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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Fong KY, Foo JCH, Chan YH, Aslim EJ, Ng LG, Gan VHL, Lim EJ. Graft retrieval incisions in minimally invasive donor nephrectomy: Systematic review and network meta-analysis. Transplant Rev (Orlando) 2024; 38:100813. [PMID: 37979238 DOI: 10.1016/j.trre.2023.100813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Various incisions are employed for graft extraction during minimally invasive donor nephrectomy, but an overarching synthesis of associated short-term donor outcomes is lacking. METHODS An electronic literature search was conducted on PubMed, EMBASE and Scopus for studies comparing ≥2 graft extraction incisions in laparoscopic or robotic donor nephrectomy with ≥10 patients per arm. Eligible study designs included randomized trials, case-control, and cohort studies. Primary outcomes were donor length of stay (LOS); in-hospital analgesic requirement; and postoperative complications. Secondary outcomes were warm ischemia time (WIT), total operation time (TOT), and estimated blood loss (EBL). Random-effects Frequentist network meta-analyses were conducted for all outcomes. RESULTS Twenty-nine studies (4702 patients) were shortlisted. Six incisions were analyzed: iliac, Pfannenstiel, midline hand-assisted laparoscopic (HAL), midline umbilical, flank and transvaginal natural orifice transluminal endoscopic surgery (NOTES). The flank incision had significantly longer LOS than all other incisions. LOS was significantly longer in Pfannenstiel than iliac incision (mean difference [MD] = 0.29, 95%CI = 0.002-0.58 days). Midline HAL had significantly shorter TOT than most other incisions. Midline umbilical incisions had significantly higher WIT than midline HAL and Pfannenstiel incisions. Midline HAL had shorter WIT than transvaginal NOTES (MD = 0.80, 95%CI = 0.05-1.56 min). No major differences were seen in analgesia requirement, postoperative complications and EBL. CONCLUSION Six different incisions for graft retrieval are broadly comparable across most short-term outcomes although long-term outcomes remain to be elucidated. Iliac and Pfannenstiel incisions yielded similar outcomes besides marginally lower LOS for the former. Midline incision for HAL may be associated with shorter TOT, and transvaginal NOTES is an effective technique for selected female donors. TRIAL REGISTRATION PROSPERO CRD42023445407.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Lay Guat Ng
- Department of Urology, Singapore General Hospital, Singapore
| | - Valerie Huei Li Gan
- Department of Urology, Singapore General Hospital, Singapore; SingHealth Duke-NUS Transplant Centre, Singapore
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore.
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Dreesmann NJ, Jung W, Shebaili M, Thompson HJ. Kidney Donor Perspectives on Acute Postoperative Pain Management. Clin Nurs Res 2023; 32:1124-1133. [PMID: 36912100 DOI: 10.1177/10547738231156151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
This study employed a qualitative descriptive approach to examine living kidney donor's experience of postoperative pain. Thirteen living kidney donors aged 46.5 (±14.4) years participated in this study. Semi-structured interviews were conducted and transcribed. Transcripts were inductively coded and reviewed for trends, patterns, and insights into donor's experience of postoperative pain. Donors experienced postoperative pain from a variety of sources that hindered recovery and created anxiety and fear in some. Donors managed pain with opioid and non-opioid medications, social support, and ambulation. Donor's past experiences with and expectations about pain, relationships with intended recipients, social support, as well as motivations for and meaning of donation informed their experience of postoperative pain. Prompt pharmacologic intervention for pain, as well as further coaching and education about pain management should be emphasized for nurses caring for living kidney donors. Further study of how donor's motivation might mediate their pain experience is needed.
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Bic A, Mazeaud C, Salleron J, Bannay A, Balkau B, Larose C, Hubert J, Eschwège P. Complications after partial nephrectomy: robotics overcomes open surgery and laparoscopy: the PMSI French national database. BMC Urol 2023; 23:146. [PMID: 37715175 PMCID: PMC10502976 DOI: 10.1186/s12894-023-01322-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 09/11/2023] [Indexed: 09/17/2023] Open
Abstract
PURPOSE To evaluate three partial nephrectomies (PN) procedures: open (OPN), standard laparoscopy (LPN), and robot-assisted laparoscopy (RAPN), for the risk of initial complications and rehospitalization for two years after the surgery. MATERIALS AND METHODS From the French national hospital database (PMSI-MCO), every hospitalization in French hospitals for renal tumor PN in 2016-2017 were extracted. Complications were documented from the initial hospitalization and any rehospitalization over two years. Chi-square and ANOVA tests compared the frequency of complications and length of initial hospitalization between the three surgical procedures. Relative risks (RR) and 95% confidence intervals were computed. RESULTS The 9119 initial hospitalizations included 4035 OPN, 1709 LPN, and 1900 RAPN; 1475 were excluded as the laparoscopic procedure performed was not determined. The average length of hospitalization was 8.1, 6.2, and 4.5 days for OPN, LPN, and RAPN, respectively. Compared to OPN, there were fewer complications at the time of initial hospitalization for the mini-invasive procedures: 29% for OPN vs. 20% for LPN (0.70 [0.63;0.78]) and 12% for RAPN (RR=0.43, 95%CI [0.38;0.49]). For RAPN compared to LPN, there were fewer haemorrhages (RR=0.55 [0.43;0.72]), anemia (0.69 {0.48;0.98]), and sepsis (0.51 [0.36;0.71]); during follow up, there were fewer urinary tract infections (0.64 [0.45;0.91]) but more infectious lung diseases (1.69 [1.03;2.76]). Over the two-year postoperative period, RAPN was associated with fewer acute renal failures (RR=0.73 [0.55;0.98]), renal abscesses (0.41 [0.23;0.74]), parietal complications (0.69 [0.52;0.92]) and urinary tract infections (0.54 [0.40;0.73]) than for OPN. CONCLUSIONS Conservative renal surgery is associated with postoperative morbidity related to the surgical procedure fashion. Mini-invasive procedures, especially robot-assisted surgery, had fewer complications and shorter hospital lengths of stay.
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Affiliation(s)
- Antoine Bic
- Service d'Urologie CHRU Nancy, Site Brabois, Nancy, 54000, France.
- Department of Urology, Nancy University Hospital, Avenue de Bourgogne, Vandoeuvre Cedex, 54511, France.
| | - Charles Mazeaud
- Service d'Urologie CHRU Nancy, Site Brabois, Nancy, 54000, France
| | - Julia Salleron
- Département de Biostatistiques, Institut de Cancérologie de Lorraine, 6 avenue de Bourgogne CS 30519, Vandoeuvre-lès-Nancy Cedex, 54519, France
| | - Aurélie Bannay
- Service d'Évaluation et Information Médicales, CHRU Nancy, Nancy, France
| | - Beverley Balkau
- Épidémiologie Clinique, Centre de Recherche en Épidémiologie et Santé des Populations, Institut National de la Santé et de la Recherche Médicale U1018, Université Paris-Saclay, USVQ, Université Paris-Sud, Villejuif, F-94807, France
| | - Clément Larose
- Service d'Urologie CHRU Nancy, Site Brabois, Nancy, 54000, France
| | - Jacques Hubert
- Service d'Urologie CHRU Nancy, Site Brabois, Nancy, 54000, France
| | - Pascal Eschwège
- Service d'Urologie CHRU Nancy, Site Brabois, Nancy, 54000, France
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Wu Q, Luo Y, Han M, Li J, Kang F. The Value of Pain Sensitivity Questionnaire in Predicting Postoperative Pain in Living Kidney Donors: A Prospective Observational Study. J Pain Res 2023; 16:2899-2907. [PMID: 37641638 PMCID: PMC10460613 DOI: 10.2147/jpr.s419719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose This study aimed to investigate the value of the Pain Sensitivity Questionnaire (PSQ) for the prediction of postoperative pain and the relationship between pain sensitivity and postoperative pain in kidney donors undergoing living-related kidney transplantation. Patients and Methods A total of 148 kidney donors were selected and the preoperative pain sensitivity questionnaire was administered the day before surgery. Kidney donors were assigned to low PSQ group (PSQ < 6.5, n = 76) or high PSQ group (PSQ ≥ 6.5, n = 72). The primary endpoint was the number of patient-controlled analgesia (PCA). Other outcomes included: the incidence of acute pain, flurbiprofen axetil remediation rate, the incidence of chronic pain, neuropathic pain assessment scale (Douleur Neuropathique 4 Questions, DN4), visual analog scale (VAS) at rest after surgery as well as the correlation between PSQ and QST (Quantitative Sensory Testing). Results The low PSQ group had a significantly lower number of PCA than high PSQ group (P < 0.0001). The incidence of acute pain was 75% in low PSQ group and 100% in high PSQ group (P < 0.0001). Furthermore, flurbiprofen axetil remediation rate was lower in low PSQ group than that in high PSQ group (P = 0.042). The incidence of chronic pain was significantly lower in low PSQ group than in high PSQ group (6.6% vs 61.1%, P < 0.001). Moreover, DN4 was significantly lower in low PSQ group than that in high PSQ group (P < 0.001). The PSQ-mean was significantly negatively correlated with QST in kidney donors. VAS at rest for the low PSQ group were lower than those of the high PSQ group. Conclusion The PSQ was found to be associated with the intensity or postoperative pain and might be used to screen patients prior to living-kidney transplantation.
