique, the right live donor nephrectomy seems to be technically as safe as the left live donor nephrectomy for both the donors and the recipients. Using inverted kidney transplantation provided convenient extensions of graft's vessels to full length with no significant increased incidence of vascular thrombosis.
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Affiliation(s)
- Nasreldin Mohammed
- Clinic for Urology and Kidney Transplantation Center, University Medical School of Martin-Luther-University Halle/Wittenberg, Germany
- Assiut Kidney Transplantation Center, Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Mohammed Ali Zarzour
- Assiut Kidney Transplantation Center, Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Amr Mostafa Abdelgawad
- Assiut Kidney Transplantation Center, Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | | | - Paolo Fornara
- Clinic for Urology and Kidney Transplantation Center, University Medical School of Martin-Luther-University Halle/Wittenberg, Germany
| | - Rabea Ahmed Gadelkareem
- Assiut Kidney Transplantation Center, Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
- Corresponding author:Rabea Ahmed Gadelkareem E-mail:
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Hiffa A, Schulte K, Saeed M, Gani I. Massive Chylous Ascites After Living Donor Nephrectomy Successfully Treated With Lymphatic Embolization. J Investig Med High Impact Case Rep 2022; 10:23247096211065631. [PMID: 35038891 PMCID: PMC8771747 DOI: 10.1177/23247096211065631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Chylous ascites may result from a variety of pathological conditions, most of them from nontraumatic causes, such as congenital defects of the lymphatic system, infections, liver cirrhosis, and malignancy. Rarely, chylous ascites occurs as an iatrogenic complication after left-sided laparoscopic donor nephrectomy (LDN). Injury to the cisterna chyli and its main lymphatic tributaries around the para-aortic region intraoperatively can cause the lymphatic fluid to accumulate. There is currently no standardized treatment for chylous ascites as there have only been 54 cases documented to date. Most patients can be managed with conservative therapy. Recommended guidelines include high-protein and low-fat diet with medium-chain triglycerides. Paracentesis is often used as a diagnostic and therapeutic first-line measure with total parenteral nutrition (TPN), bowel rest, and somatostatin analogue as adjunct therapies. We present a case of massive chylous ascites refractory to conservative therapy. The patient had progressive abdominal distention and unintentional weight gain 2 weeks postoperatively warranting multiple paracenteses of >7 L of chylous fluid. Ultimately, the patient was successfully treated with lymphatic embolization using N-butyl cyanoacrylate glue.
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7
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Kiremit MC, Arpali E, Koseoglu E, Kocak B. Utilization of single-use flexible ureterorenoscope for ex-vivo stone extraction in living kidney donors. Cent European J Urol 2021; 74:269-270. [PMID: 34336249 PMCID: PMC8318025 DOI: 10.5173/ceju.2021.0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/09/2021] [Accepted: 04/08/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Murat Can Kiremit
- Koç University, School of Medicine, Department of Urology, Istanbul, Turkey.,Koc University Hospital, Department of Urology, Istanbul, Turkey
| | - Emre Arpali
- Koc University Hospital, Department of Urology, Istanbul, Turkey
| | - Ersin Koseoglu
- Koc University Hospital, Department of Urology, Istanbul, Turkey
| | - Burak Kocak
- Koç University, School of Medicine, Department of Urology, Istanbul, Turkey.,Koc University Hospital, Department of Urology, Istanbul, Turkey
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8
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Mang J, Hennig L, Liefeldt L, Duerr M, Lehner LJ, Bichmann A, Ralla B, Cash H, Kanne MC, Peters R, Maxeiner A, Friedersdorff F. Focal Segmental Glomerulosclerosis and Recurrence in Living Donor Recipients. Res Rep Urol 2021; 13:495-499. [PMID: 34285889 PMCID: PMC8286721 DOI: 10.2147/rru.s308994] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/12/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Focal segmental glomerulosclerosis (FSGS) is a common cause for end-stage renal disease that can recur in the graft after kidney transplantation. The incidence of FSGS recurrence is reported in up to 47% of patients, predisposing those to possible poorer transplantation outcomes. Hence, we examined the incidence of FSGS recurrence and the effect on graft outcome in our patient cohort of living donor kidney transplantations (LDKT). Patients and Methods We analyzed 194 adult patients who received a LDKT between 2011 and 2017 of which 22 (11%) had FSGS as underlying disease. Demographic data and clinical outcomes, especially regarding recurrence of FSGS, were evaluated. Results FSGS recurrence was identified in three (14%) patients within three months after transplantation, of whom two patients (9%) lost their graft. There was no significant difference in graft survival comparing FSGS to other reasons for end-stage renal disease. Conclusion Incidence of FSGS recurrence in the present patient cohort was within the range reported in the literature and comparatively low. Our data support LDKT as a treatment option in patients with end-stage renal disease due to FSGS.
