Conventional Laparoscopic Donor Nephrectomy Research Articles

Minimally Invasive Laparoscopic Donor Nephrectomy With a Pfannenstiel Incision Using Size-Reduced Trocars.

Laparoendoscopic single-site surgery is performed during laparoscopic donor nephrectomy (LDN) to reduce donor invasiveness. However, the procedure is difficult and does not improve cosmesis when the incision is made at the umbilicus. Therefore, we proposed a minimally invasive LDN with a Pfannenstiel incision using size-reduced trocars (mLDN) to achieve cosmesis and operability and aimed to assess its efficacy and safety. A total of 27 patients who underwent mLDN were recruited. Data on estimated blood loss, operative time, pneumoperitoneum time, warm ischemic time (WIT), complication rate, non-steroidal anti-inflammatory drugs (NSAIDs) used, and recipient serum creatinine levels were collected retrospectively. In mLDN, the Pfannenstiel position was incised to approximately 6 cm to retrieve the kidney, and three size-reduced trocars were placed in the left upper abdomen (2.5 mm and 5 mm) and umbilicus (5 mm). The median operation time and pneumoperitoneum time were 245 and 194 minutes, respectively. The median WIT was 276 seconds, and the serum creatinine levels of the recipients at seven days and one, three, six, and 12 months were significantly improved compared with baseline. No intra- and postoperative complications (Clavien-Dindo grade ≥ 2) were observed, and no patients used additional NSAIDs after the operation. The scarring in the mLDN group was unnoticeable postoperatively. mLDN can be performed safely, with high cosmesis, and with operability similar to that of conventional LDN. Although the WIT tended to be long, the function of the harvested kidney was maintained, and the use of analgesic NSAIDs was lower in this procedure. Our procedure should be considered as an option for LDN.

Outcome of Kidney Transplantation With Transumbilical Laparoendoscopic Single-Site Donor Nephrectomy: A Single-Center Experience

AimThe aim of this study is to present the outcome of kidney transplantation after laparoendoscopic single-site donor nephrectomy (LESS DN) compared with conventional laparoscopic donor nephrectomy (LDN) in a single-center experience. MethodsThis retrospective study compares data from the initial experience with 110 consecutive LESS DN donors and their recipients (group A) with 205 consecutive conventional LDN donors and their recipients (group B). ResultsThis study compared 110 LESS DNs completed in an 18-month period with 205 LDNs completed in the immediately preceding 42-month period. All procedures were performed by the same surgeon. In groups A and B, respectively, the incidence of immediate graft function was 90% vs 91.2%, slow graft function was 9% vs 5.3%, delayed graft function was 0.9% vs 2.9%, graft loss was 0.9% vs 2.9%, and death with a functioning graft was 0.9% vs 1.5%. The mean serum creatinine levels were 1.3 ± 0.93 mg/dL vs 1.4 ± 1.2 mg/dL (P = .447), 1.1 ± 0.33 mg/dL vs 1.2 ± 0.75 mg/dL (P = .184), and 1.05 ± 0.25 mg/dL vs 1.1 ± 0.39 mg/dL (P = .224) at 7, 30, and 365 days after transplantation. The estimated glomerular filtration rate at 1 year was 88 ± 18.2 vs 83 ± 12.2 mL/min/1.73 m2 (P = .004). The mean donor operative times in groups A and B were 175.9 ± 24.9 minutes vs 199.88 ± 37.06 minutes (P = .0001), respectively, and the mean warm ischemia time was 5.2 ± 1.02 minutes vs 3.64 ± 1.38 minutes, respectively (P = .0001). The mean body mass index, the incidence of complex vascular anatomy, and the rate of complications were the same in the 2 donor groups. ConclusionsThe outcome of kidney transplantation after LESS DN is comparable to conventional LDN. LESS DN can be employed as the primary approach for kidney donation with low donor risk and without compromising recipient outcomes.

