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van de Geijn EF, Janki S, de Vries DK, Nijboer WN, Alwayn IPJ, Nieuwenhuizen J, Baranski AG, Schaapherder AFM, de Vries APJ, Huurman VAL, Lam HD. Effective and safe implementation of robot-assisted donor nephrectomy by experienced laparoscopic surgeons. World J Surg 2024; 48:1958-1966. [PMID: 38877383 DOI: 10.1002/wjs.12249] [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: 03/05/2024] [Accepted: 05/28/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND In June 2021, the first robot-assisted donor nephrectomy (RADN) was performed at the Leiden University Medical Center (LUMC), the Netherlands. The goal of this study was to investigate whether this procedure has been implemented safely and efficiently. METHODS RADN was retrospectively compared to laparoscopic donor nephrectomy (LDN) performed during the same time period (June 2021 until November 2022). Patients were assigned to RADN depending on the availability of the da Vinci robot and surgical team. The studied endpoints were postoperative complications, operative time, estimated blood loss, warm ischemic time (WIT), and postoperative pain experience. For analysis, the Student's t-test and Chi-squared test were used for, respectively, continuous and categorical data. RESULTS Forty RADN were compared to 63 LDN. Total insufflation time was significantly longer in RADN compared to LDN (188 min (169-214) versus 172 min (144-194); p = 0.02). Additionally, WIT was also found to be significantly higher in the robot-assisted group (04:54 min vs. 04:07 min; p < 0.01). No statistical differences were found in postoperative outcomes (eGFR of the recipient at 3-month follow-up, RADN 54.08 mL/min ±18.79 vs. LDN 56.41 mL/min ±16.82; p = 0.52), pain experience, and complication rate. CONCLUSION RADN was safely and efficiently implemented at the LUMC. It's results were not inferior to laparoscopic donor nephrectomy. Operative time and warm ischemic times were longer in RADN. This may relate to a learning curve effect. No clinically relevant effect on postoperative outcomes was observed.
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Affiliation(s)
- Emma F van de Geijn
- Department of Surgery, Transplant Center, Leiden University Medical Center (LUMC), Leiden, Zuid Holland, Netherlands
| | - Shiromani Janki
- Department of Surgery, Transplant Center, Leiden University Medical Center (LUMC), Leiden, Zuid Holland, Netherlands
| | - Dorottya K de Vries
- Department of Surgery, Transplant Center, Leiden University Medical Center (LUMC), Leiden, Zuid Holland, Netherlands
| | - Willemijn N Nijboer
- Department of Surgery, Transplant Center, Leiden University Medical Center (LUMC), Leiden, Zuid Holland, Netherlands
| | - Ian P J Alwayn
- Department of Surgery, Transplant Center, Leiden University Medical Center (LUMC), Leiden, Zuid Holland, Netherlands
| | - Jeroen Nieuwenhuizen
- Department of Surgery, Transplant Center, Leiden University Medical Center (LUMC), Leiden, Zuid Holland, Netherlands
| | - Andrzej G Baranski
- Department of Surgery, Transplant Center, Leiden University Medical Center (LUMC), Leiden, Zuid Holland, Netherlands
| | - Alexander F M Schaapherder
- Department of Surgery, Transplant Center, Leiden University Medical Center (LUMC), Leiden, Zuid Holland, Netherlands
| | - Aiko P J de Vries
- Department of Internal Medicine, Transplant Center, Leiden University Medical Center (LUMC), Leiden, Zuid Holland, Netherlands
| | - Volkert A L Huurman
- Department of Surgery, Transplant Center, Leiden University Medical Center (LUMC), Leiden, Zuid Holland, Netherlands
| | - Hwai-Ding Lam
- Department of Surgery, Transplant Center, Leiden University Medical Center (LUMC), Leiden, Zuid Holland, Netherlands
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Kourounis G, Tingle SJ, Hoather TJ, Thompson ER, Rogers A, Page T, Sanni A, Rix DA, Soomro NA, Wilson C. Robotic versus laparoscopic versus open nephrectomy for live kidney donors. Cochrane Database Syst Rev 2024; 5:CD006124. [PMID: 38721875 PMCID: PMC11079970 DOI: 10.1002/14651858.cd006124.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND Waiting lists for kidney transplantation continue to grow. Live kidney donation significantly reduces waiting times and improves long-term outcomes for recipients. Major disincentives to potential kidney donors are the pain and morbidity associated with surgery. This is an update of a review published in 2011. OBJECTIVES To assess the benefits and harms of open donor nephrectomy (ODN), laparoscopic donor nephrectomy (LDN), hand-assisted LDN (HALDN) and robotic donor nephrectomy (RDN) as appropriate surgical techniques for live kidney donors. SEARCH METHODS We contacted the Information Specialist and searched the Cochrane Kidney and Transplant Register of Studies up to 31 March 2024 using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal, and ClinicalTrials.gov. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing LDN with ODN, HALDN, or RDN were included. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts for eligibility, assessed study quality, and extracted data. We contacted study authors for additional information where necessary. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes and mean difference (MD) or standardised mean difference (SMD) and 95% CI for continuous outcomes. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS Thirteen studies randomising 1280 live kidney donors to ODN, LDN, HALDN, or RDN were included. All studies were assessed as having a low or unclear risk of bias for selection bias. Five studies had a high risk of bias for blinding. Seven studies randomised 815 live kidney donors to LDN or ODN. LDN was associated with reduced analgesia use (high certainty evidence) and shorter hospital stay, a longer procedure and longer warm ischaemia time (moderate certainty evidence). There were no overall differences in blood loss, perioperative complications, or need for operations (low or very low certainty evidence). Three studies randomised 270 live kidney donors to LDN or HALDN. There were no differences between HALDN and LDN for analgesia requirement, hospital stay (high certainty evidence), duration of procedure (moderate certainty evidence), blood loss, perioperative complications, or reoperations (low certainty evidence). The evidence for warm ischaemia time was very uncertain due to high heterogeneity. One study randomised 50 live kidney donors to retroperitoneal ODN or HALDN and reported less pain and analgesia requirements with ODN. It found decreased blood loss and duration of the procedure with HALDN. No differences were found in perioperative complications, reoperations, hospital stay, or primary warm ischaemia time. One study randomised 45 live kidney donors to LDN or RDN and reported a longer warm ischaemia time with RDN but no differences in analgesia requirement, duration of procedure, blood loss, perioperative complications, reoperations, or hospital stay. One study randomised 100 live kidney donors to two variations of LDN and reported no differences in hospital stay, duration of procedure, conversion rates, primary warm ischaemia times, or complications (not meta-analysed). The conversion rates to ODN were 6/587 (1.02%) in LDN, 1/160 (0.63%) in HALDN, and 0/15 in RDN. Graft outcomes were rarely or selectively reported across the studies. There were no differences between LDN and ODN for early graft loss, delayed graft function, acute rejection, ureteric complications, kidney function or one-year graft loss. In a meta-regression analysis between LDN and ODN, moderate certainty evidence on procedure duration changed significantly in favour of LDN over time (yearly reduction = 7.12 min, 95% CI 2.56 to 11.67; P = 0.0022). Differences in very low certainty evidence on perioperative complications also changed significantly in favour of LDN over time (yearly change in LnRR = 0.107, 95% CI 0.022 to 0.192; P = 0.014). Various different combinations of techniques were used in each study, resulting in heterogeneity among the results. AUTHORS' CONCLUSIONS LDN is associated with less pain compared to ODN and has comparable pain to HALDN and RDN. HALDN is comparable to LDN in all outcomes except warm ischaemia time, which may be associated with a reduction. One study reported kidneys obtained during RDN had greater warm ischaemia times. Complications and occurrences of perioperative events needing further intervention were equivalent between all methods.
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Affiliation(s)
- Georgios Kourounis
- NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, UK
- Institute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, UK
| | - Samuel J Tingle
- NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, UK
- Institute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, UK
| | - Thomas J Hoather
- Department of Education, Newcastle University, Newcastle Upon Tyne, UK
| | - Emily R Thompson
- Institute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, UK
| | - Alistair Rogers
- Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Tobias Page
- Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Aliu Sanni
- Department of Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - David A Rix
- Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Naeem A Soomro
- Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Colin Wilson
- NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, UK
- Institute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, UK
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Bijkerk V, Jacobs LM, Albers KI, Gurusamy KS, van Laarhoven CJ, Keijzer C, Warlé MC. Deep neuromuscular blockade in adults undergoing an abdominal laparoscopic procedure. Cochrane Database Syst Rev 2024; 1:CD013197. [PMID: 38288876 PMCID: PMC10825891 DOI: 10.1002/14651858.cd013197.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND Laparoscopic surgery is the preferred option for many procedures. To properly perform laparoscopic surgery, it is essential that sudden movements and abdominal contractions in patients are prevented, as it limits the surgeon's view. There has been a growing interest in the potential beneficial effect of deep neuromuscular blockade (NMB) in laparoscopic surgery. Deep NMB improves the surgical field by preventing abdominal contractions, and it is thought to decrease postoperative pain. However, it is uncertain if deep NMB improves intraoperative safety and thereby improves clinical outcomes. OBJECTIVES To evaluate the benefits and harms of deep neuromuscular blockade versus no, shallow, or moderate neuromuscular blockade during laparoscopic intra- or transperitoneal procedures in adults. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 31 July 2023. SELECTION CRITERIA We included randomised clinical trials (irrespective of language, blinding, or publication status) in adults undergoing laparoscopic intra- or transperitoneal procedures comparing deep NMB to moderate, shallow, or no NMB. We excluded trials that did not report any of the primary or secondary outcomes of our review. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. all-cause mortality, 2. health-related quality of life, and 3. proportion of participants with serious adverse events. Our secondary outcomes were 4. proportion of participants with non-serious adverse events, 5. readmissions within three months, 6. short-term pain scores, 7. measurements of postoperative recovery, and 8. operating time. We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS We included 42 randomised clinical trials with 3898 participants. Most trials included participants undergoing intraperitoneal oncological resection surgery. We present the Peto fixed-effect model for most dichotomous outcomes as only sparse events were reported. Comparison 1: deep versus moderate NMB Thirty-eight trials compared deep versus moderate NMB. Deep NMB may have no effect on mortality, but the evidence is very uncertain (Peto odds ratio (OR) 7.22, 95% confidence interval (CI) 0.45 to 115.43; 12 trials, 1390 participants; very low-certainty evidence). Deep NMB likely results in little to no difference in health-related quality of life up to four days postoperative (mean difference (MD) 4.53 favouring deep NMB on the Quality of Recovery-40 score, 95% CI 0.96 to 8.09; 5 trials, 440 participants; moderate-certainty evidence; mean difference lower than the mean clinically important difference of 10 points). The evidence is very uncertain about the effect of deep NMB on intraoperatively serious adverse events (deep NMB 38/1150 versus moderate NMB 38/1076; Peto OR 0.95, 95% CI 0.59 to 1.52; 21 trials, 2231 participants; very low-certainty evidence), short-term serious adverse events (up to 60 days) (deep NMB 37/912 versus moderate NMB 42/852; Peto OR 0.90, 95% CI 0.56 to 1.42; 16 trials, 1764 participants; very low-certainty evidence), and short-term non-serious adverse events (Peto OR 0.94, 95% CI 0.65 to 1.35; 11 trials, 1232 participants; very low-certainty evidence). Deep NMB likely does not alter the duration of surgery (MD -0.51 minutes, 95% CI -3.35 to 2.32; 34 trials, 3143 participants; moderate-certainty evidence). The evidence is uncertain if deep NMB alters the length of hospital stay (MD -0.22 days, 95% CI -0.49 to 0.06; 19 trials, 2084 participants; low-certainty evidence) or pain scores one hour after surgery (MD -0.31 points on the numeric rating scale, 95% CI -0.59 to -0.03; 22 trials, 1823 participants; very low-certainty evidence; mean clinically important difference 1 point) and 24 hours after surgery (MD -0.60 points on the numeric rating scale, 95% CI -1.05 to -0.15; 16 trials, 1404 participants; very low-certainty evidence; mean clinically important difference 1 point). Comparison 2: deep versus shallow NMB Three trials compared deep versus shallow NMB. The trials did not report on mortality and health-related quality of life. The evidence is very uncertain about the effect of deep NMB compared to shallow NMB on the proportion of serious adverse events (RR 1.66, 95% CI 0.50 to 5.57; 2 trials, 158 participants; very low-certainty evidence). Comparison 3: deep versus no NMB One trial compared deep versus no NMB. There was no mortality in this trial, and health-related quality of life was not reported. The proportion of serious adverse events was 0/25 in the deep NMB group and 1/25 in the no NMB group. AUTHORS' CONCLUSIONS There was insufficient evidence to draw conclusions about the effects of deep NMB compared to moderate NMB on all-cause mortality and serious adverse events. Deep NMB likely results in little to no difference in health-related quality of life and duration of surgery compared to moderate NMB, and it may have no effect on the length of hospital stay. Due to the very low-certainty evidence, we do not know what the effect is of deep NMB on non-serious adverse events, pain scores, or readmission rates. Randomised clinical trials with adequate reporting of all adverse events would reduce the current uncertainties. Due to the low number of identified trials and the very low certainty of evidence, we do not know what the effect of deep NMB on serious adverse events is compared to shallow NMB and no NMB. We found no trials evaluating mortality and health-related quality of life.