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Affiliation(s)
- Qixing Wu
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei City, People’s Republic of China
| | - Yiyuan Luo
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei City, People’s Republic of China
| | - Mingming Han
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei City, People’s Republic of China
| | - Juan Li
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei City, People’s Republic of China
| | - Fang Kang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei City, People’s Republic of China
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Igbokwe MC, Olatise OO, Asaolu SO, Aremu AA, Abu S, Onwuasoanya U, Adetunbi AR, Alhassan S. Donor Nephrectomy Through Mini-Flank Incision: A Single-Centre Experience Among Nigerian Patients. Cureus 2022; 14:e25206. [PMID: 35747009 PMCID: PMC9211377 DOI: 10.7759/cureus.25206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2022] [Indexed: 11/05/2022] Open
Abstract
Background and objective The field of kidney transplantation in sub-Saharan Africa is still in the rudimentary stages. The majority of patients with chronic kidney disease have no access to renal replacement therapy, leading to very high mortality rates. Donor nephrectomy (DN) is an important aspect of kidney transplantation. Over the last two decades, open DN (ODN) has given way to minimally invasive techniques like laparoscopic DN (LDN) and robotic-assisted DN. In this study, we aimed to describe our experience with mini-flank incision donor nephrectomy (MIDN) at a Nigerian renal transplant center. Materials and methods We conducted a retrospective review of all DN cases performed at a single Nigerian kidney transplantation center over a three-year period. Information obtained from these patients was classified into pre-, intra-, and postoperative. The data included sociodemographic characteristics, preoperative preparation, details of intraoperative techniques, and postoperative findings. These were entered into a proforma and analyzed using SPSS Statistics version 21 (IBM Corp., Armonk, NY). Results A total of 230 patients underwent ODN during the study period. The majority of the donors were males (92.8%) with a mean age of 30.83 ±8.43 years. The body mass index (BMI) of most (76.1%) of the donors was within the normal range (18.5-24.9 kg/m2). The duration of DNs ranged from 72 to 154 minutes with a mean duration of 130 ±28 minutes. The length of flank incisions ranged from 7.8 to 12 cm with a mean incision length of 10.8 ±1.0 cm. Donors who had MIDN attained satisfactory postoperative pain control with about 90% of them having a BMI of <30 kg/m2. Oral intake and ambulation were commenced on the first postoperative day, and the cosmetic outcomes were deemed acceptable in over 90% of kidney donors. Conclusion Mini-incision for DN through the flank approach is a suitable alternative to LDN in the developing world where facilities and skills for LDN or robotic nephrectomies are largely unavailable. It offers a short recovery time, early ambulation, and excellent allograft outcomes.
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Cherqui D, Ciria R, Kwon CHD, Kim KH, Broering D, Wakabayashi G, Samstein B, Troisi RI, Han HS, Rotellar F, Soubrane O, Briceño J, Alconchel F, Ayllón MD, Berardi G, Cauchy F, Luque IG, Hong SK, Yoon YY, Egawa H, Lerut J, Lo CM, Rela M, Sapisochin G, Suh KS. Expert Consensus Guidelines on Minimally Invasive Donor Hepatectomy for Living Donor Liver Transplantation From Innovation to Implementation: A Joint Initiative From the International Laparoscopic Liver Society (ILLS) and the Asian-Pacific Hepato-Pancreato-Biliary Association (A-PHPBA). Ann Surg 2021; 273:96-108. [PMID: 33332874 DOI: 10.1097/SLA.0000000000004475] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The Expert Consensus Guidelines initiative on MIDH for LDLT was organized with the goal of safe implementation and development of these complex techniques with donor safety as the main priority. BACKGROUND Following the development of minimally invasive liver surgery, techniques of MIDH were developed with the aim of reducing the short- and long-term consequences of the procedure on liver donors. These techniques, although increasingly performed, lack clinical guidelines. METHODS A group of 12 international MIDH experts, 1 research coordinator, and 8 junior faculty was assembled. Comprehensive literature search was made and studies classified using the SIGN method. Based on literature review and experts opinions, tentative recommendations were made by experts subgroups and submitted to the whole experts group using on-line Delphi Rounds with the goal of obtaining >90% Consensus. Pre-conference meeting formulated final recommendations that were presented during the plenary conference held in Seoul on September 7, 2019 in front of a Validation Committee composed of LDLT experts not practicing MIDH and an international audience. RESULTS Eighteen Clinical Questions were addressed resulting in 44 recommendations. All recommendations reached at least a 90% consensus among experts and were afterward endorsed by the validation committee. CONCLUSIONS The Expert Consensus on MIDH has produced a set of clinical guidelines based on available evidence and clinical expertise. These guidelines are presented for a safe implementation and development of MIDH in LDLT Centers with the goal of optimizing donor safety, donor care, and recipient outcomes.
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Krimphove MJ, Reese SW, Chen X, Marchese M, Pucheril D, Cone E, Chou W, Tully KH, Kibel AS, Urman RD, Chang SL, Kluth LA, Dasgupta P, Trinh QD. Recovery from minimally invasive vs. open surgery in kidney cancer patients: Opioid use and workplace absenteeism. Investig Clin Urol 2020; 62:56-64. [PMID: 33314804 PMCID: PMC7801161 DOI: 10.4111/icu.20200194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/23/2020] [Accepted: 07/09/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose Does surgical approach (minimally invasive vs. open) and type (radical vs. partial nephrectomy) affects opioid use and workplace absenteeism. Materials and Methods Retrospective multivariable regression analysis of 2,646 opioid-naïve patients between 18 and 64 undergoing radical or partial nephrectomy via either a minimally invasive vs. open approach for kidney cancer in the United States between 2012 and 2017 drawn from the IBM Watson Health Database was performed. Outcomes included: (1) opioid use in opioid-naïve patients as measured by opioid prescriptions in the post-operative setting at early, intermediate and prolonged time periods and (2) workplace absenteeism after surgery. Results Patients undergoing minimally invasive surgery had a lower odds of opioid use in the early and intermediate post-operative periods (early: odds ratio [OR], 0.77; 95% confidence interval [CI], 0.62–0.97; p=0.02, intermediate: OR, 0.60; 95% CI, 0.48–0.75; p<0.01), but not in the prolonged setting (prolonged: OR, 1.00; 95% CI, 0.75–1.34; p=0.98) and had earlier return to work (minimally invasive vs. open: −10.53 days; 95% CI, −17.79 to −3.26; p<0.01). Controlling for approach, patient undergoing partial nephrectomy had lower rates of opioid use across all time periods examined and returned to work earlier than patients undergoing radical nephrectomy (partial vs. radical: −14.41 days; 95% CI, −21.22 to −7.60; p<0.01). Conclusions Patients undergoing various forms of surgery for kidney cancer had lower rates of peri-operative opioid use, fewer days of workplace absenteeism, but no difference in long-term rates of opioid use in patients undergoing minimally invasive as compared to open surgery.
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Affiliation(s)
- Marieke J Krimphove
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Stephen W Reese
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Xi Chen
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Maya Marchese
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel Pucheril
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eugene Cone
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wesley Chou
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Karl H Tully
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Adam S Kibel
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven L Chang
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Luis A Kluth
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Prokar Dasgupta
- Department of Urology, King's College London, Guy's and St. Thomas' Hospitals NHS Foundation Trust, Guy's Hospital, London, United Kingdom
| | - Quoc Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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10
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Abdessater M, Champy CM, da Costa JB, Courcier J, Yiou R, Hoznek A, Vordos D, Grimbert P, Matignon M, Londero T, le Corvoisier P, Salomon L, De la Taille A, Ingels A. Comparison of the iliac, vaginal and umbilical graft extraction in robot-assisted laparoscopic living donor nephrectomy. World J Urol 2020; 39:2783-2788. [PMID: 33015741 DOI: 10.1007/s00345-020-03462-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To compare different extractions routes for robot-assisted living donor nephrectomy in terms of post-operative pain and renal function recovery. METHODS Live donor kidney transplantation data from our institution were reviewed from November 2011 to March 2017. Postoperative pain was estimated using cumulative painkillers consumption. Variables were compared between the 3 groups with ANOVA for continuous data, χ2 test for categorial data. A survival analysis with Kaplan-Meier curve assessing time to transplant recipient nadir was performed to compare the renal function recovery. RESULTS Sixty-three RLDN were performed (23 iliac, 23 vaginal and 17 umbilical extractions). There was no significant difference between the three groups in terms of operative time, blood lost, warm ischemia time, cumulative painkiller consumption and renal function recovery time. Postoperative complications for Umbilical, Vaginal and Iliac were, respectively, of 0, 3 and 1. No major difference was found between the 3 groups beside a slightly longer hospital stay in the iliac group. CONCLUSION Iliac incision might impact post-operative pain with a moderate but significant longer hospital stay. Vaginal extraction is an option when cosmetic outcomes present a real demand. The three options appeared to be safe and should be discussed with the patient in regard of the surgeon experience.