Transumbilical laparoendoscopic single-site donor nephrectomy: evolving trends

We report our experience with laparoendoscopic single-site donor nephrectomy (LESS DN). Retrospective comparative study of data from 200 Consecutive left LESS DN (group A) compared to 205 consecutive conventional laparoscopic donor nephrectomy (LDN) (group B). Standard laparoscopic instruments were used in all patients. Right nephrectomies were excluded. From 05/2015 to 12/2017, 200 LESS DN (group A) and from 10/2011 till 04/2015, 205 LDN (group B) were performed. In group A and B, respectively, the mean operative time was 175.9 ± 24.9 versus 199.88 ± 37.06min (p = 0.0001), the mean warm ischemia time was 5.2 ± 1.02 versus 3.64 ± 1.38min (p = 0.0001), the mean BMI was 24.8 ± 4.5 versus 25.2 ± 4.7kg/m2, complex vascular anatomy was found in 60 (30%) and 68 (33.2%), average length of incision was 5.2 versus 7.7cm (p = 0.001), scar satisfaction rate 8 versus 6 (p = 0.004), mean morphine equivalents 81.0 versus 70.5mg; (p = 0.03), average timing for return to work was 42 versus 50days; (p = 0.001). There was no conversion to open surgery in both groups. One case converted to hand-assisted laparoscopic nephrectomy in group A. Pure LESS-DN was successfully completed in 169 patients (84.5%). In group A, due to technical difficulties, additional 1 or 2, 5-mm port(s) was added in 21 and 10 cases, respectively. Two negative explorations were performed in the first post-operative week for picture of small bowel obstruction. We had port site hernia in one donor, superficial wound infection in three donors and blood transfusion was required in two donors in group A. Our experience with LESS-DN is encouraging. LESSDN can be integrated as a standard approach for renal donation without additional donor risk. Moreover, LESS DN gives more flexibility by possibility to add one or more 5-mm ports in case of technical difficulties.

A single-center 4-year experience with 47 pediatric renal transplants: Evolving trends.

Outcome of pediatric kidney transplantation (KT) has improved over the last several decades. We retrospectively reviewed the outcomes pediatric KT in King Faisal Specialist Hospital and Research Center-Jeddah, Saudi Arabia. Between May 2013 and November 2016, we performed renal transplantation in 47 children, 30 (64%) males, and 17 (36%) females. All patients received antibody induction with basiliximab or antithymocyte globulin along with triple immunosuppressive therapy with tacrolimus, mycophenolate mofetil and steroids. Twenty-four (51%) and 14 (30%) patients were on hemodialysis and peritoneal dialysis, respectively. Average duration on dialysis was 18.3 months. Nine patients (19%) had preemptive transplant. Forty-five patients (95.7%) received kidneys from living donors, 38 (83%) males and nine (17%) females, mean age (years), and body mass index were 30.8 ± 8.82 and 23.8 ± 4.54, respectively. Forty-one donors had left nephrectomy. Four right nephrectomies were reported, all of them were through open nephrectomy. Open nephrectomy was reported in 21 (46%) patients. Several laparoscopic nephrectomy techniques were performed; conventional laparoscopic donor nephrectomy, laparo-endoscopic single-site donor nephrectomy, and hand-assisted laparoscopic surgery in 10, 11, and three patients, respectively. The most common etiologies of end-stage renal disease were focal segmental glomerulosclerosis 19%, posterior urethral valve 8.5%, and congenital abnormalities 8.5% respectively. With a mean follow-up of 54 months, one and 4-year graft survival rates were 95.7% and 91.5%, respectively. One-and four-year patient survival rates were 100%. Outcomes were similar in patients < or ≥10 years. The graft survival was comparable in laparoscopic versus open donor nephrectomy (P = 0.72). Average serum creatinine was 0.85, 0.79, 0.79, and 0.84 at 7, 30, 90, 365 days, respectively. Four patients lost their graft due to renal vein thrombosis, chronic allograft nephropathy (cadaveric donor), Antibody-mediated rejection, and hemolytic-uremic syndrome at 0.75, 9, 19, and 24 months, respectively. The incidences of acute rejection and major infection were 2% and 4%, respectively. One patient developed posttransplant lympho-proliferative disease that was treated and is still with excellent graft function. Our pediatric KT experience is encouraging. Acute rejection, patient, and graft survival rates are similar and even better than many of western reports.