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Affiliation(s)
- Veerle Bijkerk
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Anesthesiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Lotte Mc Jacobs
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Kim I Albers
- Department of Anesthesiology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | | | - Christiaan Keijzer
- Department of Anesthesiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Michiel C Warlé
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
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Weightman AC, Coghlan S, Clayton PA. Respecting living kidney donor autonomy: an argument for liberalising living kidney donor acceptance criteria. Monash Bioeth Rev 2023; 41:156-173. [PMID: 36484936 PMCID: PMC10654180 DOI: 10.1007/s40592-022-00166-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 06/17/2023]
Abstract
Doctors routinely refuse donation offers from prospective living kidney donors with certain comorbidities such as diabetes or obesity out of concern for donor wellbeing. This refusal occurs despite the ongoing shortage of kidney transplants and the superior performance of living donor kidney transplants compared to those from deceased donors. In this paper, we argue that this paternalistic refusal by doctors is unjustified and that, within limits, there should be greater acceptance of such donations. We begin by describing possible weak and strong paternalistic justifications of current conservative donor acceptance guidelines and practices. We then justify our position by outlining the frequently under-recognised benefits and the routinely overestimated harms of such donation, before discussing the need to respect the autonomy of willing donors with certain comorbidities. Finally, we respond to a number of possible objections to our proposal for more liberal kidney donor acceptance criteria. We use the situation in Australia as our case study, but our argument is applicable to comparable situations around the world.
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Affiliation(s)
- Alison C Weightman
- Adelaide Medical School, University of Adelaide, Adelaide, Australia.
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, 5000, Australia.
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, 5000, Australia.
| | - Simon Coghlan
- Centre for AI and Digital Ethics, School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Philip A Clayton
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, 5000, Australia
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, 5000, Australia
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The Non-Muscle-Splitting Mini-Incision Donor Nephrectomy Remains a Feasible Technique in the Laparoscopic Era of Living Kidney Donation. TRANSPLANTOLOGY 2022. [DOI: 10.3390/transplantology4010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Laparoscopic donor nephrectomy (LDN) is the current gold standard in kidney donation. Mini-incision open donor nephrectomy (MINI) techniques have been used extensively but have become less popular. The aim of the present study was to compare the results and safety of a non-muscle-splitting MINI technique with the current gold standard of LDN. A single center retrospective cohort study of all living donor nephrectomies between 2011 and 2019 was used for the study. The primary outcome of this study was short term (<30 days) with Clavien–Dindo grade complications. Secondary outcomes included multivariable regression analysis of perioperative data. No differences in complication rates were observed between MINI and LDN and also after correction for known confounders. As expected, the operative time and first warm ischemia were significantly shorter in the MINI group and less blood loss was observed in the LDN group. Complications and conversion rate (LDN to open) among the LDN patients were in line with recent published meta-analyses. This study confirms the perioperative safety of living kidney donation in modern practice. Complication rates of both MINI and LDN procedures are limited and not different between procedures. In specific circumstances, the MINI procedure can still be considered a safe and feasible alternative for living kidney donation.
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The effect of single or multiple arteries in the donor kidney on renal transplant surgical outcomes. Ir J Med Sci 2022; 192:929-934. [PMID: 35697967 DOI: 10.1007/s11845-022-03024-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND As the number of end-stage renal disease (ESRD) patients is increasing, but there are not enough living donors, it is necessary to broaden the criteria for candidates who can undergo donor nephrectomy. Thanks to surgeons' increasing experience with laparoscopic donor nephrectomy (LND), multiple renal artery grafts, previously considered a relative contraindication to donor nephrectomy, have become candidates for LDN. We aimed to compare the outcomes of donors and recipients with single artery and with multiple arteries in LDN. METHODS A total of 214 patients were included in the study. Patients were divided into two groups according to the number of donor arteries: donors with one artery (group 1) and donors with multiple arteries (group 2). The number of donor arteries, operative time, warm ischemia time (WIT), cold ischemia time (CIT), arterial anastomosis time, venous anastomosis time, the extent of bleeding, and preoperative complications were recorded to evaluate the preoperative data. RESULTS The mean operation time in group 1 was 90.3 ± 11.8 min, while in group 2, it was 102.1 ± 5.5 min (p = 0.000). WIT group 1 was 90.9 ± 4.3 s and group 2 100.6 ± 2.1 s (p = 0.000). Arterial anastomosis time was 12.25 ± 3.8 in group 1 and 22.5 ± 4.5 in group 2 (p = 0.000). No statistically significant difference was found between the two groups in other parameters. CONLUSION Increasing the number of donor arteries in renal transplantation (RT) operations prolonged the operation time on both the donor and recipient sides. Still, it had no negative impact on complications or graft function in the postoperative period.
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Akin E, Altintoprak F, Firat N, Dheir H, Bas E, Demirci T, Kamburoglu B, Celebi F. Is Laparoscopic Technique Suitable for Initial Experience in Live Donor Nephrectomy? Results of The First 51 Cases. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2021. [DOI: 10.29333/ejgm/11313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Garden EB, Al-Alao O, Razdan S, Mullen GR, Florman S, Palese MA. Robotic Single-Port Donor Nephrectomy with the da Vinci SP® Surgical System. JSLS 2021; 25:e2021.00062. [PMID: 34949909 PMCID: PMC8692076 DOI: 10.4293/jsls.2021.00062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES The da Vinci SP® Surgical System received U.S. Food and Drug Administration approval for urological procedures in 2018. Here, we describe the first experience performing single-port robot-assisted donor nephrectomy (RADN) using the da Vinci SP® surgical system, present 90-day clinical outcomes, and discuss tips for operative success. METHODS Seven consecutive patients underwent single-port RADN at a single institution between September 1, 2020 and March 31, 2021. Surgery was performed through a single, 60 mm Pfannenstiel incision with a 12 mm periumbilical assistant port for suction and vascular stapling. Donor characteristics, operative details, 90-day donor clinical outcomes, and recipient renal function were retrospectively evaluated. RESULTS Four female and three male patients successfully underwent single-port RADN without conversion to standard multiport or open approach. Six cases were left-sided. Estimated blood loss for each procedure was ≤ 50 mL. Mean operative time, warm ischemia time, and extraction time were 218.3 minutes (standard deviation [SD]: 16.3 minutes), 5 minutes 4 seconds (SD: 56 seconds), and 3 minutes 37 seconds (SD: 38 seconds). Mean pre-operative creatinine and estimated glomerular filtration rate were 0.79 mg/dL and 107.3 mL/min/1.73m2, respectively. At six week's follow up, they were 1.22 mg/dL and 66.1 mL/min/1.73m2. Average pain score at 48 hours postoperatively was 1.7/10. There were no Clavien-Dindo grade ≥ III complications within 90 days. All recipients experienced immediate and sustained return of renal function post-transplant. CONCLUSION Single-port RADN is a technically feasible and safe procedure with the da Vinci SP® system and can confer acceptable functional and cosmetic outcomes. Future studies are needed to define long-term outcomes and compare with previously established techniques for donor nephrectomy.
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Affiliation(s)
- Evan B Garden
- Department of Urology, Icahn School of Medicine at Mt Sinai, New York, NY
| | - Osama Al-Alao
- Department of Urology, Icahn School of Medicine at Mt Sinai, New York, NY
| | - Shirin Razdan
- Department of Urology, Icahn School of Medicine at Mt Sinai, New York, NY
| | - Gregory R Mullen
- Department of Urology, Icahn School of Medicine at Mt Sinai, New York, NY
| | - Sander Florman
- The Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mt Sinai, New York, NY
| | - Michael A Palese
- Department of Urology, Icahn School of Medicine at Mt Sinai, New York, NY
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9
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Branchereau J, Prudhomme T, Bessede T, Verhoest G, Boissier R, Culty T, Matillon X, Defortescu G, Sallusto F, Terrier N, Drouin S, Karam G, Badet L, Timsit MO. [Living donor nephrectomy: The French guidelines from CTAFU]. Prog Urol 2021; 31:50-56. [PMID: 33423748 DOI: 10.1016/j.purol.2020.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To propose surgical recommendations for living donor nephrectomy. METHOD Following a systematic approach, a review of the literature (Medline) was conducted by the CTAFU regarding functional and anatomical assessment of kidney donors, including which side the kidney should be harvested from. Distinct surgical techniques and approaches were evaluated. References were considered with a predefined process to propose recommendations with the corresponding levels of evidence. RESULTS The recommendations clarify the legal and regulatory framework for kidney donation in France. A rigorous assessment of the donor is one of the essential prerequisites for donor safety. The impact of nephrectomy on kidney function needs to be anticipated. In case of modal vascularization of both kidneys without a relative difference in function or urologic abnormality, removal of the left kidney is the preferred choice to favor a longer vein. Mini-invasive approaches for nephrectomy provide faster donor recovery, less donor pain and shorter hospital stay than open surgery. CONCLUSION These French recommendations must contribute to improving surgical management of candidates for kidney donation.
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Affiliation(s)
- J Branchereau
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Nantes, 5, allée de lÎle-Gloriette, 44093 Nantes cedex 01, France
| | - T Prudhomme
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Toulouse, avenue du Pr-Jean-Poulhès, 31059 Toulouse, France
| | - T Bessede
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital de Bicêtre, université de Paris-Saclay, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - G Verhoest
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - R Boissier
- Service d'urologie et transplantation, hôpital de La Conception, université Aix-Marseille, 47, boulevard Baille, 13005 Marseille, France
| | - T Culty
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - X Matillon
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - G Defortescu
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU Rouen, 37, boulevard Gambetta, 76000 Rouen, France
| | - F Sallusto
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Toulouse, avenue du Pr-Jean-Poulhès, 31059 Toulouse, France
| | - N Terrier
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU Grenoble Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - S Drouin
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital de la Pitié-Salpêtrière, université Paris Sorbonne, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - G Karam
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Nantes, 5, allée de lÎle-Gloriette, 44093 Nantes cedex 01, France
| | - L Badet
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - M-O Timsit
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; PARCC, INSERM, équipe labellisée par la Ligue Contre le Cancer, 56, rue Leblanc, université de Paris, 75015 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France.
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10
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Goldsby J, Schwarz K, Kim I, Lewis V, Lyda C. An Evaluation of the Effect of Catheter-Directed Continuous Infusion of Local Anesthetic by Elastomeric Pump on Opioid Usage Following Donor Kidney Nephrectomy. Ann Pharmacother 2021; 56:146-150. [PMID: 33998320 DOI: 10.1177/10600280211017894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Postoperative pain management following donor nephrectomy can prove challenging for immediate discharge on postoperative day 1 or 2. Although the standard for pain control is utilization of opioids, this increases the risk of postoperative ileus and, if continued inappropriately, increases excess opioids circulating in the community. One strategy that proposes to limit postoperative opioids in kidney donors is the continuous infusion of local anesthetics (CILA), though the effect on patient outcomes is unclear. OBJECTIVE The purpose of this study was to evaluate the effectiveness of postoperative CILA to decrease opioid usage in kidney donors who undergo laparoscopic nephrectomy. METHODS A retrospective analysis was conducted of kidney donors who underwent laparoscopic nephrectomy and received CILA (CILA group) compared with kidney donors who received standard-of-care (SOC) postoperative analgesia. The primary outcome was the mean total oral morphine equivalents (OMEs) administered following surgery. RESULTS A total of 176 kidney donors were evaluated, 88 in each group. The mean OME administered in the CILA group was significantly higher than in the SOC group: 194.8 versus 133.5 mg (P = 0.003). Mean total postoperative administration of acetaminophen was also increased in the CILA group: 3736.9 versus 2611.6 mg (P = 0.0041). Mean length of stay following surgery was higher in the kidney donors who received CILA, whereas return to bowel function, time to ambulation, and pain scores were not significantly different. CONCLUSION AND RELEVANCE This report demonstrated that CILA is not an effective modality to reduce opioid utilization or improve recovery in kidney donors following laparoscopic nephrectomy.