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Affiliation(s)
- Maher Abdessater
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Cécile M Champy
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - José Batista da Costa
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Jean Courcier
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - René Yiou
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Andras Hoznek
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Dimitri Vordos
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Philippe Grimbert
- Department of Nephrology, APHP, Henri Mondor University Hospital, UPEC, Créteil, France
| | - Marie Matignon
- Department of Nephrology, APHP, Henri Mondor University Hospital, UPEC, Créteil, France
| | - Tiphanie Londero
- Department of Nephrology, APHP, Henri Mondor University Hospital, UPEC, Créteil, France
| | - Philippe le Corvoisier
- Department of Clinical Investigations, APHP, Henri Mondor University Hospital, UPEC, Créteil, France.,INSERM, CIC 1430, Créteil, France
| | - Laurent Salomon
- Department of Urology, Hôpital Mont-de-Marsan, Mont-de-Marsan, France
| | - Alexandre De la Taille
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Alexandre Ingels
- Department of Urology, APHP, Henri Mondor University Hospital, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
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11
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Rodrigues GJ, Guglielmetti GB, Orvieto M, Seetharam Bhat KR, Patel VR, Coelho RF. Robot-assisted endoscopic inguinal lymphadenectomy: A review of current outcomes. Asian J Urol 2021; 8:20-6. [PMID: 33569269 DOI: 10.1016/j.ajur.2020.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/11/2020] [Accepted: 05/28/2020] [Indexed: 12/27/2022] Open
Abstract
Objective To review the role of robot-assisted endoscopic inguinal lymphadenectomy (RAIL) in the management of penile cancer. Methods A PubMed search for all relevant publications regarding RAIL series up until August 2019 was performed using the keyword “robotic”, “inguinal lymph node dissection”, and “penile cancer”. Weighted mean was calculated in the largest series for all outcomes using the number of patients included in each study as the weighting factor. Results We identified 23 articles, of note the three largest series that included 102, 27, and 20 RAIL in 51, 14, and 10 patients, respectively. Saphenous vein was spared in 88.93% of RAIL cases in these series and node yield was 11.42 per groin; 35.28% of patients had positive pathological nodes. The weighted mean of operative time was 87.98 min per RAIL and the estimated blood loss was 37.08 mL per patient. The mean length of hospital stay was 1.29 days and the drain was kept in place for 17.02 days; the major complication rate was only 5.31% in these series. The mean follow-up was 33.46 months with a recurrence-free survival of 96.33%. Conclusion The literature regarding RAIL describes promising results, although it has shorter follow-up and higher costs when compared to historically series from the open approach. Initials series reported lower cutaneous complications compared to conventional approach, without compromising oncological outcomes. However, long-term results and larger trials are crucial to validate those findings.
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12
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Spaggiari M, Garcia-Roca R, Tulla KA, Okoye OT, Di Bella C, Oberholzer J, Jeon H, Tzvetanov IG, Benedetti E. Robotic Assisted Living Donor Nephrectomies: A Safe Alternative to Laparoscopic Technique for Kidney Transplant Donation. Ann Surg 2020. [PMID: 32657945 DOI: 10.1097/SLA.0000000000004247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review outcomes after laparoscopic, robotic-assisted living donor nephrectomy (RLDN) in the first, and largest series reported to date. SUMMARY OF BACKGROUND DATA Introduction of minimal invasive, laparoscopic donor nephrectomy has increased live kidney donation, paving the way for further innovation to expand the donor pool with RLDN. METHODS Retrospective chart review of 1084 consecutive RLDNs performed between 2000 and 2017. Patient demographics, surgical data, and complications were collected. RESULTS Six patients underwent conversion to open procedures between 2002 and 2005, whereas the remainder were successfully completed robotically. Median donor age was 35.7 (17.4) years, with a median BMI of 28.6 (7.7) kg/m. Nephrectomies were preferentially performed on the left side (95.2%). Multiple renal arteries were present in 24.1%. Median operative time was 159 (54) minutes, warm ischemia time 180 (90) seconds, estimated blood loss 50 (32) mL, and length of stay 3 (1) days. The median follow-up was 15 (28) months. Complications were reported in 216 patients (19.9%), of which 176 patients (81.5%) were minor (Clavien-Dindo class I and II). Duration of surgery, warm ischemia time, operative blood loss, conversion, and complication rates were not associated with increase in body mass index. CONCLUSION RLDN is a safe technique and offers a reasonable alternative to conventional laparoscopic surgery, in particular in donors with higher body mass index and multiple arteries. It offers transplant surgeons a platform to develop skills in robotic-assisted surgery needed in the more advanced setting of minimal invasive recipient operations.
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13
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Rice TC, Kassam AF, Lewis HV, Hobeika M, Cuffy MC, Ratner LE, Diwan TS. Changing Education Paradigms: Training Transplant Fellows for High Stake Procedures. J Surg Educ 2020; 77:830-836. [PMID: 32067900 DOI: 10.1016/j.jsurg.2020.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/23/2019] [Accepted: 01/19/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Living kidney donation is a unique operation, as healthy patients are placed at risks inherent with major surgery without physical benefit. The ethical implications associated with any morbidity make it a high-stakes procedure. Fellowships are faced with the dilemma of optimizing fellow training in this demanding procedure while providing safe outcomes to donors. The Laparoscopic Living Donor Nephrectomy (LDN) Workshop is a resource that can provide intense instruction to help bridge the training deficit. Our aim was to examine the course's effectiveness in improving fellows' skill and confidence related to implementing LDN into future practice. METHODS From 2017 to 2018, 36 abdominal transplant surgery fellows participated in a 2-day workshop consisting of live surgery observation, cadaver lab, and didactic sessions. Surveys were completed precourse, postcourse, and at 3-month postcourse follow-up. RESULTS Preworkshop, 61% of participants reported less than 50% confidence in independent performance of LDN. Following workshop completion, 95% reported improved confidence. At 3-month follow-up, there was a 30% (p < 0.05) increase in median confidence level. Immediately following the course, 67% reported improved ability to analyze kidneys prior to donation, 74% changed the way donor candidates were evaluated, and 67% reported enhanced ability to risk stratify donors. Eighty-five percent felt it strengthened operative techniques with 70% implementing new diagnostic treatments and surgical strategies. Seventy percent of participants felt it improved their communication with colleagues and 67% had enhanced communication with patients. These trends were maintained at 3-month follow-up. CONCLUSION These results indicated that the LDN Workshop improves confidence and increases fellows' skillset in a high-stakes procedure. The LDN Workshop is a useful adjunct to fellowship training to optimize successful, efficient, and safe performance of a demanding procedure in a uniquely healthy donor population.
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Affiliation(s)
- Teresa C Rice
- Department of Surgery, Division of Transplantation, University of Cincinnati, Cincinnati, Ohio
| | - Al-Faraaz Kassam
- Department of Surgery, Division of Transplantation, University of Cincinnati, Cincinnati, Ohio
| | - Hannah V Lewis
- Department of Surgery, Division of Transplantation, University of Cincinnati, Cincinnati, Ohio
| | - Mark Hobeika
- J.C. Walter, Jr. Transplant Center, Houston Methodist Hospital, Houston, Texas
| | - Madison C Cuffy
- Department of Surgery, Division of Transplantation, University of Cincinnati, Cincinnati, Ohio
| | - Lloyd E Ratner
- Department of Surgery, Division of Transplantation, Columbia University, New York, New York
| | - Tayyab S Diwan
- Department of Surgery, Division of Transplantation, University of Cincinnati, Cincinnati, Ohio.
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14
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Shen SA, Jafari A, Qualliotine JR, DeConde AS. Incidence and Predictive Factors for Additional Opioid Prescription after Endoscopic Skull Base Surgery. J Neurol Surg B Skull Base 2020; 81:301-307. [PMID: 32500006 DOI: 10.1055/s-0039-1692473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/11/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction Postoperative pain management and opioid use following endoscopic skull base surgery (ESBS) is not well understood. A subset of patients requires additional opioid prescription (AOP) in the postoperative period. The objective of this study is to describe the incidence of AOP, as well as evaluate patient and surgical characteristics that may predict additional pain management requirements following ESBS. Methods A retrospective review of cases undergoing ESBS between November 2016 and August 2018 was performed. We reviewed patients' sociodemographic and clinical data, and Controlled Substance Utilization Review and Evaluation System (CURES) records. Stepwise multivariable logistic regressions were performed to evaluate the factors associated with AOP within 60 days following surgery. Results A total of 42 patients were identified. Indications for ESBS included intracranial mass (64.2%), sinonasal malignancy (23.8%), and skull base reconstruction (9.5%). AOP were recorded in nine patients (21.4%). There were no significant differences in operative factors, including approach, lesion location, or perioperative analgesia between the two cohorts. On multivariable logistic regression, we found that younger age (odds ratio [OR]: 0.891, 95% confidence interval [CI]: 0.79-1.00, p = 0.050), comorbid depression (OR: 86.48, 95% CI: 1.40-5,379.07, p = 0.034), and preoperative opioid use (OR: 104.45, 95% CI: 1.41-7,751.10, p = 0.034) were associated with additional prescriptions postoperatively. Conclusion The requirement for extended postoperative opioid pain control is common after ESBS. Patient demographics including age and psychosocial factors, such as depression may predict the need for AOP after ESBS. These results suggest that patient-driven factors, rather than surgical characteristics, may determine the need for prolonged pain control requirements after ESBS.