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Affiliation(s)
- Josef Mang
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Linda Hennig
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Lutz Liefeldt
- Department of Nephrology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Michael Duerr
- Department of Nephrology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Lukas J Lehner
- Department of Nephrology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anna Bichmann
- Department of Anesthesiology and Operative Intensive Care Medicine, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Bernhard Ralla
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | | | - Robert Peters
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Maxeiner
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
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Serni S, Pecoraro A, Sessa F, Gemma L, Greco I, Barzaghi P, Grosso AA, Corti F, Mormile N, Spatafora P, Caroassai S, Berni A, Gacci M, Giancane S, Tuccio A, Sebastianelli A, Li Marzi V, Vignolini G, Campi R. Robot-Assisted Laparoscopic Living Donor Nephrectomy: The University of Florence Technique. Front Surg 2021; 7:588215. [PMID: 33521044 PMCID: PMC7844329 DOI: 10.3389/fsurg.2020.588215] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022] Open
Abstract
Objective: To provide a step-by-step overview of the University of Florence technique for robotic living donor nephrectomy (LDN), focusing on its technical nuances and perioperative outcomes. Methods: A dedicated robotic LDN program at our Institution was codified in 2012. Data from patients undergoing robotic LDN from 2012 to 2019 were prospectively collected. All robotic LDNs were performed by a highly experienced surgeon, using the da Vinci Si robotic platform in a three-arm configuration. In this report we provide a detailed overview of our surgical technique for robotic LDN. The main objective of the study was to evaluate the technical feasibility and safety of the technique, including perioperative surgical complications rate and mid-term functional outcomes. Results: Overall, 36 patients undergoing robotic LDNs were included in the study. Of these, 28 (78%) were left LDNs. Median (IQR) donor pre-operative eGFR was 88 (75.6–90) ml/min/1.73 m2. In all cases, robotic LDN was completed without need of conversion. The median (IQR) overall operative time was 230 (195–258) min, while the median console time was 133 (IQR 117-166) min. The median (IQR) warm ischemia time was 175 (140–255) s. No intraoperative adverse events or 90-d major surgical complications were recorded. At a median (IQR) follow-up of 24 months (IQR 11-46), median (IQR) eGFR patients undergoing in living donor nephrectomy was 57.4 (47.9; 63.9) ml/min/1.73 m2. Conclusions: In our experience, robotic LDN is technically feasible and safe. The use of robotic surgery for LDN may provide distinct advantages for surgeons while ensuring optimal donors' perioperative and functional outcomes.
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Affiliation(s)
- 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
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Sessa
- 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
| | - Luca Gemma
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Isabella Greco
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Paolo Barzaghi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Antonio Andrea Grosso
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Corti
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Nicola Mormile
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Pietro Spatafora
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Simone Caroassai
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Alessandro Berni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Saverio Giancane
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Agostino Tuccio
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Arcangelo Sebastianelli
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Vincenzo Li Marzi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Graziano Vignolini
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - 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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10
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Prionas A, Craddock C, Papalois V. Feasibility, Safety and Efficacy of Enhanced Recovery After Living Donor Nephrectomy: Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2020; 10:E21. [PMID: 33374793 DOI: 10.3390/jcm10010021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 12/25/2022] Open
Abstract
This meta-analysis aims to compare enhanced recovery after surgery (ERAS) vs. standard perioperative practice in the management of living kidney donors. Primary endpoints included mortality, complications, length of stay (LOS) and quality of life after living donor nephrectomy. Medline, Embase, Scopus, Cochrane and Web of Science databases were searched. In total, 3029 records were identified. We then screened 114 full texts. Finally, 11 studies were included in the systematic review corresponding to 813 living donors. Of these, four randomized controlled trials were included in the meta-analysis. ERAS resulted in shorter LOS (95CI: −1.144, −0.078, I2 = 87.622%) and lower incidence of post-operative complications (95CI: 0.158, 0.582, I2 = 0%). This referred to Clavien–Dindo I-II complications (95CI: 0.158, 0.582, I2 = 0%). There was no difference in Clavien–Dindo III-V complications (95CI: 0.061,16.173, I2 = 0%). ERAS donors consumed decreased amounts of narcotics during their hospital stay (95CI: −27.694, −8.605, I2 = 0%). They had less bodily pain (95CI: 6.735, 17.07, I2 = 0%) and improved emotional status (95CI: 6.593,13.319, I2 = 75.682%) one month postoperatively. ERAS protocols incorporating multimodal pain control interventions resulted in a mean reduction of 1 day in donors’ LOS (95CI: −1.374, −0.763, I2 = 0%). Our results suggest that ERAS protocols result in reduced perioperative morbidity, shorter length of hospital stay and improved quality of life after living donor nephrectomy.