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Affiliation(s)
- Jessica Goldsby
- UCHealth University of Colorado Hospital, Aurora, CO, USA.,University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Kerry Schwarz
- UCHealth University of Colorado Hospital, Aurora, CO, USA.,University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Ike Kim
- UCHealth University of Colorado Hospital, Aurora, CO, USA.,University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Victor Lewis
- UCHealth University of Colorado Hospital, Aurora, CO, USA.,University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Clark Lyda
- UCHealth University of Colorado Hospital, Aurora, CO, USA.,University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
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11
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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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12
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Reducing Opioid Dependence and Improving Patient Experience for Living Kidney Donors with Transversus Abdominis Plane Block. TRANSPLANTOLOGY 2021. [DOI: 10.3390/transplantology2010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rapid recovery after laparoscopic living donor nephrectomy (LLDN) for kidney donation is highly desirable for living kidney donors. To uphold rapid recovery, good analgesia with minimal adverse effects, including those related to opioid dependence, is essential. A pre-operative transversus abdominis plane (TAP) block with liposomal bupivacaine can effectively aid in perioperative pain management, while reducing opioid requirements. We conducted a single-center retrospective study involving patients 18 years and older who underwent LLDN to determine whether a TAP block with liposomal bupivacaine is efficacious in pain management after LLDN, while reducing opioid use. The study group comprised of patients who received a preoperative TAP block with liposomal bupivacaine in place of hydromorphone patient-controlled analgesia (PCA) and the control group included patients who received hydromorphone PCA post-operatively. Both groups were supplemented with oral and intravenous analgesics for breakthrough pain, as needed. The primary endpoint was reduction in post-operative opioid use in morphine milligram equivalents (MME). Secondary endpoints included: post-operative pain scores, postoperative length of stay, and re-hospitalizations within 7 days of discharge. Sixty-six patients were included in our study, with 33 in each group. Patients in both groups were well matched demographically. The study group who received TAP block demonstrated a significant reduction in post-operative opioid use (92.05 MME vs. 53.98 MME, p < 0.05) when compared to the control group who received hydromorphone PCA. Both groups achieved similar analgesia with comparable pain scores. There was no difference between postoperative hospital lengths of stay for both groups. Two patients in the control group were re-admitted due to small bowel obstruction within seven days of discharge. In conclusion, TAP block with liposomal bupivacaine significantly reduced postoperative opioid use, while also proving to be safe, efficacious and feasible in patients undergoing LLDN.
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13
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Zeuschner P, Siemer S, Stöckle M, Saar M. [The first 50 robot-assisted donor nephrectomies : Lessons learned]. Urologe A 2020; 59:1512-1518. [PMID: 32780177 PMCID: PMC7721693 DOI: 10.1007/s00120-020-01302-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hintergrund Die minimal-invasive Donornephrektomie (DN) ist inzwischen operativer Standard, bezüglich der Rolle von roboterassistierten Verfahren gibt es bisher keinen Konsens. Fragestellung Die ersten 50 transperitonealen roboterassistierten Donornephrektomien (RDN) einer urologischen Universitätsklinik in Deutschland wurden retrospektiv ausgewertet. Material und Methoden Patientencharakteristika, intra- und postoperative Parameter wurden erfasst und die Nierenfunktion in einem 5‑jährigen Follow-up ausgewertet. Signifikante Prädiktoren für die Nierenfunktion bei Entlassung und ein Jahr postoperativ wurden in einem multivariablen Regressionsmodell bestimmt. Ergebnisse Die RDN hat exzellente Ergebnisse mit niedriger Komplikationsrate, kurzer warmer (WIZ) und kalter Ischämiezeit (KIZ) sowie geringem Blutverlust und kurzer Patientenverweildauer. Die Seite der Nierenentnahme hat hierauf keine Auswirkungen. Nach RDN sind etwa 50 % der Spender formal niereninsuffizient, was aber zumeist ohne Relevanz ist, weil sich die Nierenfunktion der Spender im Follow-up nicht weiter verschlechtert. Die postoperative Nierenfunktion lässt sich bei der RDN mithilfe der präoperativen eGFR (errechnete glomeruläre Filtrationsrate) und dem Spenderalter sehr gut vorhersagen. Schlussfolgerungen Die robotische DN stellt eine sehr gute Alternative zu anderen minimal-invasiven Operationsverfahren dar, die von Beginn an exzellente operative Ergebnisse ermöglicht.
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Affiliation(s)
- Philip Zeuschner
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrberger Straße 100, 66421, Homburg/Saar, Deutschland.
| | - Stefan Siemer
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrberger Straße 100, 66421, Homburg/Saar, Deutschland
| | - Michael Stöckle
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrberger Straße 100, 66421, Homburg/Saar, Deutschland
| | - Matthias Saar
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrberger Straße 100, 66421, Homburg/Saar, Deutschland
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14
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Franquet Q, Matillon X, Terrier N, Rambeaud JJ, Crouzet S, Long JA, Fassi-Fehri H, Codas-Duarte R, Poncet D, Jouve T, Noble J, Malvezzi P, Rostaing L, Descotes JL, Badet L, Fiard G. The Mayo Adhesive Probability score can help predict intra- and postoperative complications in patients undergoing laparoscopic donor nephrectomy. World J Urol 2020; 39:2775-2781. [PMID: 33175210 DOI: 10.1007/s00345-020-03513-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Living donor nephrectomy is a high-stake procedure involving healthy individuals, therefore every effort should be made to define each patient's individualized risk and improve potential donors' information. The aim of this study was to evaluate the interest of the Mayo adhesive probability (MAP) score, an imaging-based score initially designed to estimate the risk of adherent perinephric fat in partial nephrectomy, to predict intra- and postoperative complications of living donor nephrectomy. MATERIALS AND METHODS We retrospectively reviewed the imaging, clinical, and follow-up data of 452 kidney donors who underwent laparoscopic donor nephrectomy in two academic centers. RESULTS Imaging and follow-up data were available for 307 kidney donors, among which 44 (14%) had a high MAP score (≥ 3). Intraoperative difficulties were encountered in 50 patients (16%), including difficult dissection (n = 35) and bleeding (n = 17). Conversion to open surgery was required for 13 patients (4.2%). On multivariate analysis, a MAP score ≥ 3 was significantly associated with the risk of intraoperative difficulty [OR 14.12 (5.58-35.7), p < 0.001] or conversion to open surgery [OR 18.96 (3.42-105.14), p = 0.0042]. Postoperative complications were noted in 99 patients (32%), including 12 patients (3.9%) with Clavien-Dindo grade III-IV complications. On multivariate analysis, a high MAP score was also associated with the risk of postoperative complications [OR 2.55 (1.20-5.40), p = 0.01]. CONCLUSIONS In this retrospective bicentric study, a high MAP score was associated with the risk of intra- and postoperative complications of laparoscopic donor nephrectomy. The MAP score appears of interest in the living donor evaluation process to help improve donors' information and outcomes.
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Affiliation(s)
- Quentin Franquet
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France
| | - Xavier Matillon
- Department of Urology and Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Terrier
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France
| | - Jean-Jacques Rambeaud
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France
| | - Sebastien Crouzet
- Department of Urology and Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jean-Alexandre Long
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France.,Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, 38000, Grenoble, France
| | - Hakim Fassi-Fehri
- Department of Urology and Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Ricardo Codas-Duarte
- Department of Urology and Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Delphine Poncet
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France
| | - Thomas Jouve
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation, Grenoble Alpes University Hospital, Grenoble, France
| | - Johan Noble
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation, Grenoble Alpes University Hospital, Grenoble, France
| | - Paolo Malvezzi
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation, Grenoble Alpes University Hospital, Grenoble, France
| | - Lionel Rostaing
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Luc Descotes
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France.,Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, 38000, Grenoble, France
| | - Lionel Badet
- Department of Urology and Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Gaelle Fiard
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France. .,Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, 38000, Grenoble, France.
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15
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Gavriilidis P, Papalois V. Retroperitoneoscopic Standard or Hand-Assisted Versus Laparoscopic Standard or Hand-Assisted Donor Nephrectomy: A Systematic Review and the First Network Meta-Analysis. J Clin Med Res 2020; 12:740-746. [PMID: 33224376 PMCID: PMC7665870 DOI: 10.14740/jocmr4374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/27/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND At the present four minimally invasive procedures namely retroperitoneoscopic (RPDN), laparoscopic (LPDN), hand-assisted retroperitoneoscopic (HARDN) and hand-assisted laparoscopic donor nephrectomy (HALDN) are used to perform donor nephrectomies. The current evidence based on retrospective studies and on pairwise only meta-analyses is inconclusive. Up to authors' best knowledge there is no so far network meta-analysis to compare all the above-mentioned procedures. Therefore, a network meta-analysis was conducted to compare the feasibility, safety and reproducibility of the four donor nephrectomies procedures. METHODS Google Scholar, EMBASE, PubMed, and Cochrane library were used for a systematic literature search. Both updated pairwise and network meta-analyses were performed. RESULTS Compared to LPDN there was evidence of significantly more right kidneys retrieved with RPDN; nonsignificant differences demonstrated both with HALDN and HARDN compared to LPDN. There was evidence that the operative time was significantly shorter by 77 min in RPDN compared to LPDN; on the other hand, HARDN and HALDN did not demonstrate significant differences when compared to LPDN. CONCLUSIONS The present study demonstrates that each approach can be applied safely in adequately selected patients. Moreover, retroperitoneoscopic is reliable, safe and easily reproducible alternative of LPDN for both left and right kidneys.
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Affiliation(s)
- Paschalis Gavriilidis
- Department of Vascular Access and Renal Transplantation, Queen Elizabeth University Hospitals Birmingham NHS Foundation Trust, B15 2TH, UK
- Department of Vascular Access and Renal Transplantation, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Vassilios Papalois
- Department of Vascular Access and Renal Transplantation, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK
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16
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Xiao Q, Fu B, Song K, Chen S, Li J, Xiao J. Comparison of Surgical Techniques in Living Donor Nephrectomy: A Systematic Review and Bayesian Network Meta-Analysis. Ann Transplant 2020; 25:e926677. [PMID: 33122621 PMCID: PMC7607668 DOI: 10.12659/aot.926677] [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] [Indexed: 11/09/2022] Open
Abstract
Background The aim of this study was to compare and evaluate surgical techniques used for living donor nephrectomy (LDN). Material/Methods We performed a meta-analysis to compare 4 surgical techniques: open LDN (OLDN), laparoscopic LDN (LLDN), hand-assisted LLDN (HALLDN), and robot-assisted LLDN (RLDN). Results No significant differences were found among these surgical techniques in terms of BMI, donor postoperative complications, 1-year graft survival, and DGF. Compared to the OLDN, the other 3 surgical techniques preferred to harvest the left kidney. When the right kidney was chosen as a donor, OLDN was the first-choice surgical technique. EBL was significantly lower in the HALLDN, LLDN, and RLDN groups when compared to the OLDN group. However, operative time and WIT were significantly shorter in the OLDN group. The RLDN group had an increased rate of donor intraoperative complications and a significantly lower VAS on day 1. The OLDN group required more morphine intake than the LLDN group. The length of hospital stay was significantly longer and AR was significantly higher in the OLDN group than in the LLDN and HALLDN groups. Conclusions There are no significant differences in donor postoperative complications, recipient DGF, and graft survival among the 4 surgical techniques. OLDN reduces WIT and operation time, but increases EBL and AR. RLDN and LLDN reduce the length of hospital stay, morphine intake, and VAS, and thus accelerate recovery. However, RLDN is associated with increased intraoperative complications.
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Affiliation(s)
- Qi Xiao
- Department of Transplantation, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Biqi Fu
- Department of Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Keqin Song
- Department of Transplantation, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Sufen Chen
- Department of Transplantation, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Jianfeng Li
- Department of Transplantation, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Jiansheng Xiao
- Department of Transplantation, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
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17
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Favi E, Iesari S, Catarsini N, Sivaprakasam R, Cucinotta E, Manzia T, Puliatti C, Cacciola R. Outcomes and surgical complications following living-donor renal transplantation using kidneys retrieved with trans-peritoneal or retro-peritoneal hand-assisted laparoscopic nephrectomy. Clin Transplant 2020; 34:e14113. [PMID: 33051895 DOI: 10.1111/ctr.14113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 01/06/2023]
Abstract
The best minimally invasive procedure for living-donor kidney retrieval remains debated. Our objective was to assess trans-peritoneal (TP) and retro-peritoneal (RP) hand-assisted laparoscopic donor nephrectomy (HALDN). In this single-center retrospective study, we analyzed results from 317 living-donor renal transplants (RT) performed between 2008 and 2016. Donor and recipient outcomes were compared between TP-HALDN (n = 235) and RP-HALDN (n = 82). Conversion to open nephrectomy (0.4% vs 0%; P = 1.000), intra-operative complications (1.7% vs 1.2%; P = 1.000), and 1-year overall post-operative complications (11.9% vs 17.1%; P = .258) rates were similar in TP-HALDN and RP-HALDN. Overall surgical site infections were higher in RP-HALDN (6.1% vs 1.7%; P = .053), whereas incisional hernias were only recorded following TP-HALDN (3.4% vs 0%; P = .118). The duration of the procedure was 11-minute shorter for TP-HALDN than RP-HALDN (P < .001) but extraction time was equivalent (2, IQR 1.5-2.5 minutes; P = 1.000). RT following TP-HALDN and RP-HALDN showed comparable one-year death-censored allograft survival (97% vs 98.8%; P = .685), primary non-function (0.4% vs 0%; P = .290), delayed graft function (1.3% vs 4.9%; P = .077), and urological complications (2.6% vs 4.9%; P = .290) rates. In our series, donor and recipient outcomes were not substantially affected by the approach used for donor nephrectomy. TP-HALDN and RP-HALDN were both safe and effective.