Comparison of Cosmesis and Body Image After Laparoendoscopic Single-Site Versus Conventional Laparoscopic Donor Nephrectomy

BackgroundThis study used a questionnaire to objectively assess the body image of donors who underwent conventional laparoscopic donor nephrectomy (L-DN) or laparoscopic single-site donor nephrectomy (LESS-DN). Surgical outcomes were compared between the two groups. MethodsTwenty patients underwent L-DN and 20 underwent LESS-DN. The postoperative outcomes of the two approaches were retrospectively compared and evaluated for differences in cosmesis and body image. The questionnaire comprised a body image questionnaire, including a body image scale (BIS) and cosmetic scale (CS), and a photo-series questionnaire (PSQ). A higher score indicated a more favorable assessment. Pain was assessed by comparing the number of times an analgesic was administered during hospitalization. ResultsThere were no significant differences in operative outcomes between L-DN and LESS-DN. The average BIS score (maximum possible, 20 points) was 18.5 points for patients who underwent L-DN and 19.5 points for patients who underwent LESS-DN (P = .025). Patients who underwent L-DN had a median CS score (maximum possible, 24 points) of 17.5 points, whereas patients who underwent LESS-DN had a median CS score of 19.0 points (P = .113). The average PSQ score was 7.1 points for patients who underwent L-DN and 8.8 points for patients who underwent LESS-DN (P = .01). Patients who underwent LESS-DN were administered an analgesic was significantly number of times less than patients who underwent DN (P = .01). ConclusionsLESS-DN results in a better body image and better cosmetic appearance than does L-DN, indicating the clinical usefulness of LESS-DN.

A Randomized, Prospective, Parallel Group Study of Laparoscopic Versus Laparoendoscopic Single Site Donor Nephrectomy for Kidney Donation

Few prospective, randomized studies have assessed the benefits of laparoendoscopic single site donor nephrectomy (LESS-DN) over laparoscopic donor nephrectomy (LDN). Our center initiated such a trial in January 2011, following subjects randomized to LESS-DN versus LDN from surgery through 5 years postdonation. Subjects complete recovery/satisfaction questionnaires at 2, 6 and 12 months postdonation; transplant recipient outcomes are also recorded. One hundred subjects (49 LESS-DN, 51 LDN) underwent surgery; donor demographics were similar between groups, and included a predominance of female, living-unrelated donors, mean age of 47 years who underwent left donor nephrectomy. Operative parameters (overall time, time to extraction, warm ischemia time, blood loss) were similar between groups. Conversion to hand-assist laparoscopy was required in 3 LESS-DN (6.1%) versus 2 LDN (3.9%; p = 0.67). Questionnaires revealed that 97.2% of LESS-DN versus 79.5% of LDN (p = 0.03) were 100% recovered by 2 months after donation. No significant difference was seen in satisfaction scores between the groups. Recipient outcomes were similar between groups. Our randomized trial comparing LESS donor nephrectomy to LDN confirms that LESS-DN offers a safe alternative to conventional LDN in terms of intra- and post-operative complications. LDN and LESS-DN offer similar recovery and satisfaction after donation.

Laparoendoscopic Single-Site Donor Nephrectomy Video

Introduction: Laparoendoscopic single-site (LESS) surgery is a modification of multiport or conventional laparoscopy. Utilizing a single site for access, LESS attempts to minimize the number of scars produced. This may result in improvements in pain, convalescence, and cosmesis. Outcomes, however, must not be compromised using this approach. At our institution, we have performed LESS donor nephrectomy (LESS-DN) and have compared it to conventional laparoscopic donor nephrectomy (LDN) in a prospective, randomized fashion to assure that LESS-DN outcomes are not inferior to LDN. The technique and the outcomes of our trial are outlined in the video. Methods: LESS-DN access is obtained through the extraction pfannenstiel incision. Three ports are placed within this incision and donor nephrectomy is performed with the aid of the EndoEye articulating scope. The colon is reflected after incising the white line of Toldt, and the ureter is identified. Dissection toward the hilum is performed and the renal artery and vein are skeletonized with branching vessels ligated and transected with hemolock clips. The lateral and upper pole renal attachments are freed and the renal artery and vein are staple ligated. The kidney is placed in an endocatch bag and extracted through the pfannenstiel incision. Results: LDN and LESS-DN were performed in 14 and 15 patients, respectively. Patients had similar parameters on study entry and had similar outcomes with LESS-DN patients enjoying less pain on postoperative days 1 and 2. Conclusion: LESS-DN is safe, feasible, and comparable to LDN. LESS-DN may result in improvement in pain and convalescence. Number of scars are decreased with the use of LESS-DN. No competing financial interests exist. Runtime of video: 5 mins 37 secs