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Affiliation(s)
- Sarek A Shen
- School of Medicine, University of California San Diego, La Jolla, California, United States
| | - Aria Jafari
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, United States
| | - Jesse R Qualliotine
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, United States
| | - Adam S DeConde
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, United States
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15
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Bøe C, Bondevik H, Wahl AK, Andersen MH. Going through laparoscopic liver resection in patients with colorectal liver metastases-A qualitative study. Nurs Open 2019; 6:260-267. [PMID: 30918677 PMCID: PMC6419298 DOI: 10.1002/nop2.206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/25/2017] [Accepted: 08/31/2018] [Indexed: 12/21/2022] Open
Abstract
AIM Colorectal cancer is one of the most common cancers worldwide. Surgery is seen as the only curative treatment. There are two approaches to liver resection: open or laparoscopic surgery. Knowledge from the patient perspective can illuminate how it is experienced going through laparoscopic surgery. We aimed to study patient perspectives of the experience of undergoing laparoscopic liver resection surgery in patients with colorectal liver metastases. DESIGN This study has a qualitative research design. Nine patients participated in semi-structured interviews 6 months after surgery. Data were analysed according to Kvale's five-step analysis method. RESULTS Though the patients were satisfied with the laparoscopic approach, they expressed unmet informational needs about the new technique, time after discharge and surgery outcomes related to having metastatic cancer. Healthcare professionals should provide information and support that recognizes the needs of patients with cancer undergoing laparoscopic liver resection surgery.
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Affiliation(s)
- Camilla Bøe
- Department of Health SciencesUniversity of OsloOsloNorway
| | - Hilde Bondevik
- Department of Health SciencesUniversity of OsloOsloNorway
| | | | - Marit Helen Andersen
- Department of Health SciencesUniversity of OsloOsloNorway
- Division of Surgery, Inflammation Medicine and TransplantationOslo University HospitalOsloNorway
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16
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Zorgdrager M, van Londen M, Westenberg LB, Nieuwenhuijs-Moeke GJ, Lange JFM, de Borst MH, Bakker SJL, Leuvenink HGD, Pol RA. Chronic pain after hand-assisted laparoscopic donor nephrectomy. Br J Surg 2019; 106:711-719. [PMID: 30919435 PMCID: PMC6593841 DOI: 10.1002/bjs.11127] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/18/2018] [Accepted: 01/03/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Data on chronic pain after kidney donation are sparse. The aim of this study was to assess the incidence of chronic pain after hand-assisted laparoscopic nephrectomy. METHODS Living kidney donors who donated between 2011 and 2017 at the University Medical Centre Groningen were included. All patients underwent hand-assisted laparoscopic donor nephrectomy. Postdonation pain and movement disabilities were assessed using the Carolinas Comfort Scale (CCS) and a visual analogue scale (VAS). The prevalence, severity of pain and the need for analgesics were reported. RESULTS Some 333 living kidney donors with a mean age of 56 years were included. At a median of 19 (i.q.r. 10-33) months after donation, 82 donors (24·6 per cent) had a CCS score above 0, of which 58 (71 per cent) had a CCS score of at least 2 and 57 (70 per cent) reported movement limitations. Some 110 donors (33·0 per cent) had a VAS score of more than 0. Complaints mainly occurred during bending over (12·3 per cent) and exercising (12·4 per cent). Thirty-two donors (9·7 per cent) required analgesics during follow-up between donation and the time of measurement, and six of 82 (7 per cent) reported chronic inguinal pain. In multivariable analysis, donor age (odds ratio (OR) 0·97, 95 per cent c.i. 0·95 to 0·99; P = 0·020) and length of hospital stay (OR 1·21, 1·01 to 1·51; P = 0·041) were independently associated with chronic pain. CONCLUSION One-quarter of donors experienced chronic postdonation pain or discomfort, most of which was bothersome. Younger donors and those with a longer postoperative hospital stay had more symptoms.
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Affiliation(s)
- M Zorgdrager
- Department of Radiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - M van Londen
- Department of Internal Medicine, Division of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - L B Westenberg
- Department of Radiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - G J Nieuwenhuijs-Moeke
- Department of Anaesthesiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - J F M Lange
- Department of Surgery, Division of Transplant Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - M H de Borst
- Department of Internal Medicine, Division of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - S J L Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - H G D Leuvenink
- Department of Surgery, Division of Transplant Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - R A Pol
- Department of Surgery, Division of Transplant Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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17
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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18
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Garcia-Covarrubias L, Prieto-Olivares P, Bahena-Portillo A, Cicero-Lebrija A, Hinojosa-Heredia H, Fernández-Lopez LJ, Almeida-Nieto C, Visag-Castillo VJ, Carrión-Barrera J, Castro-Ñuco I, Pedraza-Rojas E, Rosas-Herrera A, García-Covarrubias A, Fernández-Angel D, Diliz-Perez HS. Experience and Security of the Hand-Assisted Laparoscopic Nephrectomy of a Living Donor in a Public Health Center. Transplant Proc 2018; 50:433-5. [PMID: 29579821 DOI: 10.1016/j.transproceed.2017.12.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 12/05/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hand-assisted laparoscopic nephrectomy (HALDN) is currently the procedure of choice for obtaining living donor kidneys for transplantation. In our institution, it has been the standard procedure for 5 years. Previous studies have shown the same function of the graft as that obtained by open surgery, with a lower rate of bleeding and no differences in complications. We sought to demonstrate the experience and safety of HALDN compared with open donor nephrectomy in healthy donors for kidney transplantation. METHODS A retrospective analytical observational study was conducted, reviewing the records of the living donors for kidney transplant undergoing open donor nephrectomy or HALDN in our center from March 1, 2009, to March 1, 2016. Renal function was assessed by the estimated glomerular filtration rate by the Modification of Diet in Renal Disease method before and after donation, as well as bleeding (mL), and complications (according to Clavien), performing a comparative analysis between the two techniques using parametric or nonparametric tests. RESULTS A total of 179 living donor nephrectomies were performed during the study period-31 open donor nephrectomy (17.3%) and 148 HALDN (82.7%)-without relevant baseline differences, except for creatinine. HALDN has a shorter surgical time (156,473 ± 87.75 minutes vs 165,484 ± 69.95 minutes) and less bleeding (244.59 ± 416.08 mL vs 324.19 ± 197.986 mL) and a shorter duration of hospital stay (3.74 ± 1.336 days vs 4.75 ± 1.226 days). There were no significant differences in surgical complications at 30 days, or graft loss reported; there were 3 conversions (1.7%) from the HALDN to the open technique. There were no differences in renal function in the donors or recipients at the 5th day or the month after surgery. CONCLUSIONS Laparoscopic nephrectomy has replaced open surgery as the gold standard for living kidney donors. HALDN is a safe and feasible procedure when compared with open donor nephrectomy, achieving a shorter surgical time with less bleeding, and no difference in the number of complications. This procedure lowers costs by decreasing the duration of the hospital stay, making is feasible to perform it at any institution with appropriately trained personnel.
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19
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Myhre M, Romundstad L, Stubhaug A. Pregabalin reduces opioid consumption and hyperalgesia but not pain intensity after laparoscopic donor nephrectomy. Acta Anaesthesiol Scand 2017; 61:1314-1324. [PMID: 28849588 DOI: 10.1111/aas.12963] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/06/2017] [Accepted: 08/02/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Gabapentinoids are increasingly used to reduce acute postoperative pain, opioid consumption and opioid-related adverse effects. We explored the opioid-sparing, analgesic and anti-hyperalgesic effect of perioperative administered pregabalin in laparoscopic living donor nephrectomy. METHODS In this randomized controlled trial, 80 patients were recruited and randomized to receive pregabalin 150 mg twice daily or placebo on the day of surgery and the first postoperative day as part of a multimodal analgesic regimen. Primary outcome was opioid consumption 0-48 h after surgery. Secondary outcomes were pain intensity at rest and with movement 0-48 h after surgery using the 0-10 Numeric Rating Scale and incisional hyperalgesia measured 24 h post-surgery and at hospital discharge. Further secondary outcomes were adverse effects. Persistent post-surgical pain was registered 6 weeks, 6 and 12 months after surgery. RESULTS Pregabalin significantly reduced opioid consumption compared with placebo 0-48 h after surgery (median mg [25th, 75th percentile]); 29.0 (22.0-45.5) vs. 41.8 (25.8-63.6) (P = 0.04). Pain intensity 0-48 h after surgery calculated as area under the pain (NRS) vs. time curve was not statistically different between groups at rest (P = 0.12) or with movement (P = 0.21). Pregabalin decreased incisional hyperalgesia 24 h after surgery (median cm [25th, 75th percentile] 8.5 (1.0-18.5) vs. 15.5 (9.5-24.0) (P = 0.02). Nausea (P ≤ 0.01), use of antiemetics (P ≤ 0.01) and pain-related sleep interference (P = 0.02) were reduced with pregabalin. CONCLUSIONS Perioperative pregabalin added to a multimodal analgesic regimen was opioid-sparing, but made no difference to pain intensity score 0-48 h after surgery. Pregabalin may reduce incisional hyperalgesia on the first day after surgery.