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Affiliation(s)
- Evaldo Favi
- Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Samuele Iesari
- Pôle de Chirurgie Expérimentale et Transplantation, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Nivia Catarsini
- General Surgery, Azienda Ospedaliera Universitaria Policlinico G. Martino, Messina, Italy
| | - Rajesh Sivaprakasam
- Renal Transplantation, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Eugenio Cucinotta
- General Surgery, Azienda Ospedaliera Universitaria Policlinico G. Martino, Messina, Italy
| | - Tommaso Manzia
- HPB Surgery and Transplantation, Fondazione PTV, Rome, Italy
| | | | - Roberto Cacciola
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.,HPB Surgery and Transplantation, Fondazione PTV, Rome, Italy
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18
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Fleishman A, Khwaja K, Schold JD, Comer CD, Morrissey P, Whiting J, Vella J, Kayler LK, Katz D, Jones J, Kaplan B, Pavlakis M, Mandelbrot DA, Rodrigue JR. Pain expectancy, prevalence, severity, and patterns following donor nephrectomy: Findings from the KDOC Study. Am J Transplant 2020; 20:2522-2529. [PMID: 32185880 PMCID: PMC7483675 DOI: 10.1111/ajt.15861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/14/2020] [Accepted: 03/03/2020] [Indexed: 01/25/2023]
Abstract
Postoperative pain is an outcome of importance to potential living kidney donors (LKDs). We prospectively characterized the prevalence, severity, and patterns of acute or chronic postoperative pain in 193 LKDs at six transplant programs. Three pain measurements were obtained from donors on postoperative Day (POD) 1, 3, 7, 14, 21, 28, 35, 41, 49, and 56. The median pain rating total was highest on POD1 and declined from each assessment to the next until reaching a median pain-free score of 0 on POD49. In generalized linear mixed-model analysis, the mean pain score decreased at each pain assessment compared to the POD3 assessment. Pre-donation history of mood disorder (adjusted ratio of means [95% confidence interval (CI)]: 1.40 [0.99, 1.98]), reporting "severe" on any POD1 pain descriptors (adjusted ratio of means [95% CI]: 1.47 [1.12, 1.93]) and open nephrectomy (adjusted ratio of means [95% CI]: 2.61 [1.03, 6.62]) were associated with higher pain scores across time. Of the 179 LKDs who completed the final pain assessment, 74 (41%) met criteria for chronic postsurgical pain (CPSP), that is, any donation-related pain on POD56. Study findings have potential implications for LKD education, surgical consent, postdonation care, and outcome measurements.
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Affiliation(s)
- A Fleishman
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA,Harvard Medical School, Boston, MA
| | - K Khwaja
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA,Harvard Medical School, Boston, MA
| | - JD Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - CD Comer
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
| | - P Morrissey
- Transplant Center, Rhode Island Hospital, Providence, RI
| | - J Whiting
- Maine Transplant Center, Maine Medical Center, Portland, ME
| | - J Vella
- Maine Transplant Center, Maine Medical Center, Portland, ME
| | - LK Kayler
- Montefiore Einstein Center for Transplantation, Bronx, NY,Regional Center of Excellence for Transplantation & Kidney Care, Erie County Medical Center, University of Buffalo, Buffalo, NY
| | - D Katz
- Organ Transplantation Program, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - J Jones
- Organ Transplantation Program, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - B Kaplan
- Baylor Scott and White Health, Temple, TX
| | - M Pavlakis
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA,Harvard Medical School, Boston, MA
| | - DA Mandelbrot
- Department of Medicine, University of Wisconsin, Madison, WI
| | - JR Rodrigue
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA,Harvard Medical School, Boston, MA
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19
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Are gamers better laparoscopic surgeons? Impact of gaming skills on laparoscopic performance in "Generation Y" students. PLoS One 2020; 15:e0232341. [PMID: 32845892 PMCID: PMC7449406 DOI: 10.1371/journal.pone.0232341] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 07/02/2020] [Indexed: 01/22/2023] Open
Abstract
Background Both laparoscopic surgery and computer games make similar demands on eye-hand coordination and visuospatial cognitive ability. A possible connection between both areas could be used for the recruitment and training of future surgery residents. Aim The goal of this study was to investigate whether gaming skills are associated with better laparoscopic performance in medical students. Methods 135 medical students (55 males, 80 females) participated in an experimental study. Students completed three laparoscopic tasks (rope pass, paper cut, and peg transfer) and played two custom-designed video games (2D and 3D game) that had been previously validated in a group of casual and professional gamers. Results There was a small significant correlation between performance on the rope pass task and the 3D game, Kendall’s τ(111) = -.151, P = .019. There was also a small significant correlation between the paper cut task and points in the 2D game, Kendall’s τ(102) = -.180, P = .008. Overall laparoscopic performance was also significantly correlated with both the 3D game, Kendall’s τ(112) = -.134, P = .036, and points in the 2D game, Kendall’s τ(113) = -.163, P = .011. However, there was no significant correlation between the peg transfer task and both games (2D and 3D game), P = n.s.. Conclusion This study provides further evidence that gaming skills may be an advantage when learning laparoscopic surgery.
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20
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Vest LS, Sarabu N, Koraishy FM, Nguyen MT, Park M, Lam NN, Schnitzler MA, Axelrod D, Hsu CY, Garg AX, Segev DL, Massie AB, Hess GP, Kasiske BL, Lentine KL. Prescription patterns of opioids and non-steroidal anti-inflammatory drugs in the first year after living kidney donation: An analysis of U.S. Registry and Pharmacy fill records. Clin Transplant 2020; 34:e14000. [PMID: 32502285 PMCID: PMC7449599 DOI: 10.1111/ctr.14000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 01/01/2023]
Abstract
We examined a novel database linking national donor registry identifiers to records from a US pharmaceutical claims warehouse (2007-2015) to describe opioid and NSAID prescription patterns among LKDs during the first year postdonation, divided into three periods: 0-14 days, 15-182 days, and 183-365 days. Associations of opioid and NSAID prescription fills with baseline factors were examined by logistic regression (adjusted odds ratio, LCL aORUCL ). Among 23,565 donors, opioid prescriptions were highest during days 0-14 (36.6%), but 12.6% of donors filled opioids during days 183-365. NSAID prescriptions rose from 0.5% during days 0-14 to 3.3% during days 183-365. Women filled opioids more commonly than men, and black donors filled both opioids and NSAIDs more commonly than white donors. After covariate adjustment, significant correlates of opioid prescription fills during days 183-365 included obesity (aOR,1.24 1.381.53 ), less than college education (aOR,1.19 1.311.43 ), smoking (aOR,1.33 1.451.58 ), and nephrectomy complications (aOR,1.11 1.291.49 ). NSAID prescription fills in year 1 were not associated with differences in estimated glomerular filtration rate, incidence of proteinuria or new-onset hypertension at the first and second year postdonation. Prescription fills for opioids and NSAIDs for LKDs varied with demographic and clinic traits. Future work should examine longer-term outcome implications to help inform safe analgesic regimen choices after donation.
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Affiliation(s)
- Luke S Vest
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Nagaraju Sarabu
- Nephrology, Department of Medicine, University Hospitals Cleveland Medical, Cleveland, OH, USA
| | - Farrukh M Koraishy
- Nephrology, Department of Medicine, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Minh-Tri Nguyen
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Meyeon Park
- Nephrology, Department of Medicine, UCSF, San Francisco, CA, USA
| | - Ngan N Lam
- Nephrology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mark A Schnitzler
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - David Axelrod
- University of Iowa Transplant Institute, University of Iowa School of Medicine, Iowa City, IA, USA
| | - Chi Yuan Hsu
- Nephrology, Department of Medicine, UCSF, San Francisco, CA, USA
| | - Amit X Garg
- Nephrology, Department of Medicine, Western University, London, Ontario, Canada
| | - Dorry L Segev
- Center for Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Allan B Massie
- Center for Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gregory P Hess
- Drexel University School of Medicine, Philadelphia, PA, USA
| | - Bertram L Kasiske
- Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
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21
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Broudeur L, Karam G, Rana Magar R, Glemain P, Loubersac T, Fosse A, De Vergie S, Chelghaf I, Perrouin-Verbe MA, Rigaud J, Branchereau J. Right Kidney Mini-Invasive Living Donor Nephrectomy: A Safe and Efficient Alternative. Urol Int 2020; 104:859-864. [PMID: 32702689 DOI: 10.1159/000509064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/29/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Right kidney living donor transplantation is considered more difficult and associated with more complications. The objective was to evaluate donor safety and graft function of right hand-assisted laparoscopic donor nephrectomy (HALDN). METHODS A total of 270 consecutive HALDN procedures have been performed in our institution up to April 2017. We retrospectively compared the outcomes of right-sided nephrectomy (R-HALDN) to left-sided nephrectomy (L-HALDN) to evaluate donor safety and graft function of R-HALDN. RESULTS Sixty-seven right kidneys were removed for functional asymmetry in favour of left kidney (35/67) or left kidney multiple arteries (28/67). Among the donors, neither conversion to open surgery nor preoperative blood transfusion was necessary. There was no significant difference in operative time, compared to L-HALDN group (170 ± 37 min vs. 171 ± 32 min; p value = 0.182). Warm ischaemia time was significantly longer for R-HALDN (4.0 ± 1.6 min vs. 3.0 ± 1.7 min; p < 0.001). There was no significant difference in terms of post-operative complications and serum Cr levels. Among the recipients, there were no graft venous thrombosis. There was no significant difference in delayed graft function (3 for R-HALDN group and 8 for L-HALDN group; p value = 0.847), serum Cr levels, and graft survival. CONCLUSION R-HALDN is a safe procedure for kidney donors, with excellent graft function for the recipients, compared to L-HALDN.
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Affiliation(s)
- Lucas Broudeur
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France,
| | - Georges Karam
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France
| | - Reshma Rana Magar
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Pascal Glemain
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France
| | - Thomas Loubersac
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France
| | - Arthur Fosse
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France
| | - Stéphane De Vergie
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France
| | - Ismaël Chelghaf
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France
| | | | - Jérôme Rigaud
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France
| | - Julien Branchereau
- Department of Urology and Transplantation Surgery, University Hospital Center, Nantes, France.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.,Centre Hospitalier Universitaire de Nantes, Institut de Transplantation Urologie Néphrologie (ITUN), Nantes, France.,Centre de Recherche en Transplantation et Immunologie UMR 1064, INSERM, Université de Nantes, Nantes, France
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22
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Robot-Assisted versus Laparoscopic Donor Nephrectomy: A Comparison of 250 Cases. J Clin Med 2020; 9:jcm9061610. [PMID: 32466503 PMCID: PMC7355615 DOI: 10.3390/jcm9061610] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 12/22/2022] Open
Abstract
Living kidney donation is the best treatment for end-stage renal disease, however, the best surgical approach for minimally-invasive donor nephrectomy (DN) is still a matter of debate. This bi-centric study aimed to retrospectively compare perioperative outcomes and postoperative kidney function after 257 transperitoneal DNs including 52 robot-assisted (RDN) and 205 laparoscopic DNs (LDN). As primary outcomes, the intraoperative (operating time, warm ischemia time (WIT), major complications) and postoperative (length of stay, complications) results were compared. As secondary outcomes, postoperative kidney and graft function were analyzed including delayed graft function (DGF) rates, and the impact of the surgical approach was assessed. Overall, the type of minimally-invasive donor nephrectomy (RDN vs. LDN) did not affect primary outcomes, especially not operating time and WIT; and major complication and DGF rates were low in both groups. A history of smoking and preoperative kidney function, but not the surgical approach, were predictive for postoperative serum creatinine of the donor and recipient. To conclude, RDN and LDN have equivalent perioperative results in experienced centers. For this reason, not the surgical approach, but rather the graft- (preoperative kidney function) and patient-specific (history of smoking) aspects impacted postoperative kidney function.
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23
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Arpalı E, Karataş C, Akyollu B, Yaprak D, Günaydın B, Koçak B. Hand-assisted laparoscopic donor nephrectomy in kidneys with multiple renal arteries versus a single renal artery: An analysis of vascular complications from 1,350 cases. Turk J Urol 2020; 46:tud.2020.19280. [PMID: 32449674 PMCID: PMC7360166 DOI: 10.5152/tud.2020.19280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/30/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Laparoscopic donor nephrectomy (LDN) has been shown to be a safe approach with better morbidity results. Impact of multiple renal arteries (MRAs) and anatomical variations has been reviewed by many authors. In our study, the relationship between the donors with MRAs and risk of perioperative vascular complications related to donor nephrectomy was investigated. MATERIAL AND METHODS Patients who underwent hand-assisted LDNs between January 2007 and February 2018 were reviewed retrospectively. Patient age, sex, body mass index (BMI), waist circumference, side of donor nephrectomies, donors with MRAs, intraoperative vascular complications, conversion rates, hospitalization durations, and operative times were extracted. Risk factors for perioperative vascular complications were defined. RESULTS There were MRAs in 288 kidney donors (21.3%). The number of patients who underwent a right donor nephrectomy was 113 (8.4%). BMI, waist circumference, and postoperative hospital stay were not significantly different between donors with one artery and those with MRAs (p>0.05). The renovascular complication rate and overall conversion rate to open surgery were significantly higher in donors with MRAs (p<0.05). CONCLUSION Perioperative safety of the kidney donors is of crucial importance. Surgeons performing LDNs must be aware of the potential risks. Our analysis suggests that procurement of kidneys from donors with MRAs is a risk factor for renovascular complications.