Laparoscopic Donor Nephrectomy with Transvaginal Extraction: Initial Experience of 30 Cases

To assess the safety and feasibility of laparoscopic donor nephrectomy with transvaginal extraction and impact of body mass index (BMI), menopausal status, previous surgery, and uterine fibroids. Five-port conventional laparoscopic donor nephrectomy with successful transvaginal extraction of the kidney was performed in 30 donors. The parameters assessed included age, BMI, operative time, estimated blood loss, warm ischemia time, postoperative pain score, preoperative and postoperative sexual function, wound complications, hospital stay, return to normal activities, recipient creatinine level, and other recipient-related complications. The data were compared with 30 female donors who had laparoscopic donor nephrectomy and transabdominal extraction. The total number of patients who consented for the study was 38. In seven patients, an intraoperative decision to abort the transvaginal extraction was made because of obesity, pelvic adhesions, large uterine fibroids, and uterine artery injury. When compared with transabdominal extraction, there was no significant difference in warm ischemia time, mean operative time, estimated blood loss, hospital stay, recipient creatinine level, and complications. The mean pain score was significantly less on postoperative day 3 and day 4. There was also an earlier return to normal activities in the transvaginal group. There was no increase in infectious complication in both donors and recipient. Based on our initial experience with laparoscopic donor nephrectomy with transvaginal extraction, we recommend this procedure for a premenopausal donor, with a BMI <30. Our initial cases demonstrate that transvaginal extraction is feasible and safe for the donors.

Pfannenstiel laparoendoscopic single‐site (LESS) vs conventional multiport laparoscopic live donor nephrectomy: a prospective randomized controlled trial

To present outcomes of a randomized, patient-blinded controlled trial on Pfannenstiel laparoendoscopic single-site (LESS) vs conventional multiport laparoscopic live donor nephrectomy. Patients presenting as left kidney donors between January 2009 and November 2011 were randomized to LESS donor nephrectomy (LESS-DN: n = 15) or conventional laparoscopic donor nephrectomy (LDN: n = 14). Patients were blinded to the surgical approach preoperatively and attempts to continue patient blinding postoperatively were made by applying dressings consistent with multiple conventional laparoscopic incisions for all patients. De-identified data related to the operation, peri-operative course and postoperative follow-up were prospectively collected and compared between the two groups with an intention-to-treat analysis. There were no significant differences between the groups when comparing operating time, estimated blood loss (EBL), i.v. fluid administration, renal allograft warm ischaemia time (WIT), length of hospital stay (LOS) and total inpatient analgesic requirements. Quantitative pain assessment was not significantly different on postoperative day (POD) #0, however, it was significantly lower in the LESS-DN group, beginning on POD #1 (P < 0.05). The changes in haematocrit and serum creatinine in the two groups were not significantly different, and there were no blood transfusions in either group, nor was there a decline in estimated glomerular filtration rate to <60 mL/min per 1.73 m² of body surface area in any patients. Two patients in the LESS-DN group were converted to conventional LDN, both because of failure to progress effectively. All allografts were functional at the time of transplantation and revascularization, with no cases of hyperacute rejection. Peri-operative variables including EBL, WIT and LOS were equivalent when comparing Pfannenstiel LESS-DN with conventional LDN. Patient-reported visual analogue pain scale scores were significantly lower in the LESS-DN group beginning on the first postoperative day.

2121 RANDOMIZED CONTROLLED TRIAL OF LAPAROENDOSCOPIC SINGLE SITE DONOR NEPHRECTOMY VERSUS. CONVENTIONAL LAPAROSCOPIC DONOR NEPHRECTOMY FOR LIVING KIDNEY DONORS