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Affiliation(s)
- M. Myhre
- Institute of Clinical Medicine; Faculty of Medicine; University of Oslo; Oslo Norway
- Department of Anesthesiology; Division of Emergencies and Critical Care; Oslo University Hospital, Rikshospitalet; Oslo Norway
| | - L. Romundstad
- Department of Anesthesiology; Division of Emergencies and Critical Care; Oslo University Hospital, Rikshospitalet; Oslo Norway
| | - A. Stubhaug
- Department of Pain Management and Research; Division of Emergencies and Critical Care; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; Faculty of Medicine; University of Oslo; Oslo Norway
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21
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Jendoubi A, Naceur IB, Bouzouita A, Trifa M, Ghedira S, Chebil M, Houissa M. A comparison between intravenous lidocaine and ketamine on acute and chronic pain after open nephrectomy: A prospective, double-blind, randomized, placebo-controlled study. Saudi J Anaesth 2017; 11:177-184. [PMID: 28442956 PMCID: PMC5389236 DOI: 10.4103/1658-354x.203027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Recently, there has been increasing interest in the use of analgesic adjuncts such as intravenous (IV) ketamine and lidocaine. OBJECTIVES To compare the effects of perioperative IV lidocaine and ketamine on morphine requirements, pain scores, quality of recovery, and chronic pain after open nephrectomy. STUDY DESIGN A prospective, randomized, placebo-controlled, double-blind trial. SETTINGS The study was conducted in Charles Nicolle University Hospital of Tunis. METHODS Sixty patients were randomly allocated to receive IV lidocaine: bolus of 1.5 mg/kg at the induction of anesthesia followed by infusion of 1 mg/kg/h intraoperatively and for 24 h postoperatively or ketamine: bolus of 0.15 mg/kg followed by infusion of 0.1 mg/kg/h intraoperatively and for 24 h postoperatively or an equal volume of saline (control group [CG]). MEASUREMENTS Morphine consumption, visual analog scale pain scores, time to the first passage of flatus and feces, postoperative nausea and vomiting (PONV), 6-min walk distance (6MWD) at discharge, and the incidence of chronic neuropathic pain using the "Neuropathic Pain Questionnaire" at 3 months. RESULTS Ketamine and lidocaine reduced significantly morphine consumption (by about 33% and 42%, respectively) and pain scores compared with the CG (P < 0.001). Lidocaine and ketamine also significantly improved bowel function in comparison to the CG (P < 0.001). Ketamine failed to reduce the incidence of PONV. The 6 MWD increased significantly from a mean ± standard deviation of 27 ± 16.2 m in the CG to 82.3 ± 28 m in the lidocaine group (P < 0.001). Lidocaine, but not ketamine, reduced significantly the development of neuropathic pain at 3 months (P < 0.05). CONCLUSION Ketamine and lidocaine are safe and effective adjuvants to decrease opioid consumption and control early pain. We also suggest that lidocaine infusion serves as an interesting alternative to improve the functional walking capacity and prevent chronic neuropathic pain at 3 months after open nephrectomy.
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Affiliation(s)
- Ali Jendoubi
- Department of Anaesthesia and Intensive Care and Urology, Charles Nicolle Hospital of Tunis, Tunis, Tunisia
| | - Imed Ben Naceur
- Department of Anaesthesia and Intensive Care and Urology, Charles Nicolle Hospital of Tunis, Tunis, Tunisia
| | - Abderrazak Bouzouita
- Department of Anaesthesia and Intensive Care and Urology, Charles Nicolle Hospital of Tunis, Tunis, Tunisia
| | - Mehdi Trifa
- Department of Anaesthesia and Intensive Care, Children Hospital of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Salma Ghedira
- Department of Anaesthesia and Intensive Care and Urology, Charles Nicolle Hospital of Tunis, Tunis, Tunisia
| | - Mohamed Chebil
- Department of Anaesthesia and Intensive Care and Urology, Charles Nicolle Hospital of Tunis, Tunis, Tunisia
| | - Mohamed Houissa
- Department of Anaesthesia and Intensive Care and Urology, Charles Nicolle Hospital of Tunis, Tunis, Tunisia
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Banegas MP, Harlan LC, Mann B, Yabroff KR. Toward greater adoption of minimally invasive and nephron-sparing surgical techniques for renal cell cancer in the United States. Urol Oncol 2016; 34:433.e9-433.e17. [PMID: 27321355 PMCID: PMC5035195 DOI: 10.1016/j.urolonc.2016.05.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 03/22/2016] [Accepted: 05/16/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To examine national, population-based utilization trends of nephron-sparing and minimally invasive techniques for the surgical management of patients with adult renal cell cancer (RCC) in the United States. METHODS Linked data from the National Cancer Institute׳s Patterns of Care studies and the Area Health Resource File were used to evaluate trends of nephron-sparing and minimally invasive techniques in a sample of 1,110 patients newly diagnosed with American Joint Committee on Cancer stages I-II RCC, in 2004 and 2009, who underwent surgery. Descriptive statistics were used to assess patterns of surgery between 2004 and 2009. Multivariable logistic regression analyses were used to evaluate the associations between demographic, clinical, hospital, and area-level health care characteristics with surgery utilization, stratified by the subset of patients who were potentially eligible for partial nephrectomy (PN) vs. radical nephrectomy (RN) and laparoscopic RN (LRN) vs. open RN, respectively. RESULTS Between 2004 and 2009, PN use among stage I patients with tumors≤7cm increased from 29% to 41%, respectively (P = 0.22). Among patients with stage I tumors≤4cm, use of PN significantly increased from 43% in 2004 to 55% in 2009 (P≤0.05). Among patients with stage I tumors>4 to 7cm, laparoscopic partial nephrectomy increased from 8% to 15%, whereas LRN increased from 38% to 69%, between 2004 and 2009 (P = 0.07). Significant increases in LRN use were observed for both stage I (from 43% in 2004 to 58% in 2009; P≤0.05) and stage II patients (from 16% in 2004 to 47% in 2009; P≤0.01). Patients diagnosed at an older age, with larger tumors, non-clear cell RCC and who did not receive treatment in a hospital with residency training were significantly less likely to receive PN vs. RN; whereas, those diagnosed in 2009 with stage I disease were significantly more likely to receive LRN vs. open RN. CONCLUSIONS This study highlights a significant shift toward increased use of nephron-sparing and minimally invasive surgical techniques to treat patients with RCC in the United States. Our findings are among the first population-based reports in which most eligible patients with RCC received PN over RN. In light of the long-standing evidence on the improved patient outcomes, future investigation is warranted to identify the barriers to increased adoption of these nephron-sparing and minimally invasive approaches.
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Affiliation(s)
- Matthew P Banegas
- Kaiser Permanente Northwest, The Center for Health Research, Portland, OR.
| | - Linda C Harlan
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Bhupinder Mann
- Clinical Investigations Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - K Robin Yabroff
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 04/03/2016] [Indexed: 11/19/2022]
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24
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Fabián JF, Mancilla E, Aburto JS, Kasep J, Lopez JO, Almaguer F, Basilio CI, García HB, Arcos AG. Hand-Assisted Laparoscopic Nephrectomy for Live Donor Kidney Transplantation. Transplant Proc 2016; 48:568-71. [PMID: 27110004 DOI: 10.1016/j.transproceed.2016.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The live donor nephrectomy is an unusual surgical procedure as it is performed on healthy individuals. It is important to make the procedure as safe as possible without compromising the health of the donor and graft function. JUSTIFICATION In Mexico during 2014, 2610 kidney transplantations performed, and 1862 grafts were from living donors. OBJECTIVE We describe our experience with hand-assisted laparoscopic nephrectomy on live donors for kidney transplantation. MATERIALS AND METHODS We present a descriptive and observational study in which all living donors who completed the study protocol for renal transplantation are included. RESULTS From September 2006 to July 2015, there were 238 hand-assisted laparoscopic nephrectomies with live donors; 227 (95.37%) were performed on the left side and 11 (4.63%) on the right side. Of donors, 54.1% were females. The average values for the variables analyzed were age 38.17 years, 25.94 BMI, creatinine 0.82-1.13 mg/dL pre- and postoperative month respectively, length of stay 4.95 (range 2-8), warm ischemia 5.07 (range 3-13) minutes, surgical time 168.85 minutes (range 90-306), and transsurgical bleeding 139 055 mL (range 25-650). One patient was reoperated for abdominal pain and bloating without evidence of pathology, attributing it to metabolic ileus. Two patients were converted to open surgery; 1 by technical problems with the laparoscopic equipment and the second by bleeding from the renal vein, both with good results. DISCUSSION AND CONCLUSIONS Laparoscopic nephrectomy is a safe method that allows kidney donors to have a speedy recovery without modifying the survivals of renal grafts.