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Affiliation(s)
- Emre Arpalı
- Organ Transplant Center, Koç University Hospital, İstanbul, Turkey
| | - Cihan Karataş
- Organ Transplant Center, Koç University Hospital, İstanbul, Turkey
| | - Başak Akyollu
- Organ Transplant Center, Koç University Hospital, İstanbul, Turkey
| | - Doğukan Yaprak
- Organ Transplant Center, Koç University Hospital, İstanbul, Turkey
| | - Bilal Günaydın
- Department of Urology, Niğde Ömer Halis Demir University, Niğde, Turkey
| | - Burak Koçak
- Organ Transplant Center, Koç University Hospital, İstanbul, Turkey
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24
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Bruintjes MHD, van Helden EV, de Vries M, Wirken L, Evers AWM, van Middendorp H, Kloke H, d'Ancona FCH, Langenhuijsen JF, Steegers MAH, Warlé MC. Chronic pain following laparoscopic living-donor nephrectomy: Prevalence and impact on quality of life. Am J Transplant 2019; 19:2825-2832. [PMID: 30868731 PMCID: PMC6790588 DOI: 10.1111/ajt.15350] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/21/2019] [Accepted: 03/03/2019] [Indexed: 01/25/2023]
Abstract
Chronic postsurgical pain (CPSP) following laparoscopic donor nephrectomy (LDN) is a disregarded topic. In this cross-sectional study, all consecutive patients who underwent an LDN at the Radboud University Medical Center (Radboudumc; 2003-2016) were approached for participation. Five hundred twelve living kidney donors were included and asked to complete two questionnaires, including the McGill Pain Questionnaire and the RAND Short Form-36 Health Status Inventory (RAND SF-36) regarding their health-related quality of life (HRQoL). The mean prevalence of CPSP following LDN was 5.7%, with a mean follow-up time of 6 years. Possible predictors of CPSP following LDN are severe early postoperative pain, previous abdominal surgery, and preexisting backache. The RAND SF-36 revealed an impaired HRQoL in patients with CPSP when compared to patients without CPSP. In conclusion, this study revealed that the prevalence of CPSP following LDN is substantial. Given the possible association between the presence of CPSP and impaired HRQoL scores, living kidney donors should be well informed in the preoperative phase about the risk of CPSP.
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Affiliation(s)
| | - Esmee V. van Helden
- Department of SurgeryRadboud University Medical CenterNijmegenThe Netherlands
| | - Marjan de Vries
- Department of SurgeryRadboud University Medical CenterNijmegenThe Netherlands
| | - Lieke Wirken
- Institute of Psychology, Health, Medical and Neuropsychology UnitLeiden UniversityLeidenThe Netherlands,Department of Medical PsychologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Andrea W. M. Evers
- Institute of Psychology, Health, Medical and Neuropsychology UnitLeiden UniversityLeidenThe Netherlands,Department of Medical PsychologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Henriët van Middendorp
- Institute of Psychology, Health, Medical and Neuropsychology UnitLeiden UniversityLeidenThe Netherlands,Department of Medical PsychologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Heinrich Kloke
- Department of NephrologyRadboud University Medical CenterNijmegenThe Netherlands
| | | | | | | | - Michiel C. Warlé
- Department of SurgeryRadboud University Medical CenterNijmegenThe Netherlands
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25
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Shahbazov R, Maluf D, Azari F, Hakim D, Martin O, Dicocco P, Alejo JL, Saracino G, Hakim N. Laparoscopic Versus Finger-Assisted Open Donor Nephrectomy Technique: A Possible Safe Alternative. EXP CLIN TRANSPLANT 2019; 18:585-590. [PMID: 31526334 DOI: 10.6002/ect.2019.0115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Despite the present use ofthe laparoscopic technique for living-donor kidney nephrectomy, a search for alternative techniques continues.The aim of this study was to compare finger-assisted open donor nephrectomy versus laparoscopic donor nephrectomy. MATERIALS AND METHODS This study included retrospective data of 95 consecutive donors in a transplant center who were under going donor nephrectomy RESULTS: Donor demographics and clinical characteristics were generally similar between treatment groups. There were fewer female donors in the finger-assisted open donor nephrectomy treatment group (70.5% vs 29.5%; P = .003), but median body mass index was similar between groups (28 vs 26 kg/m²; P = .032). Patients who received laparoscopic donor nephrectomy had longer operative duration (3.5 vs 1.2 h; P < .001), longer combined length of incision (6 vs 5 cm; P = .001), andshorter median hospital length of stay (3 vs 4 days; P < .001). A left nephrectomy was preferred in both groups. Minor postoperative complications occurred less often in the finger-assisted open donor nephrectomy group (14.7% vs 31.6%; P = .0094). Donors who received laparoscopic nephrectomy had lower glomerular filtration rate at 1 year after donation (60 vs 89 mL/min/1.73 m²; P < .001) than donors who received finger-assisted nephrectomy. However, recipients of donors of both procedures had similar glomerular filtration rate at 1 year after transplant (65 vs 69 mL/min/1.73 m²; P = .5). CONCLUSIONS Our study demonstrated that finger-assisted open donor nephrectomy is a successful and safe alternative versus laparoscopic donor nephrectomy, providing favorable results for patients in terms of complications and outcomes.
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Affiliation(s)
- Rauf Shahbazov
- >From the Department of Surgery, Division of Transplantation, SUNY Upstate Medical University, Syracuse, New York, USA
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26
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Wahba R, Datta RR, Hedergott A, Bußhoff J, Bruns T, Kleinert R, Dieplinger G, Fuchs H, Giezelt C, Möller D, Hellmich M, Bruns CJ, Stippel DL. 3D vs. 4K Display System - Influence of "State-of-the-art"-Display Technique On Surgical Performance (IDOSP-Study) in minimally invasive surgery: protocol for a randomized cross-over trial. Trials 2019; 20:299. [PMID: 31138290 PMCID: PMC6540550 DOI: 10.1186/s13063-019-3330-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/25/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Three-dimensional (3D) stereoscopic vision is crucial to perform any kind of manual task. The reduction from real life 3D to virtual two-dimensional (2D) sight is a major challenge in minimally invasive surgery (MIS). A 3D display technique has been shown to reduce operation time and mistakes and to improve the learning curve. Therefore, the use of a3D display technique seems to optimize surgical performance for novice and experienced surgeons. Inspired by consumer electronics, a 4K display technique was recently introduced to MIS. Due to its high resolution and zoom effect, surgeons should benefit from it. The aim of this study is to evaluate if "state-of-the-art" 3D- vs. 4K-display techniques could influence surgical performance. METHODS A randomized, cross-over, single-institution, single-blinded trial is designed. It compares the primary outcome parameter "surgical performance", represented by "performance time "and "number of mistakes", using a passive polarizing 3D and a 4K display system (two arms) to perform different tasks in a minimally invasive/laparoscopic training parkour. Secondary outcome parameters are the mental stress load (National Aeronautics and Space Administration (NASA) Task Load Index) and the learning curve. Unexperienced novices (medical students), non-board-certified, and board-certified abdominal surgeons participate in the trial (i.e., level of experience, 3 strata). The parkour consists of seven tasks (for novices, five tasks), which will be repeated three times. The 1st run of the parkour will be performed with the randomized display system, the 2nd run with the other one. After each run, the mental stress load is measured. After completion of the parkour, all participants are evaluated by an ophthalmologist for visual acuity and stereoscopic vision with five tests. Assuming a correlation of 0.5 between measurements per subject, a sample size of 36 per stratum is required to detect a standardized effect of 0.5 (including an additional 5% for a non-parametric approach) with a power of 80% at a two-sided type I error of 5%. Thus, altogether 108 subjects need to be enrolled. DISCUSSION Complex surgical procedures are performed in a minimally invasive/laparoscopic technique. This study should provide some evidence to decide which display technique a surgeon could choose to optimize his performance. TRIAL REGISTRATION ClinicalTrials.gov, NCT03445429 . Registered on 7 February 2018.
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Affiliation(s)
- Roger Wahba
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Rabi Raj Datta
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Andrea Hedergott
- Department of Ophthalmology, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Jana Bußhoff
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Thomas Bruns
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Robert Kleinert
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Georg Dieplinger
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Hans Fuchs
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Caroline Giezelt
- Department of Ophthalmology, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Desdemona Möller
- Faculty of Management, Economics and Social Sciences, Department of Business Administration and Health Care Management, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Christiane J. Bruns
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Dirk L. Stippel
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
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27
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Broudeur L, Karam G, Chelghaf I, De Vergie S, Rigaud J, Perrouin Verbe MA, Branchereau J. Feasibility and safety of laparoscopic living donor nephrectomy in case of right kidney and multiple-renal artery kidney: a systematic review of the literature. World J Urol 2019; 38:919-927. [PMID: 31129713 DOI: 10.1007/s00345-019-02821-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 05/21/2019] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To access the current status of the security and feasibility of right kidney (RK) and multiple-renal artery (MRA) laparoscopic living donor nephrectomy (LLDN) which are more challenging compared to left kidney (LK) and single renal artery (SRA) because of a shorter renal vein and more complex vascular anatomy. METHODS We did a systematic review of the literature according to the PRISMA recommendations, reporting RK or MRA donor nephrectomy performed with a laparoscopic technique compared to LK or SRA kidney LLDN. The identified and analyzed primary outcomes of interest were operating time (OT), warm ischemia time (WIT), rate of conversion and transfusion, donor length of stay (LOS), delayed graft function (DGF) and rate of graft loss (GL). RESULTS 16 comparative studies (1397 cases) of RK-LLDN and 12 comparative studies including 15 series (993 cases) of MRA-LLDN were selected. For RK-LLDN review, conversion rate was 0.8% and blood transfusion rate 0.2%, only one case of graft venous thrombosis was reported, OT was shorter in four studies and there was no any difference of DGF and GL rate compared to LK-LLDN. For MRA-LLDN review, conversion rate was 1.3% and blood transfusion rate 1.1%, OT and WIT were longer compared to SRA-LLDN, there were more ureteral complications in two studies, and no difference in terms of vascular complications and graft loss rate. CONCLUSION RK-LLDN and MRA-LLDN would be similar to LK-LLDN and SRA-LLDN in terms of feasibility and safety for the donor as well as graft function results for RK-LLDN.
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Affiliation(s)
- L Broudeur
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - G Karam
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - I Chelghaf
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - S De Vergie
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - J Rigaud
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - M A Perrouin Verbe
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France
| | - Julien Branchereau
- Department of Urology and Transplantation Surgery, University Hospital Center, 1 Place Alexis Ricordeau, 44093, Nantes Cedex 03, France. .,Centre de Recherche en Transplantation et Immunologie (ou CRTI), Inserm, Nantes University, Nantes, France. .,Institut de Transplantation Urologie Néphrologie (ou ITUN), CHU Nantes, Nantes, France.
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28
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Noguchi H, Kakuta Y, Okumi M, Omoto K, Okabe Y, Ishida H, Nakamura M, Tanabe K. Pure versus hand-assisted retroperitoneoscopic live donor nephrectomy: a retrospective cohort study of 1508 transplants from two centers. Surg Endosc 2019; 33:4038-4047. [PMID: 30888499 DOI: 10.1007/s00464-019-06697-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 02/06/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Although minimally invasive procedures have been established as the standard for a donor nephrectomy, there are many different surgical techniques described in the literature. The aim of this study is to compare the outcomes of kidney transplant procedures using the pure retroperitoneoscopic donor nephrectomy (PRDN) and hand-assisted retroperitoneoscopic donor nephrectomy (HARDN) techniques. METHODS A retrospective study involving 1508 transplant procedures was conducted; 874 were PRDN procedures; and 634 were HARDN. We reviewed the outcomes of the PRDN and HARDN groups, which were performed at two different centers over an identical time period. RESULTS Donors in the PRDN group had a longer operation time (P < 0.0001), reduced estimated blood loss (P < 0.0001), less open conversion (P = 0.0002), lower postoperative serum C-reactive protein levels (P < 0.0001), and a shorter postoperative hospital stay (P < 0.0001) than the HARDN group. Recipients in the PRDN group had lower serum creatinine levels at postoperative day 1-6 and the decreased incidence of slow graft function (P = 0.0017) than the HARDN group. The HARDN procedure was an independent risk factor for the incidence of acute rejection (P = 0.0211) and graft loss (P = 0.0193). CONCLUSIONS Our study suggests that the PRDN procedure is less invasive for donors as it results in reduced blood loss, lower postoperative serum CRP levels, and a shorter postoperative stay than the HARDN procedure. Additionally, PRDN provides a better outcome for recipients as it lowers the incidence of acute rejection and improves graft survival compared to HARDN.
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Affiliation(s)
- Hiroshi Noguchi
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan.,Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoichi Kakuta
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Masayoshi Okumi
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Kazuya Omoto
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Yasuhiro Okabe
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan.