INTRODUCTION AND OBJECTIVES: Laparoendoscopic single site (LESS) surgery has been increasingly used to perform donor nephrectomies. However it remains unclear if the benefits of LESS are limited to improved cosmesis. We performed a randomized controlled trial of LESS versus conventional laparoscopic donor nephrectomy (LDN) to assess potential benefits in clinical outcomes. METHODS: After IRB approval, 100 consecutive patients were randomized to a donor nephrectomy utilizing either the LESS or LDN technique starting January 2011 at a single center. Donors were stratified by laterality, single or multiple arteries, and body mass index (BMI). All LESS procedures utilized the GelPoint system (Applied Medical, RanchoSanta Margarita, CA). Subjects are followed postdonation for complications and satisfaction with validated questionnaires at 2-, 6-, and 12-months. Ninety-three patients had follow-up data for at least 2 months postoperatively. RESULTS: Baseline characteristics were similar between the two treatment arms. There were no significant differences in the overall operative time, warm ischemia time, estimated blood loss, and conversion to hand-assisted laparoscopy rates (p 0.05). There were similarly no differences in the 30and 90-day postoperative complication rates (p 0.05). Of those with follow up of at least 2 months (n 93), 97% of those who underwent LESS reported full recovery at two months, compared to 80% of LDN (p 0.03). There were no significant differences in surgical scar rating or overall satisfaction between LESS and LDN (p 0.05). All allografts had immediate graft function, and donor and graft survival are 100% to date. CONCLUSIONS: In this randomized controlled trial, we found that LESS donor nephrectomies could be performed with similar operative outcomes and postoperative complication rates. LESS donor nephrectomies have a significantly faster recovery time compared to LDN, with no impact on allograft function. Table 1: Outcomes in LDN vs LESS

Comparison of laparoendoscopic single site (LESS) and conventional laparoscopic donor nephrectomy at a single institution

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Most transplant centres harvest living donor kidneys via a conventional laparoscopic surgical approach. Laparoendoscopic single-site donor nephrectomy (LESS-DN) is a relatively novel minimally invasive approach that allows the surgery to be performed via a single incision. This technique may be advantageous in decreasing surgical morbidity and improving cosmetic outcomes, thus plausibly reducing the barriers to kidney donation. The study demonstrates the safety and feasibility of LESS-DN in a large consecutive series of kidney donors. Comparative analysis between LDN and LESS-DN showed that there was a significant decrease in intra-operative blood loss and allograft warm ischaemia time in the LESS-DN group, but also a significant increase in operating time. Other peri-operative outcomes were similar between the two approaches. Evaluation of the LESS-DN cases alone revealed that, the operating times did not significantly change through the course of the series. Using this outcome as a surrogate for technical difficulty suggests a relatively shallow learning curve for LESS-DN. To present a comparative analysis of peri-operative outcomes for >200 cases of conventional laparoscopic donor nephrectomy (LDN) and laparoendoscopic single site donor nephrectomy (LESS-DN). From 2006 to 2011, 213 donor nephrectomies were performed by two surgeons (R.E.L and W.A.M.) at a tertiary transplant centre. The approach changed from conventional LDN to LESS-DN over the course of the series. The two approaches were compared retrospectively and evaluated for differences in peri-operative outcomes. Statistical significance was assessed using Student's t-test and chi-squared analysis. A total of 111 patients underwent LDN and 102 patients underwent LESS-DN. Total operating time was significantly longer in the LESS-DN group (206.1 vs 181.9 min, P < 0.001), but LESS-DN resulted in less intra-operative blood loss (61.5 mL vs 85.9 mL, P < 0.001) and shorter warm ischaemia times (4.4 vs 5.0 min, P = 0.01). There were no significant differences in analgesic requirements, subjective pain scores, length of hospital stay, postoperative graft function, or donor's postoperative glomerular filtration rate between the two approaches. Complication rates were low regardless of the approach, and there were no major complications (>grade II) in the LESS-DN group. In experienced hands, LESS-DN results in peri-operative outcomes similar to those of conventional LDN without compromising donor safety, while providing a desirable cosmetic result. For surgeons familiar with LDN, transitioning to the LESS approach using this technique appears to have a relatively short learning curve.