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Affiliation(s)
- J F Fabián
- Department of Nephrology and Kidney Transplantation, Instituto Nacional de Cardiología "Dr. Ignacio Chávez", México.
| | - E Mancilla
- Department of Nephrology and Kidney Transplantation, Instituto Nacional de Cardiología "Dr. Ignacio Chávez", México
| | - J S Aburto
- Department of Nephrology and Kidney Transplantation, Instituto Nacional de Cardiología "Dr. Ignacio Chávez", México; Department of Urology, Instituto Nacional de Cardiología "Dr. Ignacio Chávez", México
| | - J Kasep
- Department of Urology, Instituto Nacional de Cardiología "Dr. Ignacio Chávez", México
| | - J O Lopez
- Department of Nephrology and Kidney Transplantation, Instituto Nacional de Cardiología "Dr. Ignacio Chávez", México
| | - F Almaguer
- Department of Nephrology and Kidney Transplantation, Instituto Nacional de Cardiología "Dr. Ignacio Chávez", México
| | - C I Basilio
- Department of Urology, Instituto Nacional de Cardiología "Dr. Ignacio Chávez", México
| | - H B García
- Department of Nephrology and Kidney Transplantation, Instituto Nacional de Cardiología "Dr. Ignacio Chávez", México
| | - A G Arcos
- Department of Nephrology and Kidney Transplantation, Instituto Nacional de Cardiología "Dr. Ignacio Chávez", México
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Abstract
We evaluated postoperative pain intensity and the incidence of chronic pain in patients with renal cell carcinoma undergoing laparoscopic or open radical nephrectomy. In this prospective study, 27 laparoscopic nephrectomy (Group LN) and 25 open nephrectomy (Group ON) patients were included. All patients received paracetamol infusion and intramuscular morphine 30 minutes before the end of the operation and intravenous patient controlled analgesia with morphine postoperatively. Data including patients' demographics, visual analog scale (VAS) pain scores at postoperative 0.5, 1, 2, 4, 6, 12, and 24 hours, postoperative morphine consumption, analgesic demand, analgesic delivery, number of patients requiring rescue analgesics, side effects because of analgesic medications, and overall patient satisfaction were recorded and compared between the two groups. Two and 6 months after the operation, patients were evaluated for chronic postsurgical pain (CPSP). Postoperative average VAS pain scores were not different between the two groups. However, only at 2 hours postoperatively, pain score was significantly higher in Group ON than in Group LN. In both groups, the highest pain scores were recorded at 30 minutes and 1 hour after surgery. Ninety-six percent of group ON patients and 88% of group LN patients required additional analgesia in the early postoperative period (P = 0.33). Postoperative morphine consumption and analgesic demand were found to be similar between the two groups. CPSP at 2 months after surgery was observed in 4 out of 25 patients (16%) in the ON group and 3 out of 27 patients (11.1%) in the LN group (P = 0.6). Chronic pain at 6 months after surgery was observed in 1 ON patient (4%) and 1 LN patient (3.7%, P = 0.9). This study demonstrated that postoperative acute pain scores were not different after laparoscopic or open nephrectomy and patients undergoing laparoscopic or open nephrectomy were at equal risk of developing CPSP. Pain control should be carefully planned in order to reduce early postoperative pain and also potentially prevent CPSP.
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Affiliation(s)
- Isik Alper
- From the Ege University School of Medicine, Depatment of Anesthesiology and Reanimation, Bornova, Izmir, Turkey
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26
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Lentine KL, Lam NN, Schnitzler MA, Garg AX, Xiao H, Leander SE, Brennan DC, Taler SJ, Axelrod D, Segev DL. Gender differences in use of prescription narcotic medications among living kidney donors. Clin Transplant 2015; 29:927-37. [PMID: 26227016 DOI: 10.1111/ctr.12599] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2015] [Indexed: 11/27/2022]
Abstract
Prescription narcotic use among living kidney donors is not well described. Using a unique database that integrates national registry identifiers for living kidney donors (1987-2007) in the United States with billing claims from a private health insurer (2000-2007), we identified pharmacy fills for prescription narcotic medications in periods 1-4 and >4 yr post-donation and estimated relative likelihoods of post-donation narcotic use by Cox regression. We also compared narcotic fill rates and medication possession ratios (MPRs, defined as (days of medication supplied)/(days observed)), between donors and age- and sex-matched non-donors. Overall, rates of narcotic medication fills were 32.3 and 32.4 per 100 person-years in periods 1-4 and >4 yr post-donation. After age and race adjustment, women were approximately twice as likely as men to fill a narcotic prescription in years 1-4 (adjusted hazard ratio, aHR, 2.28; 95% confidence interval, CI, 1.86-2.79) and >4 yr (aHR 1.70; 95% CI 1.50-1.93). MPRs in donors were low (<2.5% days exposed), and lower than among age- and sex-matched non-donors. Prescription narcotic medication use is more common among women than men in the intermediate term after live kidney donation. Overall, total narcotic exposure is low, and lower than among non-donors from the general population.
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Affiliation(s)
- Krista L Lentine
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA.,Division of Abdominal Transplantation, Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Ngan N Lam
- Division of Nephrology, University of Alberta, Edmonton, AB, Canada
| | - Mark A Schnitzler
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA.,Division of Abdominal Transplantation, Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Amit X Garg
- Division of Nephrology, Western University, London, ON, Canada
| | - Huiling Xiao
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA
| | | | - Daniel C Brennan
- Transplant Nephrology, Washington University School of Medicine, St. Louis, MO, USA
| | - Sandra J Taler
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - David Axelrod
- Division of Abdominal Transplantation, Department of Surgery, Dartmouth Hitchcock Medical Center, Hanover, NH, USA
| | - Dorry L Segev
- Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
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27
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Cabral J, Braga I, Fraga A, Castro-henriques A, Príncipe P, Silva-ramos M. From Open to Laparoscopic Living-donor Nephrectomy: Changing the Paradigm in a High-volume Transplant Center. Transplant Proc 2015; 47:903-5. [DOI: 10.1016/j.transproceed.2015.03.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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28
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Özdemir-van Brunschot DM, Koning GG, van Laarhoven KC, Ergün M, van Horne SB, Rovers MM, Warlé MC. A comparison of technique modifications in laparoscopic donor nephrectomy: a systematic review and meta-analysis. PLoS One 2015; 10:e0121131. [PMID: 25816148 DOI: 10.1371/journal.pone.0121131] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 01/28/2015] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To compare the effectiveness of different technique modifications in laparoscopic donor nephrectomy. DESIGN Systematic review and meta-analyses. DATA SOURCES Searches of PubMed, EMBASE, Web of Science and Central from January 1st 1997 until April 1st 2014. STUDY DESIGN All cohort studies and randomized clinical trials comparing fully laparoscopic donor nephrectomy with modifications of the standard technique including hand-assisted, retroperitoneoscopic and single port techniques, were included. DATA-EXTRACTION AND ANALYSIS The primary outcome measure was the number of complications. Secondary outcome measures included: conversion to open surgery, first warm ischemia time, estimated blood loss, graft function, operation time and length of hospital stay. Each technique modification was compared with standard laparoscopic donor nephrectomy. Data was pooled with a random effects meta-analysis using odds ratios, weighted mean differences and their corresponding 95% confidence intervals. To assess heterogeneity, the I2 statistic was used. First, randomized clinical trials and cohort studies were analyzed separately, when data was comparable, pooled analysis were performed. RESULTS 31 studies comparing laparoscopic donor nephrectomy with other technique modifications were identified, including 5 randomized clinical trials and 26 cohort studies. Since data of randomized clinical trials and cohort studies were comparable, these data were pooled. There were significantly less complications in the retroperitoneoscopic group as compared to transperitoneal group (OR 0.52, 95%CI 0.33-0.83, I2 = 0%). Hand-assisted techniques showed shorter first warm ischemia and operation times. CONCLUSIONS Hand-assistance reduces the operation and first warm ischemia times and may improve safety for surgeons with less experience in laparoscopic donor nephrectomy. The retroperitoneoscopic approach was significantly associated with less complications. However, given the, in general, poor to intermediate quality and considerable heterogeneity in the included studies, further high-quality studies are required. TRIAL REGISTRATION The review protocol was registered in the PROSPERO database before the start of the review process (CRD number 42013006565).
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Abstract
OBJECTIVES To evaluate the technique of laparoscopic kidney transplant and demonstrate the feasibility of this procedure by an extraperitoneal approach. MATERIALS AND METHODS The procedure was performed on 2 human cadavers. Retroperitoneal endoscopic left nephrectomy was performed. An extraperitoneal space was established by inflation of a balloon dilator. The external iliac artery and vein were exposed. A Pfannenstiel incision (6 cm) was made and a hand-access device was used. The renal artery was anastomosed to the external iliac artery (end-to-side anastomosis); the renal vein was anastomosed to the external iliac vein (end-to-side anastomosis). The ureter was anastomosed to the bladder with an extravesical tunnelling technique. RESULTS The donor kidney grafts were obtained successfully. The preparation of the external iliac artery and vein was satisfactory. The entire procedure for the renal artery, renal vein, and ureteral anastomoses was performed with laparoscopic technique without any difficulty. CONCLUSIONS The present model on human cadavers may provide a feasible approach for training surgeons to perform human laparoscopic kidney transplant. The present technique may be applied to clinical human kidney transplant.