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Lentine KL, Lam NN, Segev DL. Risks of Living Kidney Donation: Current State of Knowledge on Outcomes Important to Donors. Clin J Am Soc Nephrol 2019; 14:597-608. [PMID: 30858158 PMCID: PMC6450354 DOI: 10.2215/cjn.11220918] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In the past decade, there have been increasing efforts to better define and quantify the short- and long-term risks of living kidney donation. Recent studies have expanded upon the previous literature by focusing on outcomes that are important to potential and previous donors, applying unique databases and/or registries to follow large cohorts of donors for longer periods of time, and comparing outcomes with healthy nondonor controls to estimate attributable risks of donation. Leading outcomes important to living kidney donors include kidney health, surgical risks, and psychosocial effects of donation. Recent data support that living donors may experience a small increased risk of severe CKD and ESKD compared with healthy nondonors. For most donors, the 15-year risk of kidney failure is <1%, but for certain populations, such as young, black men, this risk may be higher. New risk prediction tools that combine the effects of demographic and health factors, and innovations in genetic risk markers are improving kidney risk stratification. Minor perioperative complications occur in 10%-20% of donor nephrectomy cases, but major complications occur in <3%, and the risk of perioperative death is <0.03%. Generally, living kidney donors have similar or improved psychosocial outcomes, such as quality of life, after donation compared with before donation and compared with nondonors. Although the donation process should be financially neutral, living kidney donors may experience out-of-pocket expenses and lost wages that may or may not be completely covered through regional or national reimbursement programs, and may face difficulties arranging subsequent life and health insurance. Living kidney donors should be fully informed of the perioperative and long-term risks before making their decision to donate. Follow-up care allows for preventative care measures to mitigate risk and ongoing surveillance and reporting of donor outcomes to inform prior and future living kidney donors.
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Affiliation(s)
- Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri; .,Department of Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Ngan N Lam
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada; and
| | - Dorry L Segev
- Department of Surgery and .,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
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Bruintjes MH, Albers KI, Gurusamy KS, Rovers MM, van Laarhoven CJHM, Warle MC. Deep neuromuscular blockade in adults undergoing an abdominal laparoscopic procedure. Hippokratia 2018. [DOI: 10.1002/14651858.cd013197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Moira H Bruintjes
- Radboud University Nijmegen Medical Center; Department of Surgery; Geert Grooteplein Zuid 10 Nijmegen Netherlands 6525 GA
| | - Kim I Albers
- Radboud University Nijmegen Medical Centre; Department of Anesthesiology; Nijmegen Netherlands
| | - Kurinchi Selvan Gurusamy
- University College London; Division of Surgery and Interventional Science; 9th Floor, Royal Free Hospital Rowland Hill Street London UK NW3 2PF
| | - Maroeska M Rovers
- Radboud University Nijmegen Medical Centre; Department of Operating Rooms; Hp 630, route 631 PO Box 9101 Nijmegen Netherlands 6500 HB
| | - Cornelis JHM van Laarhoven
- Radboud University Nijmegen Medical Centre; Department of Surgery; PO Box 9101 internal code 618 Nijmegen Netherlands 6500 HB
| | - Michiel C Warle
- Radboud University Nijmegen Medical Center; Department of Surgery; Geert Grooteplein Zuid 10 Nijmegen Netherlands 6525 GA
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Hager B, Herzog SA, Hager B, Sandner-Kiesling A, Zigeuner R, Pummer K. Comparison of early postoperative pain after partial tumour nephrectomy by flank, transabdominal or laparoscopic access. Br J Pain 2018; 13:177-184. [PMID: 31308942 DOI: 10.1177/2049463718808542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim To explore whether the total pain experience differs after (partial) kidney tumour nephrectomies via flank, transabdominal or laparoscopic access. Materials and methods We analyzed retrospectively 107 patients with flank, 12 with transabdominal and 21 with laparoscopic interventions. For pain treatment, conventional analgesics (A) or intravenous patient-controlled analgesia (PCIA) or thoracic peridural analgesia (tPDA) were used. Self-reported pain was measured with a Visual Analogue Scale three times daily. The area under the curve (AUC) at rest (R) and during a standardized body movement (M) were calculated from the intervention till the end of the second T(0-2) and seventh postoperative day T(0-7), respectively. Results The median AUC for T(0-2) at R was more intense for laparoscopy (13) than for flank incision (A, 9) and approximately the same during M. For flank incisions (A), the median AUC at R rises from 9 for T(0-2) to 22 for T(0-7) and at M the median AUC increases from 18 to 37. In contrast, laparoscopy did not cause further pain after the second postoperative day. Furthermore, with flank incision for T(0-2), at R, tPDA was superior to A (median AUC: 5 versus 9, p = 0.02) and at M again tPDA (median AUC: 12) had a better pain-control as A (18) or even as PCIA (19, p = 0.005). Conclusion Laparoscopic nephrectomies cause a relatively intense mean cumulative pain for T(0-2) and a subsequent absence of pain. However, flank incisions went on to increased pain levels until the seventh postoperative day with tPDA as most effective therapy.
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Affiliation(s)
- Boris Hager
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Sereina A Herzog
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Barbara Hager
- Department of Anesthesiology, Medical University of Graz, Graz, Austria
| | | | - Richard Zigeuner
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Karl Pummer
- Department of Urology, Medical University of Graz, Graz, Austria
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Broe MP, Galvin R, Keenan LG, Power RE. Laparoscopic and hand-assisted laparoscopic donor nephrectomy: A systematic review and meta-analysis. Arab J Urol 2018; 16:322-334. [PMID: 30140469 PMCID: PMC6104662 DOI: 10.1016/j.aju.2018.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 02/08/2018] [Indexed: 01/11/2023] Open
Abstract
Objective To compare the perioperative outcomes of hand-assisted laparoscopic donor nephrectomy (HALDN) and pure LDN, as HALDN and LDN are the two most widely used techniques of DN to treat end-stage renal disease. Methods In this systematic review and meta-analysis, we performed a literature search of PubMed, Embase, Web of Science, and Cochrane from 01/01/1995 to 31/12/2014. The primary outcome was conversion to an open procedure. Secondary outcomes were warm ischaemia time (WIT), operation time (OT), estimated blood loss (EBL), complications, and length of stay (LOS). Data analysed were presented as odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs), I2, and P values. Subgroup analysis was performed. Results There were 24 studies included in the meta-analysis; three randomised controlled trials (RCTs), one randomised pilot study, two prospective, and 18 retrospective cohort studies. There were no differences in conversion to an open procedure between the two techniques for both RCTs (OR 0.42, 95% CI 0.06, 2.90; I2 = 0%, P < 0.001) and cohort studies (OR 1.06, 95% CI 0.63, 1.78; I2 = 0%, P = 0.84). WIT was shorter for the HALDN (-41.79 s, 95% CI -71.85, -11.74; I2 = 96%, P = 0.006), as was the OT (-26.32 min, 95% CI -40.67, -11.97; I2 = 95%, P < 0.001). There was no statistically significant difference in EBL, complications or LOS. Conclusion There is little statistical evidence to recommend one technique. HALDN is associated with a shorter WIT and OT. LDN has equal safety to HALDN. Further studies are required.
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Key Words
- (L)DN, (laparoscopic) donor nephrectomy
- BMI, body mass index
- EBL, estimated blood loss
- FEM, fixed-effects model
- HALDN, hand-assisted laparoscopic donor nephrectomy
- HARPDN, hand-assisted retroperitoneal donor nephrectomy
- Hand-assisted donor nephrectomy
- LOS, length of stay
- Laparoscopic donor nephrectomy
- OR, odds ratio
- OT, operation time
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analyses
- RALDN, robot-assisted laparoscopic donor nephrectomy
- RCT, randomised controlled trial
- REM, random-effects model
- Renal transplantation
- WIT, warm ischaemia time
- WMD, weighted mean difference
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Affiliation(s)
- Mark P Broe
- Department of Urology and Renal Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Rose Galvin
- Department of Postgraduate Studies, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Lorna G Keenan
- Department of Urology and Renal Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Richard E Power
- Department of Urology and Renal Transplantation, Beaumont Hospital, Dublin, Ireland
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Kim TS, Kang SH, Kang PM, Ha H, Kim SD, Yoon J, Hwang H. Clinical significance of serum neutrophil gelatinase-associated lipocalin in the early diagnosis of renal function deterioration after radical nephrectomy. KOSIN MEDICAL JOURNAL 2018. [DOI: 10.7180/kmj.2018.33.1.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives The standard metrics used to monitor the progression of acute kidney injury (AKI) include markers such as serum creatinine, blood urea nitrogen, and estimated glomerular filtration rate (eGFR). Moreover, neutrophil gelatinase-associated lipocalin (NGAL) expression has been reported to modulate oxidative stress. Methods We aimed to evaluate the usefulness of serum NGAL levels for monitoring renal function after radical nephrectomy (RN). We prospectively collected data from 30 patients who underwent RN. We analyzed serum NGAL and creatinine at 6 time points: preoperative day 1, right after surgery, 6 hours after surgery, postoperative day (POD) 1, POD 3, and POD 5. We compared these measurements according to the eGFR values (classified as chronic kidney disease stage III; CKD III or not) using data obtained 3 months after surgery. Results The mean age was 65.5 years (range, 45–77 years), and the male-to-female ratio was 2:1. At the last follow-up examination, there were 12 patients (40%) with CKD III. Using receiver operating characteristic analysis, we found that serum creatinine on POD 5 (area under the curve [AUC], 0.887; P = 0.000) and NGAL at 6 hours after LRN (AUC, 0.743, P = 0.026) were significant predictors of CKD III. The development of CKD III after LRN was associated with the serum creatinine level on POD 5 and the NGAL at 6 hours after surgery. Conclusions Compared to serum creatinine, serum NGAL enabled earlier prediction of postoperative CKD III. Therefore, serum NGAL measured 6 hours after surgery could be a useful marker for managing patients after RN.
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Sevinç C, Özkaptan O, Balaban M, Karadeniz T, As A, Çicek NSK, Sarıyar M, Şahin S, Tuğcu V. Hand-assisted laparoscopic and laparoscopic donor nephrectomy: A comparison of surgical outcomes from two centres. Turk J Urol 2018; 44:362-366. [PMID: 29932406 DOI: 10.5152/tud.2018.67424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 02/21/2018] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of the study was to compare the different surgical approaches of two centers on outcomes of live donor laparoscopic nephrectomy. MATERIAL AND METHODS The first 98 patients of each centre who underwent laparoscopic donor nephrectomy (LDN) or hand-assisted laparoscopic donor nephrectomy (HALDN) were included in the study. The following data were used for analyses: donor age, weight, height, body mass index (BMI), transfusion requirement, operative time, ischemia time and postoperative complications. RESULTS Median age, BMI, operation time and estimated blood loss (EBL) was 47.29 years, 27.91 kg/m2, 110.73 minutes, and 78.95 mL, respectively. Operation time was significantly shorter in the HALDN group (t=-3.554, p<0.01). EBL was not significantly different between the two groups. The difference in hospitalization time and warm ischemia times (WIT) was not significant between the two surgical technique groups (t=-1.554, t=1.258; p>0.05). No statistically significant difference was detected in the intraoperative and postoperative complication rates between two groups (p>0.05). The postoperative complication rate was 7.14% (n=7) and 6.12% (n=6) in the LDN and HALDN groups, respectively. There were two patients with conversion to open surgery in the HALDN group because of lumbar vein injury. CONCLUSION The operative and postoperative outcomes for the two techniques were found to be similar. The HALDN technique preserves the benefits of minimally invasive surgery. In experienced urologic laparoscopy centres both techniques promise similar success rates.
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Affiliation(s)
- Cüneyd Sevinç
- Department of Urology, Medicana International Hospital, İstanbul, Turkey
| | - Orkunt Özkaptan
- Department of Urology, Medicana International Hospital, İstanbul, Turkey
| | - Muhsin Balaban
- Department of Urology, Medicana International Hospital, İstanbul, Turkey
| | - Tahir Karadeniz
- Department of Urology, Medicana International Hospital, İstanbul, Turkey
| | - Abdullah As
- Department of General Surgery, Medicana International, İstanbul, Turkey
| | | | - Muzaffar Sarıyar
- Department of General Surgery, Medicana International, İstanbul, Turkey
| | - Selçuk Şahin
- Department of Urology and Kidney Transplantation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Volkan Tuğcu
- Department of Urology and Kidney Transplantation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
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Özdemir-van Brunschot DMD, Scheffer GJ, van der Jagt M, Langenhuijsen H, Dahan A, Mulder JEEA, Willems S, Hilbrands LB, Donders R, van Laarhoven CJHM, d'Ancona FA, Warlé MC. Quality of Recovery After Low-Pressure Laparoscopic Donor Nephrectomy Facilitated by Deep Neuromuscular Blockade: A Randomized Controlled Study. World J Surg 2018; 41:2950-2958. [PMID: 28608013 PMCID: PMC5643361 DOI: 10.1007/s00268-017-4080-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background The use of low intra-abdominal pressure (<10 mmHg) reduces postoperative pain scores after laparoscopic surgery.
Objective To investigate whether low-pressure pneumoperitoneum with deep neuromuscular blockade improves the quality of recovery after laparoscopic donor nephrectomy (LDN). Design, setting and participants In a single-center randomized controlled trial, 64 live kidney donors were randomly assigned to 6 or 12 mmHg insufflation pressure. A deep neuromuscular block was used in both groups. Surgical conditions were rated by the five-point Leiden-surgical rating scale (L-SRS), ranging from 5 (optimal) to 1 (extremely poor) conditions. If the L-SRS was insufficient, the pressure was increased stepwise.
