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Olumba FC, Vachharajani N, Yu J, Scherer M, Matson S, Hill AL, Kiani A, Lin Y, Doyle MMB, Chapman WC, Wellen JR, Khan AS. Robotic donor nephrectomy: optimizing outcomes beyond the limitations of laparoscopy. Surg Endosc 2023; 37:7511-7519. [PMID: 37415014 DOI: 10.1007/s00464-023-10246-z] [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: 03/09/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Robotic donor nephrectomy (RDN) has emerged as a safe alternate to laparoscopic donor nephrectomy (LDN), offering improved visualization, instrument dexterity and ergonomics. There is still concern about how to safely transition from LDN to RDN. METHODS We performed a retrospective review of 150 consecutive living donor operations (75 LDN and 75 RDN) at our center, comparing the first 75 RDN's with the last 75 LDN's performed prior to the initiation of the robotic transplant program. Operative times and complications were used as surrogates of efficiency and safety, respectively, to estimate the learning curve with RDN. RESULTS RDN was associated with a longer total operative time (RDN 182 vs LDN 144 min; P < 0.0001) but a significantly shorter post-operative length of stay (RDN 1.8 vs LDN 2.1 days; P = 0.0213). Donor complications and recipient outcomes were the same between both groups. Learning curve of RDN was estimated to be about 30 cases. CONCLUSIONS RDN is a safe alternate to LDN with acceptable donor morbidity and no negative impact on recipient outcomes even during the early part of the RDN learning curve. Surgeon preferences for the robotic approach compared to traditional laparoscopy will require further scrutiny to improve ergonomics and operative efficiency.
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Affiliation(s)
- Franklin C Olumba
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Neeta Vachharajani
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Jennifer Yu
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Meranda Scherer
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Sarah Matson
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Angela L Hill
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Amen Kiani
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Yiing Lin
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Majella M B Doyle
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - William C Chapman
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Jason R Wellen
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA
| | - Adeel S Khan
- Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA.
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Olumba FC, Zhou F, Doyle MM, Vachharajani N, Upadhya GA, Park Y, Chapman WC. Carving Out The Future of Marginal Liver Rescue With Normothermic Machine Preservation. J Am Coll Surg 2023:00019464-990000000-00659. [PMID: 37171097 DOI: 10.1097/xcs.0000000000000759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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Olumba FC, Zhou F, Park Y, Chapman WC. Normothermic Machine Perfusion for Declined Livers: A Strategy to Rescue Marginal Livers for Transplantation. J Am Coll Surg 2023; 236:614-625. [PMID: 36728302 DOI: 10.1097/xcs.0000000000000555] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 02/03/2023]
Abstract
BACKGROUND Organ waste is a major cause of the donor liver shortage. Roughly 67% of recovered organ donors have liver utilization annually. A new technology called normothermic machine perfusion (NMP) offers a way to recover marginal and declined livers for transplant. We report interim results of the RESTORE trial (FDA investigational drug exemption trial NCT04483102) that aims to transplant NMP-treated livers that would otherwise be discarded. STUDY DESIGN Declined livers were screened for NMP eligibility (eg donation after circulatory death [DCD] grafts with warm ischemic time <40 minutes, donation after brain death [DBD] grafts with cold ischemic time <8 hours). Livers meeting pre-NMP eligibility criteria received NMP using the OrganOx metra device for a minimum of 4 hours. All NMP-treated livers meeting the viability criteria were transplanted to consented recipients. RESULTS Over 22 months, 60 declined livers from three organ procurement organizations (OPOs; 40 DCD and 20 DBD donor livers) were offered, and 22 livers (10 DCD and 12 DBD livers) met the pre-NMP eligibility. After NMP, 16 of 22 livers passed viability testing and were transplanted into needy recipients (median Model for End-Stage Liver Disease [MELD] score of 8, range 6 to 24), resulting in a 72.7% rescue rate (50% DCD, 91.7% DBD). The rate of early allograft dysfunction was 31.3%, but there were no graft-related deaths, primary nonfunction, or instances of nonanastomotic biliary strictures. CONCLUSIONS Interim results of the RESTORE trial suggest that a sizable number of declined livers can be reclaimed. They are safe for transplantation and can enable lower MELD patients at high risk of morbidity and mortality to receive lifesaving grafts while offering OPOs a way to allocate more livers and reduce organ waste.
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Affiliation(s)
- Franklin C Olumba
- From the Department of Abdominal Organ Transplantation Surgery, Washington University School of Medicine, St Louis, MO (Olumba, Zhou, Chapman)
| | - Fangyu Zhou
- From the Department of Abdominal Organ Transplantation Surgery, Washington University School of Medicine, St Louis, MO (Olumba, Zhou, Chapman)
| | - Yikyung Park
- the Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO (Park)
| | - William C Chapman
- From the Department of Abdominal Organ Transplantation Surgery, Washington University School of Medicine, St Louis, MO (Olumba, Zhou, Chapman)
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