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Affiliation(s)
- Bulang He
- Liver and Kidney Transplant Unit, Sir Charles Gairdner Hospital and School of Surgery, The University of Western Australia, Perth, Australia
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30
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Hu JC, Liu CH, Treat EG, Ernest A, Veale J, Carter S, Huang KH, Blumberg JM, Schulam PG, Gritsch HA. Determinants of Laparoscopic Donor Nephrectomy Outcomes. Eur Urol 2014; 65:659-64. [DOI: 10.1016/j.eururo.2013.09.048] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 09/27/2013] [Indexed: 10/26/2022]
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31
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Dols LF, Kok NF, d’Ancona FC, Klop KW, Tran TK, Langenhuijsen JF, Terkivatan T, Dor FJ, Weimar W, Dooper IM, Ijzermans JN. Randomized Controlled Trial Comparing Hand-Assisted Retroperitoneoscopic Versus Standard Laparoscopic Donor Nephrectomy. Transplantation 2014; 97:161-7. [DOI: 10.1097/tp.0b013e3182a902bd] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Candiotti K, Yang Z, Xue L, Zhang Y, Rodriguez Y, Wang L, Hao S, Gitlin M. Single-Nucleotide Polymorphism C3435T in the ABCB1 Gene is Associated with Opioid Consumption in Postoperative Pain. Pain Med 2013; 14:1977-84. [DOI: 10.1111/pme.12226] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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34
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He B, Musk GC, Mou L, De Boer B, Delriviere L, Hamdorf J. Laparoscopic surgery for orthotopic kidney transplant in the pig model. J Surg Res 2013; 184:1096-101. [DOI: 10.1016/j.jss.2013.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 02/17/2013] [Accepted: 03/07/2013] [Indexed: 10/27/2022]
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Machado C, Malheiros DMAC, Adamy A, Santos LS, Silva Filho AFD, Nahas WC, Lemos FBC. Protective response in renal transplantation: no clinical or molecular differences between open and laparoscopic donor nephrectomy. Clinics (Sao Paulo) 2013; 68:483-8. [PMID: 23778338 PMCID: PMC3634954 DOI: 10.6061/clinics/2013(04)08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 12/11/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Prolonged warm ischemia time and increased intra-abdominal pressure caused by pneumoperitoneum during a laparoscopic donor nephrectomy could enhance renal ischemia reperfusion injury. For this reason, laparoscopic donor nephrectomy may be associated with a slower graft function recovery. However, an adequate protective response may balance the ischemia reperfusion damage. This study investigated whether laparoscopic donor nephrectomy modified the protective response of renal tissue during kidney transplantation. METHODS Patients undergoing live renal transplantation were prospectively analyzed and divided into two groups based on the donor nephrectomy approach used: 1) the control group, recipients of open donor nephrectomy (n = 29), and 2) the study group, recipients of laparoscopic donor nephrectomy (n = 26). Graft biopsies were obtained at two time points: T-1 = after warm ischemia time and T+1 = 45 minutes after kidney reperfusion. The samples were analyzed by immunohistochemistry for the Bcl-2 and HO-1 proteins and by real-time polymerase chain reaction for the mRNA expression of Bcl-2, HO-1 and vascular endothelial growth factor. RESULTS The area under the curve for creatinine and delayed graft function were similar in both the laparoscopic and open groups. There was no difference in the protective gene expression between the laparoscopic donor nephrectomy and open donor nephrectomy groups. The protein expression of HO-1 and Bcl-2 were similar between the open and laparoscopic groups. Furthermore, the gene expression of B-cell lymphoma 2 correlated with the warm ischemia time in the open group (p = 0.047) and that of vascular endothelial growth factor with the area under the curve for creatinine in the laparoscopic group (p = 0.01). CONCLUSION The postoperative renal function and protective factor expression were similar between laparoscopic donor nephrectomy and open donor nephrectomy. These findings ensure laparoscopic donor nephrectomy utilization in renal transplantation.
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Affiliation(s)
- Christiano Machado
- Hospital de Caridade, Irmandade Santa Casa de Misericórdia de Curitiba, Division of Urology, Curitiba/PR, Brazil.
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Rodríguez O, Breda A, Esquena S, Villavicencio H. [Surgical aspects of living donor nephrectomy]. Actas Urol Esp 2013; 37:181-7. [PMID: 22840385 DOI: 10.1016/j.acuro.2012.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 05/11/2012] [Indexed: 11/21/2022]
Abstract
CONTEXT Living donor renal transplant surgery has evolved from the classical nephrectomy by lumbotomy to less invasive surgery, the laparoscopic and robotic nephrectomy currently being the most important. It is important to know the available evidence on whether nephrectomy in patients with multiple arteries, right kidney and in obese patients can be performed safely when there is a correct indication. OBJECTIVE To perform a review of the different surgical techniques in living donor nephrectomy, adapted to the current surgical evidence and other aspects related to the indication. EVIDENCE ACQUISITION A systematic review was made in PubMed (1997-2011). This included previous reviews randomized controlled clinical studies, cohort studies, and meta-analyses of this surgical aspects of living donor nephrectomy. CONCLUSIONS Currently, there is sufficient evidence to consider living donor laparoscopic nephrectomy as the technique of choice, although the role of hand-assisted retroperitoneoscopic technique is still not totally clear. Open surgery techniques using mini-incision are an acceptable alternative for the sites that have not yet implemented laparoscopic surgery. Right kidney nephrectomy, of those cases that present multiple pedicles and in obese donors, is justified in selected cases.
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Modi P, Pal B, Modi J, Singla S, Patel C, Patel R, Padhy S, T K, Patel K, Rizvi J, Sharma S, Sharma V, Modi M, Shah VR, Trivedi HL. Retroperitoneoscopic Living-Donor Nephrectomy and Laparoscopic Kidney Transplantation: Experience of Initial 72 Cases. Transplantation 2013; 95:100-5. [DOI: 10.1097/tp.0b013e3182795bee] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Cooper M, Kramer A, Nogueira JM, Phelan M. Recipient outcomes of dual and multiple renal arteries following 1000 consecutive laparoscopic donor nephrectomies at a single institution. Clin Transplant 2013; 27:261-6. [DOI: 10.1111/ctr.12062] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2012] [Indexed: 12/22/2022]
Affiliation(s)
- Matthew Cooper
- Division of Transplantation; Department of Surgery; University of Maryland School of Medicine; Baltimore; MD; USA
| | - Andrew Kramer
- Division of Urology; Department of Surgery; University of Maryland School of Medicine; Baltimore; MD; USA
| | - Joseph M. Nogueira
- Division of Nephrology; Department of Medicine; University of Maryland School of Medicine; Baltimore; MD; USA
| | - Michael Phelan
- Division of Urology; Department of Surgery; University of Maryland School of Medicine; Baltimore; MD; USA
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Yuan H, Liu L, Zheng S, Yang L, Pu C, Wei Q, Han P. The Safety and Efficacy of Laparoscopic Donor Nephrectomy for Renal Transplantation: An Updated Meta-analysis. Transplant Proc 2013; 45:65-76. [DOI: 10.1016/j.transproceed.2012.07.152] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 06/21/2012] [Accepted: 07/19/2012] [Indexed: 11/18/2022]
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Adam F, Pelle-Lancien E, Bauer T, Solignac N, Sessler D, Chauvin M. Anesthesia and postoperative analgesia after percutaneous hallux valgus repair in ambulatory patients. ACTA ACUST UNITED AC 2012; 31:e265-8. [DOI: 10.1016/j.annfar.2012.07.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 07/26/2012] [Indexed: 11/26/2022]
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Mathuram Thiyagarajan U, Bagul A, Nicholson ML. Pain management in laparoscopic donor nephrectomy: a review. Pain Res Treat 2012; 2012:201852. [PMID: 23150820 DOI: 10.1155/2012/201852] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Accepted: 09/20/2012] [Indexed: 11/17/2022]
Abstract
The management of postoperative pain is a key to patient early recovery, in particular, where the surgery was performed to benefit another human being. In recent years it has been recognized that multimodal analgesic methods are superior for postoperative pain relief. It is also imperative to remember that inadequately managed acute postoperative pain opens the doorway to possible suffering from chronic postoperative pain later. Although the laparoscopic donor nephrectomy has reduced the disincentives associated with open surgery, still significant percentage of donors suffers from postoperative pain. In the UK, patient-controlled analgesic system (PCAS) using morphine for postoperative pain relief is being used in majority of the transplant centres. Though opioids provide good analgesia, they are far from being an ideal analgesic due to their adverse effects. This paper pragmatically looks in depth on different modalities of pain management in patients undergoing laparoscopic live donor nephrectomy.