Main outcome measure The primary outcome measure was the overall score on the quality of recovery-40 (QOR-40) questionnaire at postoperative day 1. Results The difference in the QOR-40 scores on day 1 between the low- and standard-pressure group was not significant (p = .06). Also the overall pain scores and analgesic consumption did not differ. Eight procedures (24%), initially started with low pressure, were converted to a standard pressure (≥10 mmHg). A L-SRS score of 5 was significantly more prevalent in the standard pressure as compared to the low-pressure group at 30 min after insufflation (p < .01). Conclusions Low-pressure pneumoperitoneum facilitated by deep neuromuscular blockade during LDN does not reduce postoperative pain scores nor improve the quality of recovery in the early postoperative phase. The question whether the use of deep neuromuscular blockade during laparoscopic surgery reduces postoperative pain scores independent of the intra-abdominal pressure should be pursued in future studies. Trial registration The trial was registered at clinicaltrial.gov before the start of the trial (NCT02146417).
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Affiliation(s)
| | - Gert J Scheffer
- Department of Anesthesiology, Radboudumc, Nijmegen, The Netherlands
| | - Michel van der Jagt
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | | | - Albert Dahan
- Department of Anesthesiology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Simone Willems
- Department of Anesthesiology, Radboudumc, Nijmegen, The Netherlands
| | | | - Rogier Donders
- Department of HTA, Radboudumc, Nijmegen, The Netherlands
| | - Cees J H M van Laarhoven
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | | | - Michiel C Warlé
- Department of Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands.
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Luk ACO, Pandian RMK, Heer R. Laparoscopic renal surgery is here to stay. Arab J Urol 2018; 16:314-320. [PMID: 30140467 PMCID: PMC6104665 DOI: 10.1016/j.aju.2018.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/23/2018] [Indexed: 01/20/2023] Open
Abstract
Objectives To review the current literature comparing the outcomes of renal surgery via open, laparoscopic and robotic approaches. Materials and methods A comprehensive literature search was performed on PubMed, MEDLINE and Ovid, to look for studies comparing outcomes of renal surgery via open, laparoscopic, and robotic approaches. Results Limited good-quality evidence suggests that all three approaches result in largely comparable functional and oncological outcomes. Both laparoscopic and robotic approaches result in less blood loss, analgesia requirement, with a shorter hospital stay and recovery time, with similar complication rates when compared with the open approach. Robotic renal surgeries have not shown any significant clinical benefit over a laparoscopic approach, whilst the associated cost is significantly higher. Conclusion With the high cost and lack of overt clinical benefit of the robotic approach, laparoscopic renal surgery will likely continue to remain relevant in treating various urological pathologies.
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Key Words
- (L)(LESS-)DN, (laparoscopic) (laparoendoscopic single-site-) donor nephrectomy
- (L)(O)(RA)PN, (laparoscopic) (open) (robot-assisted) partial nephrectomy
- (L)(O)(RA)PY, (laparoscopic) (open) (robot-assisted) pyeloplasty
- (L)(O)(RA)RN, (laparoscopic) (open) (robot-assisted) radical nephrectomy
- BMI, body mass index
- Donor nephrectomy
- LOS, length of hospital stay
- Laparoscopic/open/robotic renal surgery
- NOTES, natural orifice transluminal endoscopic surgery
- PUJO, PUJ obstruction
- Partial nephrectomy
- Pyeloplasty
- RCT, randomised controlled trial
- Radical nephrectomy
- WIT, warm ischaemia time
- eGFR, estimated GFR
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Affiliation(s)
- Angus Chin On Luk
- Department of Urology, Freeman Hospital, High Heaton, Newcastle upon Tyne, UK
| | | | - Rakesh Heer
- Department of Urology, Freeman Hospital, High Heaton, Newcastle upon Tyne, UK
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Uwechue R, Chandak P, Ahmed Z, Gogalniceanu P, Kessaris N, Mamode N. Minimally invasive surgical techniques for kidney transplantation. Hippokratia 2017. [DOI: 10.1002/14651858.cd012698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Raphael Uwechue
- Department of Transplantation; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - Pankaj Chandak
- Department of Transplant Surgery; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - Zubir Ahmed
- General and Transplant Surgery; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - Petrut Gogalniceanu
- Department of Transplantation; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - Nicos Kessaris
- Department of Transplantation; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - Nizam Mamode
- Department of Transplantation; Guy's and St Thomas' NHS Foundation Trust; London UK
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Lafranca JA, Spoon EQW, van de Wetering J, IJzermans JNM, Dor FJMF. Attitudes among transplant professionals regarding shifting paradigms in eligibility criteria for live kidney donation. PLoS One 2017; 12:e0181846. [PMID: 28732093 PMCID: PMC5521829 DOI: 10.1371/journal.pone.0181846] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/26/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The transplant community increasingly accepts extended criteria live kidney donors, however, great (geographical) differences are present in policies regarding the acceptance of these donors, and guidelines do not offer clarity. The aim of this survey was to reveal these differences and to get an insight in both centre policies as well as personal beliefs of transplant professionals. METHODS An online survey was sent to 1128 ESOT-members. Questions were included about several extended donor criteria; overweight/obesity, older age, vascular multiplicity, minors as donors and comorbidities; hypertension, impaired fasting glucose, kidney stones, malignancies and renal cysts. Comparisons were made between transplant centres of three regions in Europe and between Europe and other countries worldwide. RESULTS 331 questionnaires were completed by professionals from 55 countries. Significant differences exist between regions in Europe in acceptance of donors with several extended criteria. Median refusal rate for potential live donors is 15%. Furthermore, differences are seen regarding pre-operative work-up, both in specialists who perform screening as in preoperative imaging. CONCLUSIONS Remarkably, 23.4% of transplant professionals sometimes deviate from their centre policy, resulting in more or less comparable personal beliefs regarding extended criteria. Variety is seen, proving the need for a standardized approach in selection, preferably evidence based.
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Affiliation(s)
- Jeffrey A. Lafranca
- Department of Surgery, division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Emerentia Q. W. Spoon
- Department of Surgery, division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jacqueline van de Wetering
- Department of Internal Medicine, division of Nephrology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan N. M. IJzermans
- Department of Surgery, division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank J. M. F. Dor
- Department of Surgery, division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
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Agrawal T, Kumar R, Singh P, Saini A, Seth A, Dogra P. Have we overcome the complications of laparoscopic nephrectomy? A prospective, cohort study using the modified Clavien-Dindo scale. Indian J Urol 2017; 33:216-220. [PMID: 28717272 PMCID: PMC5508433 DOI: 10.4103/iju.iju_47_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Apart from the complexity of procedure and surgeon's experience, surgical complication rates depend on case definition and method of recording data. We prospectively evaluated the complications of laparoscopic nephrectomy (LN) in a current cohort of patients, graded on the modified Clavien-Dindo (CD) scale and compared them with historical cohorts. METHODS In the Institutional Review Board approved protocol, all patients undergoing LN over a 30-month were enrolled in the study. Clinical parameters, operative data, inhospital course, and 30-day follow-up were recorded prospectively in an electronic database by a resident who did not perform any of the surgeries. The complications were analyzed using the CD scale. RESULTS A total of 103 patients (age 14-80 years) underwent LN (30 radical, 73 simple) during the study period. Forty-three of these procedures were for inflammatory conditions (stone disease or tuberculosis). Six procedures were converted to open surgery due to vascular injury (2), bowel injury (1), and adhesions (3). There were 45 (46%) complications in the 97 procedures completed laparoscopically including 34 low-grade (CD grade 1, 2) and 11 high-grade (CD grade 3, 4) complications. There was no mortality. Complications were similar in patients undergoing surgery for inflammatory or noninflammatory conditions. CONCLUSIONS LN continues to be associated with postoperative complications in 46% of cases. However, the complication rates appear to be higher than historical series, possibly due to the more rigorous case-definition and prospective recording.
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Affiliation(s)
- Tapan Agrawal
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhjot Singh
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Saini
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Amlesh Seth
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Premnath Dogra
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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He B, Mou L, De Roo R, Musk GC, Hamdorf JM. Evaluation of Three-Dimensional Versus Conventional Laparoscopy for Kidney Transplant Procedures in a Human Cadaveric Model. EXP CLIN TRANSPLANT 2017; 15:497-503. [PMID: 28447928 DOI: 10.6002/ect.2016.0177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES There are increased reports that kidney transplant can be performed by laparoscopic surgery. The further development of this technique could revolutionize human kidney transplant surgery. However, laparoscopic kidney transplant demands a high level of skill for vascular anastomoses. The emerging technology of the three-dimensional, high-definition laparoscopic system may facilitate the application of this technique. Therefore, in this study, we evaluated this system in performing kidney transplant surgery versus the two-dimensional laparoscopic system. MATERIALS AND METHODS Four fresh-frozen human cadavers were used in this study, with 2 for the 3-dimensional and 2 for the 2-dimensional system. Kidneys were retrieved by using the retroperitoneoscopic technique for living donor nephrectomy from the same cadaver. The kidney graft was transplanted at the right iliac fossa using a laparoscopic technique by extraperitoneal approach. The procedure was recorded, and the vessel anastomotic time was analyzed. RESULTS Kidney transplant procedures were conducted successfully in the 3-dimensional, high-definition and the 2-dimensional groups. We recorded no significant differences in terms of vessel anastomotic time between the 2 groups. The total surgery time was shorter in the 3-dimensional, high-definition group than in the 2-dimensional group (P = .02). CONCLUSIONS This pilot study reinforces that kidney transplant with either the 3-dimensional, high-definition or 2-dimensional laparoscopy is feasible in a human cadaveric model. The operation was the same as open kidney transplant, but the procedure was performed by a laparoscopic approach with a smaller incision.
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Affiliation(s)
- Bulang He
- From the Western Australia Liver and Kidney Transplant Service, Sir Charles Gairdner Hospital, Perth, Australia; and the School of Surgery, The University of Western Australia, Perth, Australia
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Bruintjes MHD, Braat AE, Dahan A, Scheffer GJ, Hilbrands LB, d'Ancona FCH, Donders RART, van Laarhoven CJHM, Warlé MC. Effectiveness of deep versus moderate muscle relaxation during laparoscopic donor nephrectomy in enhancing postoperative recovery: study protocol for a randomized controlled study. Trials 2017; 18:99. [PMID: 28259181 PMCID: PMC5336688 DOI: 10.1186/s13063-017-1785-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 01/05/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Postoperative recovery after live donor nephrectomy is largely determined by the consequences of postoperative pain and analgesia consumptions. The use of deep neuromuscular blockade has been shown to reduce postoperative pain scores after laparoscopic surgery. In this study, we will investigate whether deep neuromuscular blockade also improves the early quality of recovery after live donor nephrectomy. METHODS The RELAX-study is a phase IV, multicenter, double-blinded, randomized controlled trial, in which 96 patients, scheduled for living donor nephrectomy, will be randomized into two groups: one with deep and one with moderate neuromuscular blockade. Deep neuromuscular blockade is defined as a post-tetanic count of 1-2. Our primary outcome measurement will be the Quality of Recovery-40 questionnaire (overall score) at 24 h after extubation. DISCUSSION This study is, to our knowledge, the first randomized study to assess the effectiveness of deep neuromuscular blockade during laparoscopic donor nephrectomy in enhancing postoperative recovery. The study findings may also be applicable for other laparoscopic procedures. TRIAL REGISTRATION clinicaltrials.gov, NCT02838134 . Registered on 29 June 2016.
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Affiliation(s)
- Moira H D Bruintjes
- Department of Surgery, Division of Vascular and Transplant Surgery, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands.
| | - Andries E Braat
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Albert Dahan
- Department of Anesthesiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Gert-Jan Scheffer
- Department of Anesthesiology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - Frank C H d'Ancona
- Department of Urology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - Rogier A R T Donders
- Department for Health Evidence, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - Cornelis J H M van Laarhoven
- Department of Surgery, Division of General Surgery, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
| | - Michiel C Warlé
- Department of Surgery, Division of Vascular and Transplant Surgery, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
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Elmaraezy A, Abushouk AI, Kamel M, Negida A, Naser O. Should hand-assisted retroperitoneoscopic nephrectomy replace the standard laparoscopic technique for living donor nephrectomy? A meta-analysis. Int J Surg 2017; 40:83-90. [PMID: 28216391 DOI: 10.1016/j.ijsu.2017.02.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/12/2017] [Accepted: 02/14/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We performed this meta-analysis to compare hand-assisted retroperitoneoscopic (HARP) and traditional laparoscopic (TLS) techniques for living donor nephrectomy. METHODS We searched PubMed, Cochrane Central, EMBASE, and Web of science for prospective studies, comparing HARP and TLS techniques. Data were extracted from eligible studies and pooled as risk ratios (RR) or standardized mean difference (SMD), using RevMan software (version 5.3 for windows). We performed a sensitivity analysis to test the robustness of our evidence and a subgroup analysis to stratify intraoperative complications on Clavien-Dindo score. RESULTS Seven studies (498 patients) were included in the final analysis. HARP was superior to TLS in terms of shortening the operative duration (SMD = -0.84, 95% CI [-1.18 to -0.50]) and warm ischemia time (SMD = -0.93, 95% CI [-1.13 to -0.72]). There was no significant difference between HARP and TLS in terms of blood loss (SMD = 0.13, 95% CI [-0.50 to 0.76]), hospital stay (SMD = -0.27, 95% CI [-0.70 to 0.15]) or graft survival (RR = 0.97, 95% CI [0.92 to 1.02]). The overall risk ratio of intraoperative complications did not differ significantly between the two groups (RR = 0.62, 95% CI [0.31 to 1.21]). CONCLUSION Our meta-analysis shows that HARP was associated with a shorter surgery duration and less warm ischemia time than TLS. However, no significant differences were found between the two groups in terms of graft survival or intraoperative complication rates. We recommend HARP over TLS for living donor nephrectomy; however, future studies with larger sample sizes are recommended to compare both techniques in terms of operative safety and quality of life outcomes.
