Comparison of outcomes of hand-assisted laparoscopic to open donor nephrectomy for pediatric recipients

Hand-assisted laparoscopic surgery on a gigantic primary retroperitoneal mature cystic teratoma: A case report

INTRODUCTION

Primary teratomas in the retroperitoneum are rare, incidentally identified in children, and resected using a laparoscopic approach. However, when it increases in size, the laparoscopic approach is technically demanding, leaving a large skin incision for tumor removal.

PRESENTATION OF CASE

The patient was a 20-year-old woman who presented with chronic left flank pain. Abdominal and pelvic computed tomography (CT) revealed a 25-cm wide giant polycystic and solid retroperitoneal tumor containing calcification located in the upper portion of the left kidney, strongly compressing the pancreas and spleen. No other metastatic lesions were observed. Additionally, abdominal magnetic resonance imaging (MRI) revealed that the polycystic tumor consisted of serous fluid and fatty components, and bone and tooth components were found in the tumor center. Therefore, the patient was diagnosed with retroperitoneal mature teratoma and a hand-assisted laparoscopic surgery using bikini line skin incision was performed. The specimen was 27 × 25 cm in size, weighing 2512 g. Histology revealed that the tumor was a benign, mature teratoma without a malignant component. The postoperative course was uneventful and the patient was discharged on postoperative day 7. The patient remained healthy without any recurrence and the postoperative scar is barely visible under direct vision.

DISCUSSION

Primary retroperitoneal mature teratomas can enlarge without initially causing symptoms and can be incidentally identified using imaging studies.

CONCLUSION

A hand-assisted laparoscopic approach using a bikini line skin incision is safe, minimally invasive, and provides better cosmesis.

Laparoscopic Versus Finger-Assisted Open Donor Nephrectomy Technique: A Possible Safe Alternative

OBJECTIVES

Despite the present use ofthe laparoscopic technique for living-donor kidney nephrectomy, a search for alternative techniques continues.The aim of this study was to compare finger-assisted open donor nephrectomy versus laparoscopic donor nephrectomy.

MATERIALS AND METHODS

This study included retrospective data of 95 consecutive donors in a transplant center who were under going donor nephrectomy RESULTS: Donor demographics and clinical characteristics were generally similar between treatment groups. There were fewer female donors in the finger-assisted open donor nephrectomy treatment group (70.5% vs 29.5%; P = .003), but median body mass index was similar between groups (28 vs 26 kg/m²; P = .032). Patients who received laparoscopic donor nephrectomy had longer operative duration (3.5 vs 1.2 h; P < .001), longer combined length of incision (6 vs 5 cm; P = .001), andshorter median hospital length of stay (3 vs 4 days; P < .001). A left nephrectomy was preferred in both groups. Minor postoperative complications occurred less often in the finger-assisted open donor nephrectomy group (14.7% vs 31.6%; P = .0094). Donors who received laparoscopic nephrectomy had lower glomerular filtration rate at 1 year after donation (60 vs 89 mL/min/1.73 m²; P < .001) than donors who received finger-assisted nephrectomy. However, recipients of donors of both procedures had similar glomerular filtration rate at 1 year after transplant (65 vs 69 mL/min/1.73 m²; P = .5).

CONCLUSIONS

Our study demonstrated that finger-assisted open donor nephrectomy is a successful and safe alternative versus laparoscopic donor nephrectomy, providing favorable results for patients in terms of complications and outcomes.