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Wang L, Zhu L, Xie X, Wang H, Yin H, Fang C, Dai H. Long-term outcomes of laparoscopic versus open donor nephrectomy for kidney transplantation: a meta-analysis. Am J Transl Res 2020; 12:5993-6002. [PMID: 33194009 PMCID: PMC7653626] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/03/2020] [Indexed: 06/11/2023]
Abstract
Laparoscopic surgery is widely used for living donor nephrectomy and has demonstrated superiority over open surgery by improving several outcomes, such as length of hospital stay and morphine requirements. The purpose of the present study was to compare the long-term outcomes of open donor nephrectomy (ODN) versus laparoscopic donor nephrectomy (LDN) using meta-analytical techniques. The Web of Science, PubMed and Cochrane Library databases were searched, for relevant articles published between 1980 and January 20, 2020. Lists of reference articles retrieved in primary searches were manually screened for potentially eligible studies. Outcome parameters were explored using Review Manager version 5.3. The evaluated outcomes included donor serum creatinine levels, incidence of hypertension or proteinuria at 1 year postoperative, donor health-related quality of life, donation attitude, and graft survival. Thirteen of the 111 articles fulfilled the inclusion criteria. The LDN group demonstrated similar 1 year outcomes compared with ODN with respect to serum creatinine levels (weighted mean difference [WMD] -0.02 mg/dL [95% confidence interval (CI) -0.18-0.13]; P=0.77); hypertension (odds ratio [OR] 1.21 [95% CI 0.48-3.08]; P=0.68); proteinuria (OR 0.28 [95% CI 0.02-3.11]; P=0.30); and donation attitude (OR 4.26 [95% CI 0.06-298.27]; P=0.50). Donor health-related quality of life and recipient graft survival were also not significantly different between the groups analyzed. Thus, the long-term outcomes between LDN and ODN for living donor kidney transplantation are similar.
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Affiliation(s)
- Lingping Wang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South UniversityChangsha, China
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South UniversityChangsha, China
- Clinical Research Center for Organ Transplantation in Hunan ProvinceChangsha, China
- Clinical Immunology Center, Central South UniversityChangsha, China
| | - Li Zhu
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South UniversityChangsha, China
| | - Xubiao Xie
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South UniversityChangsha, China
- Clinical Research Center for Organ Transplantation in Hunan ProvinceChangsha, China
- Clinical Immunology Center, Central South UniversityChangsha, China
| | - Haifeng Wang
- Department of Urology, Longyan First Hospital Affiliated with Fujian Medical UniversityLongyan, China
| | - Hui Yin
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South UniversityChangsha, China
- Clinical Research Center for Organ Transplantation in Hunan ProvinceChangsha, China
| | - Chunhua Fang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South UniversityChangsha, China
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South UniversityChangsha, China
- Clinical Research Center for Organ Transplantation in Hunan ProvinceChangsha, China
- Clinical Immunology Center, Central South UniversityChangsha, China
| | - Helong Dai
- Department of Kidney Transplantation, The Second Xiangya Hospital of Central South UniversityChangsha, China
- Clinical Research Center for Organ Transplantation in Hunan ProvinceChangsha, China
- Clinical Immunology Center, Central South UniversityChangsha, China
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12
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Plage H, Pielka P, Liefeldt L, Budde K, Ebbing J, Sugünes N, Miller K, Cash H, Bichmann A, Sattler A, Kotsch K, Friedersdorff F. Extended Criteria Donors in Living Kidney Transplantation Including Donor Age, Smoking, Hypertension and BMI. Ther Clin Risk Manag 2020; 16:787-793. [PMID: 32922016 PMCID: PMC7455534 DOI: 10.2147/tcrm.s256962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/14/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose An expansion of selection criteria for deceased organ transplantation already exists to manage the current donor shortage. Comparable evaluation of risk factors for living donors should be investigated to improve this issue. Patients and Methods Our retrospective single-centre study analysed 158 patients with living kidney transplants performed between February 2006 and June 2012. We investigated the influence of donor risk factors (RF) including body mass index over 30 kg/m2, age >60 years, active nicotine abuse and arterial hypertension on postoperative kidney function with focus on the recipients. This was measured for long-term survival and glomerular filtration rate (GFR) in a 5-year follow-up. Results Overall, out of 158 living donors, 84 donors were identified to have no risk factors, whereas 74 donors had at least one risk factor. We noted a significant higher delayed graft function (p=0.042) in the first 7 days after transplantation, as well as lower GFR of recipients of allografts with risk factors in the first-year after transplantation. In our long-term results, there was no significant difference in the functional outcome (graft function, recipient and graft survival) between recipients receiving kidneys from donors with no and at least one risk factors. In the adjusted analysis of subgroups of different risk factors, recipients of donors with “age over 60 years” at time of transplantation had a decreased transplant survival (p=0.014). Conclusion Thus, a careful expansion for selection criteria for living donors with critical evaluation could be possible, but especially the age of the donors could be a limited risk factor.