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Klop KW, Dols LF, Kok NF, Weimar W, Ijzermans JN. Attitudes Among Surgeons Towards Live-Donor Nephrectomy: A European Update. Transplantation 2012; 94:263-8. [DOI: 10.1097/tp.0b013e3182577501] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Harper JD, Spencer ES, Porter MP, Gore JL. Adoption of laparoscopic radical nephrectomy in the state of Washington. Urology 2012; 79:326-31. [PMID: 22310748 DOI: 10.1016/j.urology.2011.10.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 10/12/2011] [Accepted: 10/18/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine state-wide trends in adoption of laparoscopic radical nephrectomy (LRN). Open radical nephrectomy and LRN confer equivalent long-term oncological outcomes, yet LRN usage has not increased analogous to diffusion of laparoscopy in other fields. MATERIAL AND METHODS From the Washington State Comprehensive Hospital Abstract Reporting System, we identified patients who underwent ORN and LRN from 1998 to 2007. Number of LRNs was examined for each hospital state-wide. Length of stay outcomes were examined, and multivariate models were created to examine characteristics of LRN patients and of patients who received care at high-volume LRN hospitals (HiLap). RESULTS The proportion of nephrectomies performed laparoscopically increased 27%. In 1998, 7 hospitals (12%) performed≥1 LRN compared with 36 hospitals (61%) in 2007. Four HiLap hospitals accounted for 61% of the increase in LRN from 1998-2002, and 36% of the increase overall. Women (OR 1.15, 95% CI 1.00-1.33) and healthier patients (OR 1.52, 95% CI 1.28-1.82 for patients with Charlson 0 vs ≥2) were more likely to undergo LRN. Mean length of stay for nephrectomies was shorter at HiLap hospitals (P=.04 for 1998-2002, P<.001 for 2003-2007). CONCLUSIONS Uptake of LRN in Washington state parallels national trends; however, the proportion of LRN is lower than expected. A handful of hospitals account for the majority of the increase in LRN. The quality of nephrectomy care may be better at these centers. Barriers exist that prevent LRN adoption even after a trial case. Dissemination of the processes or personnel associated with use of LRN may increase the proportion of patients undergoing LRN.
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Affiliation(s)
- Jonathan D Harper
- Department of Urology, University of Washington School of Medicine, Seattle, WA 98195, USA.
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Bagul A, Frost JH, Mathuram Thiyagarajan U, Mohamed IH, Nicholson ML. Extending Anatomic Barriers to Right Laparoscopic Live Donor Nephrectomy. Urology 2012; 79:465-9. [DOI: 10.1016/j.urology.2011.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 09/28/2011] [Accepted: 10/05/2011] [Indexed: 11/26/2022]
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Delanaye P, Weekers L, Dubois BE, Cavalier E, Detry O, Squifflet JP, Krzesinski JM. Outcome of the living kidney donor. Nephrol Dial Transplant 2012; 27:41-50. [DOI: 10.1093/ndt/gfr669] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Gorevski E, Wead S, Tevar A, Succop P, Volek P, Martin-Boone J. Retrospective evaluation of donor pain and pain management after laprascopic nephrectomy. Transplant Proc 2011; 43:2487-91. [PMID: 21911110 DOI: 10.1016/j.transproceed.2011.06.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 05/20/2011] [Accepted: 06/01/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this study was to evaluate donor pain and pain management beginning immediately postoperatively until hospital discharge. METHODS All kidney donors were included from 2008 and 2009. Demographic data, operative data, pain scores in the postanesthesia care unit, and visual analog pain scale (VAS) scores were collected for each patient. Standardization for comparison was made by converting doses to intravenous morphine equivalents (ME). RESULTS Eighty-five patients were identified as donors, all of which underwent laparoscopic nephrectomy. Daily analgesic requirement was significantly reduced from postoperative day 1 to postoperative day 2 (42.2 mg ME versus 19.7 mg ME, P < .0001). The use of patient-controlled analgesia (PCA) did not demonstrate improved pain management with similar VAS scores for users and nonusers on the day of operation (5.4 vs 5.6, P = .87), postoperative day 1 (4.9 vs 5.4, P = .5), and postoperative day 2 (4.7 vs 4.5, P = .65), respectively. Even though similar VAS scores were found for PCA users and nonusers, PCA users had significantly higher opioid use on the day of operation (P = .007) and postoperative day 1 (P = .004). CONCLUSIONS The average VAS score on the day of operation was 5.5, with patients experiencing a significant reduction in VAS score on postoperative day 1. PCA delivery did not provide any additional benefit in pain relief in this cohort.
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Gerbershagen HJ, Dagtekin O, Rothe T, Heidenreich A, Gerbershagen K, Sabatowski R, Petzke F, Özgür E. Risk factors for acute and chronic postoperative pain in patients with benign and malignant renal disease after nephrectomy. Eur J Pain 2009; 13:853-60. [DOI: 10.1016/j.ejpain.2008.10.001] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Revised: 09/03/2008] [Accepted: 10/05/2008] [Indexed: 11/19/2022]
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Abstract
BACKGROUND Waiting lists for kidney transplantation continue to grow and live organ donation has become more important as the number of brain stem dead cadaveric organ donors continues to fall. The major disincentive to potential kidney donors is the pain and morbidity associated with open surgery. OBJECTIVES To identify the benefits and harms of using laparoscopic compared to open nephrectomy techniques to recover kidneys from live organ donors. SEARCH METHODS We searched the online databases CENTRAL (in The Cochrane Library 2010, Issue 2), MEDLINE (January 1966 to January 2010) and EMBASE (January 1980 to January 2010) and handsearched textbooks and reference lists. SELECTION CRITERIA Randomised controlled trials comparing laparoscopic donor nephrectomy (LDN) with open donor nephrectomy (ODN). 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. MAIN RESULTS Six studies were identified that randomised 596 live kidney donors to either LDN or ODN arms. All studies were assessed as having low or unclear risk of bias for selection bias, allocation bias, incomplete outcome data and selective reporting bias. Four of six studies had high risk of bias for blinding. Various different combinations of techniques were used in each study, resulting in heterogeneity in the results. The conversion rate from LDN to ODN ranged from 1% to 1.8%. LDN was generally found to be associated with reduced analgesia use, shorter hospital stay, and faster return to normal physical functioning. The extracted kidney was exposed to longer warm ischaemia periods (2 to 17 minutes) with no associated short-term consequences. ODN was associated with shorter duration of procedure. For those outcomes that could be meta-analysed there were no significant differences between LDN or ODN for perioperative complications (RR 0.87, 95% CI 0.47 to 4.59), reoperations (RR 0.57, 95% CI 0.09 to 3.64), early graft loss (RR 0.31, 95% CI 0.06 to 1.48), delayed graft function (RR 1.09, 95% CI 0.52 to 2.30), acute rejection (RR 1.41, 95 % CI 0.87 to 2.27), ureteric complications (RR 1.51, 95% CI 0.69 to 3.31), kidney function at one year (SMD 0.15, 95% CI -0.11 to 0.41) or graft loss at one year (RR 0.76, 95% CI 0.15 to 3.85). AUTHORS' CONCLUSIONS LDN is associated with less pain compared with open surgery; however, there are equivalent numbers of complications and occurrences of perioperative events that require further intervention. Kidneys obtained using LDN procedures were exposed to longer warm ischaemia periods than ODN-acquired grafts, although this has not been reported as being associated with short-term consequences.
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Affiliation(s)
- Colin H Wilson
- Transplant Surgery, The Freeman Hospital, Newcastle-upon-Tyne, UK
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Modi P, Rizvi J, Pal B, Bharadwaj R, Trivedi P, Trivedi A, Patel K, Shah K, Vyas J, Sharma S, Shah K, Chauhan R, Trivedi H. Laparoscopic kidney transplantation: an initial experience. Am J Transplant 2011; 11:1320-4. [PMID: 21486384 DOI: 10.1111/j.1600-6143.2011.03512.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Laparoscopic donor nephrectomy has the advantages of less pain, early ambulation and shorter hospitalization compared to open donor nephrectomy. Kidney recipient surgery is, however, traditionally performed by open surgery. Our aim was to study feasibility and safety of laparoscopic kidney transplantation (LKT). After permission from Internal Review Board, LKT was performed in four patients. All kidneys were procured from deceased donors. Left kidney was used for LKT and transplanted in left iliac fossa while right kidney was used for standard open kidney transplantation (OKT). All transplantation procedures were performed successfully. Cold ischemia time varied between 4 h and 14 h. For LKT, mean time for anastomosis was 65 (range 62-72) min, mean operative time was 3.97 (range 3.5-5) h, mean blood loss was 131.25 mL (range 45-350) mL. Mean wound length was 7 cm in LKT group and 18.4 cm in OKT group. Delayed graft function was observed in one patient in each group. One patient was lost in OKT group due to posttransplant bacterial meningitis. At 6 months, both groups have comparable value of serum creatinine. In conclusion, LKT is technically feasible and safe. Long term outcome needs to be evaluated in a larger study.
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Affiliation(s)
- P Modi
- Department of Urology and Transplantation Surgery, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre and Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India.
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