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Affiliation(s)
- Ahmed Elmaraezy
- Medical Research Group of Egypt, Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, 11884, Egypt; NovaMed Medical Research Association, Cairo, Egypt
| | - Abdelrahman Ibrahim Abushouk
- Medical Research Group of Egypt, Cairo, Egypt; NovaMed Medical Research Association, Cairo, Egypt; Faculty of Medicine, Ain Shams University, Cairo, 11566, Egypt.
| | - Moaz Kamel
- Medical Research Group of Egypt, Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, 11884, Egypt
| | - Ahmed Negida
- Medical Research Group of Egypt, Cairo, Egypt; Faculty of Medicine, Zagazig University, El-Sharkia, Egypt; Student Research Unit, Zagazig University, El-Sharkia, Egypt
| | - Omar Naser
- Urological Surgery Department, West Wales General Hospital, UK
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Mackinnon S, Aitken E, Ghita R, Clancy M. A comparison of the effects of oral vs. intravenous hydration on subclinical acute kidney injury in living kidney donors: a protocol of a randomised controlled trial. BMC Nephrol 2017; 18:30. [PMID: 28103829 PMCID: PMC5244581 DOI: 10.1186/s12882-017-0447-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/11/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Optimal treatment for established renal failure is living donor kidney transplantation. However this pathway exposes healthy individuals to significant reduction in nephron mass via major surgical procedure. Laparoscopic donor nephrectomy is now the most common method for live donor transplantation, reducing both donor post-operative pain and recovery time. However this procedure exposes kidneys to additional haemodynamic stresses. It has been suggested that donor hydration-particularly the use of preoperative intravenous fluids-may counteract these stresses, reducing subclinical acute kidney injury and ultimately improving long-term renal function. This may be important in both preservation of donor renal function and recipient graft longevity. METHODS/DESIGN A prospective single-centre single-blinded randomized controlled trial will be carried out to determine the effects of donor preoperative intravenous fluids. The primary outcome is donor subclinical acute kidney injury (defined as plasma NGAL, >153 ng/ml) on day 1 postoperatively. Secondary outcomes include intraoperative haemodynamics, recipient subclinical acute kidney injury, perioperative complications and donor sleep quality. Donors will be randomised into two groups: the intervention group will receive active pre-hydration consisting of three litres of intravenous Hartmann's solution between midnight and 8 am before morning kidney donation, while the control group will not receive this. Both groups will receive unlimited oral fluids until midnight, as is routine. Plasma NGAL will be measured at pre-specified perioperative time points, intraoperative haemodynamic data will be collected using non-invasive cardiac output monitoring and clinical notes will be used to obtain demographic and clinical data. The researcher will be blinded to the donor fluid hydration status. Blinded statistical analysis will be performed on an intention-to-treat basis. A prospective power calculation estimates a required sample size of 86 patients. DISCUSSION This study will provide important data, as there is currently little evidence about the use of donor preoperative fluids in laparoscopic nephrectomy. It is hoped that the results obtained will guide future clinical practice. TRIAL REGISTRATION This study has been approved by the West of Scotland Research Ethics Committee 3 (reference no. 14/WS/1160, 27 January 2015) and is registered with the International Standard Randomised Controlled Trial Number Register (reference no. ISRCTN10199225 , 20 April 2015).
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Affiliation(s)
- Shona Mackinnon
- Department of Renal Transplantation, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK.
- College of Medical, Veterinary and Life Sciences, Wolfson Medical School Building, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK.
| | - Emma Aitken
- Department of Renal Transplantation, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Ryan Ghita
- Department of Renal Transplantation, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Marc Clancy
- Department of Renal Transplantation, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
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Özdemir-van Brunschot DMD, Warlé MC. Is the Reluctance for the Implantation of Right Kidneys Justified: Reply. World J Surg 2016; 41:326-327. [PMID: 27853814 PMCID: PMC5209412 DOI: 10.1007/s00268-016-3808-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
| | - Michiel C Warlé
- Department of Vascular and Transplant Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Abstract
Background The lengths of right renal veins are shorter when compared to their left counterparts. Since the implantation of kidneys with short renal veins is considered more challenging, many surgeons prefer left kidneys for transplantation. Therefore, our hypothesis is that the implantation of right kidneys from living and deceased donors is associated with more technical graft failures as compared to left kidneys. Methods Two consecutive cohorts of adult renal allograft recipients of living (n = 4.372) and deceased (n = 5.346) donor kidneys between January 1, 2000 and January 1, 2013 were analyzed. Data were obtained from the prospectively maintained electronic database of the Dutch Organ Transplant Registry. Technical graft failure was defined as failure of the renal allograft within 10 days after renal transplantation without signs of acute rejection. Results In the living donor kidney transplantation cohort, the implantation of right donor kidneys was associated with a higher incidence of technical graft failure (multivariate analysis p = 0.03). For recipients of deceased donor kidneys, the implantation of right kidneys was not significantly associated with technique-related graft failure (multivariate analysis p = 0.16). Conclusions Our data show that the implantation of right kidneys from living donors is associated with a higher incidence of technique-related graft failure as compared to left kidneys.
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Rampersad C, Patel P, Koulack J, McGregor T. Back-to-back comparison of mini-open vs. laparoscopic technique for living kidney donation. Can Urol Assoc J 2016; 10:253-257. [PMID: 27878046 DOI: 10.5489/cuaj.3725] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Laparoscopic living donor nephrectomy is the standard of care at high-volume renal transplant centres, with benefits over the open approach well-documented in the literature. Herein, we present a retrospective analysis of our single-institution donor nephrectomy series comparing the mini-open donor nephrectomy (mini-ODN) to the laparoscopic donor nephrectomy (LDN) with regards to operative, donor, and recipient outcomes. METHODS From 2007-2011, there were 89 cases of mini-ODN, at which point our centre transitioned to LDN; 94 cases were performed from 2011-2014. In total, 366 patients were reviewed, including donor and recipient pairs. Donor and recipient demographics, intraoperative data, postoperative donor recovery, recipient graft outcomes, and financial cost were assessed comparing the surgical approaches. RESULTS We demonstrate a reduced estimated blood loss (347.83 vs. 90.3 cc), lower intraoperative complication rate (4 vs. 11) and shorter length of hospital stay (2.4 vs. 3.3 days) for patients in the LDN group. Operative time was significantly longer for the LDN group (108.4 vs. 165.9 minutes), although this did not translate to a longer warm ischemia time (mean 2.0 minutes for each group). The rate of delayed graft function and recipient 12-month creatinine were comparable for ODN and LND. Overall cost of LDN was $684 higher for an uncomplicated admission. CONCLUSIONS Despite a longer surgical time and higher upfront cost, our study supports that LDN yields several advantages over the mini-ODN, with a lower estimated blood loss, fewer intraoperative complications, and shorter length of hospital stay, all while maintaining excellent renal allograft outcomes.
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Affiliation(s)
| | - Premal Patel
- Section of Urology, University of Manitoba, Winnipeg, MB, Canada
| | - Joshua Koulack
- Section of Vascular Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Thomas McGregor
- Section of Urology, University of Manitoba, Winnipeg, MB, Canada
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Zhu YC, Lin J, Guo YW, Zhang L, Zhu X, Tian Y. Modified Hand-Assisted Retroperitoneoscopic Living Donor Nephrectomy with a Mini-Open Muscle Splitting Gibson Incision. Urol Int 2016; 97:186-94. [DOI: 10.1159/000445909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 04/03/2016] [Indexed: 11/19/2022]
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Assessing the effects of modality of surgery on postoperative weight loss in patients undergoing partial nephrectomy. World J Urol 2016; 35:271-275. [PMID: 27272313 DOI: 10.1007/s00345-016-1872-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/01/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To compare the early BMI changes postoperatively between patients undergoing open partial nephrectomy (OPN) and robotic partial nephrectomy (RPN). METHODS Patients undergoing open NSS for a single renal tumor between 2010 and 2013 were retrospectively selected for the study. These patients were matched with RPN patients based on preoperative BMI and tumor R.E.N.A.L nephrometry score (1:1 matching). RESULTS A total of 568 patients (284 pairs) met our inclusion criteria. The median time to lowest BMI was comparable between the OPN and RPN groups (24 vs. 29 days; p = 0.7). The mean BMI preservation was lower for the OPN group (96.8 ± 4.4 vs. 98.1 ± 4.7 %). On multivariable analysis after controlling for age, CCI, gender, tumor size, nephrometry score, estimated blood loss, occurrence of major complications and preoperative renal function, the modality of surgery favoring the RPN approach and the occurrence of major complications remained significant predictors for BMI preservation after surgery. CONCLUSIONS Occurrence of major complications is associated with weight loss after NSS. Minimally invasive NSS delivered by RPN had lower impact on BMI loss in patients undergoing the procedure compared to OPN. This finding further suggests that RPN delivers minimally invasive surgery beyond the boundaries of just smaller incision sites.
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Gupta A, Ahmed K, Kynaston HG, Dasgupta P, Chlosta PL, Aboumarzouk OM. Laparoendoscopic single-site donor nephrectomy (LESS-DN) versus standard laparoscopic donor nephrectomy. Cochrane Database Syst Rev 2016; 2016:CD010850. [PMID: 27230690 PMCID: PMC6823261 DOI: 10.1002/14651858.cd010850.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Advances in minimally invasive surgery for live kidney donors have led to the development of laparoendoscopic single site donor nephrectomy (LESS-DN). At present, laparoscopic donor nephrectomy is the technique of choice for donor nephrectomy globally. Compared with open surgical approaches, laparoscopic donor nephrectomy is associated with decreased morbidity, faster recovery times and return to normal activity, and shorter hospital stays. LESS-DN differs from standard laparoscopic donor nephrectomy; LESS-DN requires a single incision through which the procedure is performed and donor kidney is removed. Previous studies have hypothesised that LESS-DN may provide additional benefits for kidney donors and stimulate increased donor rates. OBJECTIVES This review looked at the benefits and harms of LESS-DN compared with standard laparoscopic nephrectomy for live kidney donors. SEARCH METHODS We searched the Cochrane Kidney and Transplant's Specialised Register to 28 January 2016 through contact with the Information Specialist using search terms relevant to this review. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared LESS-DN with laparoscopic donor nephrectomy in adults. DATA COLLECTION AND ANALYSIS Three authors independently assessed studies for eligibility and conducted risk of bias evaluation. Summary estimates of effect were obtained using a random-effects model and results were expressed as risk ratios (RR) or risk difference (RD) and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) and 95% CI for continuous outcomes. MAIN RESULTS We included three studies (179 participants) comparing LESS-DN with laparoscopic donor nephrectomy. There were no significant differences between LESS-DN and laparoscopic donor nephrectomy for mean operative time (2 studies, 79 participants: MD 6.36 min, 95% CI -11.85 to 24.57), intra-operative blood loss (2 studies, 79 participants: MD -8.31 mL, 95% CI -23.70 to 7.09), or complication rates (3 studies, 179 participants: RD 0.05, 95% CI -0.04 to 0.14). Pain scores at discharge were significantly less in the LESS-DN group (2 studies, 79 participants: MD -1.19, 95% CI -2.17 to -0.21). For all other outcomes (length of hospital stay; length of time to return to normal activities; blood transfusions; conversion to another form of surgery; warm ischaemia time; total analgesic requirement; graft loss) there were no significant differences observed.Although risk of bias was assessed as low overall, one study was assessed at high risk of attrition bias. AUTHORS' CONCLUSIONS Given the small number and size of included studies it is uncertain whether LESS-DN is better than laparoscopic donor nephrectomy. Well designed and adequately powered RCTs are needed to better define the role of LESS-DN as a minimally invasive option for kidney donor surgery.
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Affiliation(s)
- Ameet Gupta
- University Hospital WalesDepartment of UrologyHeath ParkCardiffUKCF14 4XW
| | - Kamran Ahmed
- King's College LondonMRC Centre for Transplantation, Division of Transplantation Immunology and Mucosal Biology, School of MedicineSt Thomas StreetLondonEnglandUKSE1 9RT
| | - Howard G Kynaston
- University Hospital WalesDepartment of UrologyHeath ParkCardiffUKCF14 4XW
| | - Prokar Dasgupta
- King's College LondonMRC Centre for Transplantation, Division of Transplantation Immunology and Mucosal Biology, School of MedicineSt Thomas StreetLondonEnglandUKSE1 9RT
| | - Piotr L Chlosta
- Jagiellonian University, Collegium MedicumDepartment of UrologyGrzegorzecka 18KrakowPoland31531
| | - Omar M Aboumarzouk
- Islamic University of GazaDepartment of UrologyCollege of MedicineGazaPalestine
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