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Affiliation(s)
- Henning Plage
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Poline Pielka
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Lutz Liefeldt
- Department of Nephrology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Klemens Budde
- Department of Nephrology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Jan Ebbing
- Department of Urology, University Hospital Basel, Urological University Clinic Basel-Liestal, Basel, Switzerland
| | - Nesrin Sugünes
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Kurt Miller
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Hannes Cash
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Anna Bichmann
- Department of Anaesthesia and Operative Intensive Care Medicine, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Arne Sattler
- Department of General, Visceral- and Vascular Surgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katja Kotsch
- Department of General, Visceral- and Vascular Surgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
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13
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Bellini MI, Wilson RS, Veitch P, Brown T, Courtney A, Maxwell AP, D'Andrea V, McDaid J. Hyperamylasemia Post Living Donor Nephrectomy Does Not Relate to Pain. Cureus 2020; 12:e8217. [PMID: 32582478 PMCID: PMC7306643 DOI: 10.7759/cureus.8217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction The aetiology of pain after laparoscopic donor nephrectomy remains unclear. Given the proximity of the left kidney to the tail of the pancreas, we aimed to assess whether mobilisation and retrieval of the left kidney might inflame the pancreas, leading to pain and hyperamylasaemia in the post-operative period. Patient and methods In the present study, 16 consecutive live kidney donors were analysed in the same three months period. Amylase levels were measured on days 1 and 2. For each 24-hour period post-operatively analgesia consumption was recorded, as well as pain scores at rest on a visual analogue scale (VAS). Results Three out of 16 donors presented hyperamylasemia. A multiple regression analysis found levobupivacaine dose, propofol dose, transversus abdominis plane block and day 1 amylase did not significantly predict pain scores. Interestingly, body mass index significantly correlated with increased pain scores (p = 0.041). Also, increasing CO2 insufflation pressure and use of local anaesthetic infusion catheters predicted a decreased deep pain score (p = 0.036 and p = 0.037). Conclusion There was no correlation of amylase levels and pain scores. Pancreatitis is a rare complication of nephrectomy and no overt cases were seen in the case of donor nephrectomy.
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Affiliation(s)
| | - Rebekah S Wilson
- Regional Transplant Unit, Belfast Health and Social Care Trust, Belfast, GBR
| | - Peter Veitch
- Regional Transplant Unit, Belfast Health and Social Care Trust, Belfast, GBR
| | - Tim Brown
- Regional Transplant Unit, Belfast Health and Social Care Trust, Belfast, GBR
| | - Aisling Courtney
- Regional Transplant Unit, Belfast Health and Social Care Trust, Belfast, GBR
| | | | | | - James McDaid
- Regional Transplant Unit, Belfast Health and Social Care Trust, Belfast, GBR
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14
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Sokolov AA, Martov AG. [Laparoscopic living donor nephrectomy for kidney transplantation]. Urologiia 2016:92-95. [PMID: 28247669] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Globally, the number of patients with end-stage renal disease (ESRD) has been steadily increasing every year. These patients need renal replacement therapy which includes peritoneal dialysis, programmed hemodialysis and kidney transplantation, which is the ultimate form of replacement. Living donor kidney transplantation has significant advantages over cadaveric kidney transplantation regarding the long-term functional results of renal transplant and the survival of recipients. Open nephrectomy, previously used to retrieve a healthy kidney from a donor is associated with traumatic access and a long recovery period of the donor. With the development of minimally invasive technologies, laparoscopic living donor nephrectomy has been developed, which currently is the best method for retrieving transplant kidney. The review outlines the characteristics and outcomes of laparoscopic living donor nephrectomy for kidney transplantation.
