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Saifee Y, Bhatia S, Chamania CS, Salgia P, Kriplani J, Sepaha A. Introduction of Laparoscopic Donor Nephrectomy: Challenges, Outcomes and Success Strategies. Int J Organ Transplant Med 2021; 12:23-31. [PMID: 34987730 PMCID: PMC8717876] [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] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Laparoscopic live donor nephrectomy (LLDN) has become the standard of care and is popular among most of the transplant centers across the globe. Despite proven advantages of LLDN, some transplantation centers hesitate to start the program because of issues concerning donor safety and allograft function. OBJECTIVE To discusses the main barriers for creating a successful LLDN program, strategies that allowed us to start a successful LLDN program along with the study results. METHODS The donors undergoing LLDN from December 2016 to February 2018 were enrolled in the study and prospectively evaluated. LLDN were performed by two senior surgeons alternately with assistance by the laparoscopic urologist in all cases. Also, in the present study, two technical alterations were done in the standard surgical technique of transperitoneal LDN. The first important modification made was the use of two additional ports for use by laparoscopic urologists. The second modification involved dissection on both poles of the kidney before hilar dissection. RESULTS A total of 112 transperitoneal LLDN were performed during the study period. The mean (range) of operation time was 117.5 (81-158) min; the ischemia time was 194 (171-553) sec. Only one patient needed conversion to open surgery. No other major peri-operative or posto-perative complications occurred. All kidney grafts were functioning well. CONCLUSION With proper planning, team approach, and few technical modifications, introduction of LLDN is safe and effective.
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Affiliation(s)
- Y. Saifee
- Correspondence: Dr. Yusuf Saifee, Consultant Urologist, Department of Urology, Choithram Hospital and Research Centre, Manik Bagh Road, Indore, Madhya Pradesh, India-452014.Tel: +91-756-786-6653,E-mail:
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Pal BC, Modi PR, Modi JD, Nagarajan R, Kumar S, Patel K, Saifee Y, Sarmah A, Trivedi HL. Buccal Mucosal Graft Urethroplasty in Patients Awaiting Renal Transplantation. Transplant Proc 2016; 48:21-5. [PMID: 26915837 DOI: 10.1016/j.transproceed.2015.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/13/2015] [Accepted: 12/07/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the perioperative morbidity and early outcome of buccal mucosal graft (BMG) urethroplasty in patients with urethral stricture awaiting renal transplantation. METHODS Thirteen patients awaiting renal transplantation underwent BMG urethroplasty for long anterior urethral stricture between June 2011 and March 2013. The management issues, complications, and outcome of the BMG urethroplasty in this cohort of patients were studied. RESULTS Mean age of the patient was 38.7 ± 12.7 years. History of urethral manipulation was present in 8 patients. Mean stricture length was 6.92 ± 2.90 cm. Mean serum creatinine of the patient was 8.1 ± 3.6 mg%. Three patients required oral exploration for bleeding. Two patients had urinary extravasation, 3 patients had infected hematoma, and 1 patient developed dry gangrene of the glans. One patient had sepsis due to pyonephrosis in the postoperative period and succumbed to it. Mean follow-up of the patients was 34.54 ± 6.46 months. Three patients underwent VIU for recurrence of the stricture in the follow-up. At 3-month follow-up mean Qmax was 23.8 mL/sec, whereas at 6-month and 1-year follow-up, Qmax was 23.6 and 23.4 mL/sec, respectively. CONCLUSION This study shows a relatively higher complication rate of urethroplasty in prerenal transplant patients. Although the number of cases is too small to arrive at any definite conclusion, this study does gives an insight into the management issues, complications, and success of urethroplasty in this group of patients.
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Affiliation(s)
- B C Pal
- Department of Urology and Transplantation Surgery, Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, Gujarat, India.
| | - P R Modi
- Department of Urology and Transplantation Surgery, Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - J D Modi
- Department of Urology and Transplantation Surgery, Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - R Nagarajan
- Department of Urology and Transplantation Surgery, Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - S Kumar
- Department of Urology and Transplantation Surgery, Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - K Patel
- Department of Urology and Transplantation Surgery, Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Y Saifee
- Department of Urology and Transplantation Surgery, Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - A Sarmah
- Department of Urology and Transplantation Surgery, Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - H L Trivedi
- Department of Nephrology and Transplantation Medicine, Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
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Modi P, Pal B, Kumar S, Modi J, Saifee Y, Nagraj R, Qadri J, Sharmah A, Agrawal R, Modi M, Shah V, Kute V, Trivedi H. Laparoscopic Transplantation Following Transvaginal Insertion of the Kidney: Description of Technique and Outcome. Am J Transplant 2015; 15:1915-22. [PMID: 25809421 DOI: 10.1111/ajt.13224] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 07/10/2014] [Revised: 01/15/2015] [Accepted: 01/16/2015] [Indexed: 01/25/2023]
Abstract
Laparoscopic kidney transplantation (LKT) is well accepted modality of treatment for ESRD patients at our center. Usually, the kidney is inserted through small Pfannenstiel incision. With the permission of the Internal Review Board, we carried out LKT in eight female recipients following insertion of the kidney through the vagina. The kidney was procured by the retroperitoneoscopic approach. Antibiotic prophylaxis was given. All cases were carried out successfully with immediate graft function and 100% graft and patient survival at 1 year of follow-up. Estimated glomerular filtration rate at 1 month and 1 year was similar to eight randomly selected female recipients who underwent open kidney transplantation (OKT). No analgesia was required in seven out of eight patients after the 3rd postoperative day. In summary, vaginal insertion of kidney and LKT is safe and feasible in a selected group of patients. It is associated with better analgesia and has similar allograft function as compare to OKT.
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Affiliation(s)
- P Modi
- Department of Urology and Transplantation Surgery, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - B Pal
- Department of Urology and Transplantation Surgery, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - S Kumar
- Department of Urology and Transplantation Surgery, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - J Modi
- Department of Urology and Transplantation Surgery, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Y Saifee
- Department of Urology and Transplantation Surgery, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - R Nagraj
- Department of Urology and Transplantation Surgery, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - J Qadri
- Department of Urology and Transplantation Surgery, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - A Sharmah
- Department of Urology and Transplantation Surgery, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - R Agrawal
- Department of Obstetrics and Gynecology, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - M Modi
- Department of Anesthesiology, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - V Shah
- Department of Anesthesiology, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - V Kute
- Department of Nephrology, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - H Trivedi
- Department of Nephrology, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
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