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Affiliation(s)
| | - A G Martov
- Department of Endoscopic Urology, RMAPE
- Department of Andrology and Urology, A.I. Burnazyan SSC Federal Medical Biophysical Center of FMBA of Russia
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Blankholm AD, Pedersen BG, Østrat EØ, Andersen G, Stausbøl-Grøn B, Laustsen S, Ringgaard S. Noncontrast-Enhanced Magnetic Resonance Versus Computed Tomography Angiography in Preoperative Evaluation of Potential Living Renal Donors. Acad Radiol 2015; 22:1368-75. [PMID: 26307028 DOI: 10.1016/j.acra.2015.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 06/19/2015] [Accepted: 06/24/2015] [Indexed: 12/26/2022]
Abstract
RATIONALE AND OBJECTIVES Living renal donors undergo an extensive examination program. These examinations should be as safe, gentle, and patient friendly as possible. To compare computed tomography angiography (CTA) and an extensive magnetic resonance imaging (MRI) protocol without contrast agents to observations from nephrectomy in living renal donors and to evaluate whether noncontrast-enhanced MRI can replace CTA for vessel assessment in living renal donors. MATERIAL AND METHODS CTA and MRI results were compared to observations from nephrectomy, which served as the reference standard. Fifty-one potential kidney donors underwent imaging, and 31 donated a kidney. Comparisons in sensitivity, specificity, and accuracy were made with respect to the number of arteries, early branching, and the number of veins. Agreement was assessed using Cohen's kappa. The exact McNemar's test was used to test for statistically significant differences. RESULTS In the assessment of more than one renal artery, the sensitivity and specificity of MRI and CTA were high and in perfect agreement compared to observations from surgery. The results for both MRI and CTA were as follows: (sensitivity 100%/specificity100%/accuracy 100%/Kappa = 1/P = 1). When comparing the ability to test for early branching we found, MRI: (sensitivity 33%/specificity 100%/accuracy 87%/Kappa = 0.45/P = 1) and CTA: (sensitivity 50%/specificity 100%/accuracy 90%/Kappa = 0.62/P = 1). When used to depict supernumerary veins, we found MRI: (sensitivity60%/specifivity100%/accuracy 93%/Kappa = 0.72/P = 1), whereas CTA showed: (sensitivity 40%/specificity 96%/accuracy 87% Kappa = 0.43/P = 1). CONCLUSIONS In conclusion, an optimized MRI protocol that includes noncontrast-enhanced magnetic resonance angiography can be substituted for CTA for preoperative assessment of the renal vessels before living donor nephrectomy.
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Alessimi A, Adam E, Haber GP, Badet L, Codas R, Fehri HF, Martin X, Crouzet S. LESS living donor nephrectomy: Surgical technique and results. Urol Ann 2015; 7:361-5. [PMID: 26229326 PMCID: PMC4518375 DOI: 10.4103/0974-7796.160321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 10/26/2014] [Indexed: 11/25/2022] Open
Abstract
Purpose: We present the findings of 50 patients undergoing pure trans-umbilical laparo-endoscopic single-site surgery (LESS) living donor nephrectomy (LDN), between February 2010 and May 2014. Materials and Methods: Laparo-endoscopic single-site surgery LDN was performed through an umbilical incision. Different trocars were used, namely Gelpoint (Applied Mιdical, Rancho Santa Margarita, CA) SILS port (Covidien, Hamilton, Bermuda), R-port (Olympus Surgical, Orangeburg, NY) and standard trocars, inserted through the same skin incision but using separate fascial punctures. The standard laparoscopic technique was employed. The kidney was pre-entrapped in a retrieval bag and extracted trans-umbilically. Data were collected prospectively including questionnaires containing patient reported oral pain medication duration and time to recovery. Results: LESS LDN was successful in all patients. Mean warm ischemia time was 6.2 min (3–15), mean procedure time was 233.2 min (172–300), and hospitalization stay was 3.94 days (3–7) with a visual analogue pain score at discharge of 1.32 (0–3). No intraoperative complications occurred. The mean time of oral pain medication was 8.72 days (1–20) and final scar length was 4.06 cm (3–5). Each allograft was functional. Conclusion: Although challenging, trans-umbilical LESS LDN seems to be feasible and safe. Hence, LESS has the potential to improve cosmetic results and decrease morbidity.
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Affiliation(s)
- Abdullah Alessimi
- Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France
| | - Emilie Adam
- Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France
| | - Georges-Pascal Haber
- Center for Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lionel Badet
- Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France
| | - Ricardo Codas
- Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France
| | - Hakim Fassi Fehri
- Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France
| | - Xavier Martin
- Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France
| | - Sébastien Crouzet
- Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France
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