Trans-umbilical laparo-endoscopic single-site donor nephrectomy without the use of a single-port access device

Laparoendoscopic single-site donor nephrectomy (LESS-DN) is a procedure in evolution. Currently described techniques utilize single port access devices and articulating, flexible, and bent working instruments. We describe a modified technique of transumbilical LESS-DN with conventional laparoscopic instruments in five kidney donors.Three standard laparoscopic ports (10 mm × 1, 5 mm × 2) were placed through a 4.5 cm vertical transumbilical incision. A 10 mm 45°, long bariatric lens (Karl Storz) was used. Renal mobilization was performed using conventional rigid laparoscopy instruments. A port closure needle loaded with a blunt plastic needle cap was used for traction. After hilar clamping, an incision was made connecting the three ports, and the kidney was extracted using a preplaced suture over the lower pole fat. All data were prospectively recorded.LESS-DN was performed successfully in all five patients. The mean operative time was 157.2 minutes (range, 134-184) and the mean warm ischemia time was 3.2 minutes (range, 3-4). All donors were discharged on postoperative day 3 and were able to resume normal physical activity by 2 weeks after the procedure. All donors had an excellent cosmetic outcome. The mean serum creatinine (recipient) at discharge was 1.14 mg% (range, 0.9-1.4).Transumbilical LESS-DN can be cost-effectively performed using conventional laparoscopy instruments and without the need for a single port access device. Warm ischemia times with this technique are comparable with that during conventional multiport laparoscopic donor nephrectomy.

Comparison of Transumbilical and Conventional (Pfannenstiel) Laparoscopic Donor Nephrectomy

Forty-eight healthy voluntary renal donors between 18 and 60 years of age with BMI less than 30 who were planned for laparoscopic left side donor nephrectomy were enrolled in the study. After randomization 25 donors (group A) underwent a conventional laparoscopic donor nephrectomy with a Pfannenstiel incision used for kidney extraction whereas in 23 donors (group B) the kidney was extracted via a midline extension of the transumbilical port. Both groups of recipients were comparable in terms of basic disease leading to end stage renal disease and were given triple drug immunosuppression comprising of calcineurin inhibitor, mycophenolate and steroid. Mean age of donors in group A was 41.72 yrs and 38.04 yrs in group B. Mean duration of surgery and warm ischemia time were comparable (227.12 min/ 263 seconds in group A versus 228.91 min/ 283 seconds in group B). Estimated blood loss was similar in both groups (165.6 ml in group A versus 151.3 ml in group B). There were no intraoperative or postoperative complications in both groups. Weight of the kidneys (128.2 gm in group A vs. 120.4 gm in group B), length of renal artery (2.37 cm in group A vs. 2.30 cm in group B) and length of renal vein (2.58 cm in group A vs. 2.67 cm in group B) were statistically similar in both groups. Length of ureter (8.7 cm in group A vs. 10.17 cm in group B) and length of extraction site incision (7.95 cm in group A vs. 10.17 cm in group B) showed statistically significant difference. Pain scores noted by numerical rating scale on day 1 (8 in group A vs. 6 in group B) and 3 (6 in group A vs. 3 in group B) after surgery and at time of discharge (5 in group A vs. 3 in group B) showed statistically significant difference. Both groups of donors rated pain at 0 at 1 month following surgery. Day of discharge was similar in both groups with median 3 days post operative stay. Serum creatinine of recipients on day 1 (2.57 vs. 2.99 mg/dl in groups A and B respectively) and 3 (1.74 vs. 2.15 mg/dl in groups A and B respectively) after surgery were comparable while mean serum creatinine on post operative day 7 (1.74 vs. 2.15 mg/dl in groups A and B respectively) was significantly higher in recipients of group B. Serum creatinine of recipients at 1 month post transplantation was similar in both groups (1.11 vs. 1.18 mg/dl in groups A and B respectively). The higher creatinine at day 7 may be explained by two patients in group B who had delayed graft function due to calcineurin inhibitor toxicity. In conclusion the lower pain scores and shorter incision length with similar outcomes suggests that a transumbilical route may be a better approach for kidney retrieval.

Minimally Invasive Suprapubic Laparoscopic Donor Nephrectomy

Abstract Introduction: There is an increasing discrepancy between the number of patients awaiting transplantation and the number of available transplantable organs. To increase the donor pool, live...

Comparison of laparoendoscopic single-site donor nephrectomy and conventional laparoscopic donor nephrectomy: donor and recipient outcomes

Comparison of laparoendoscopic single-site donor nephrectomy and conventional laparoscopic donor nephrectomy: donor and recipient outcomes

Comparison of Laparoendoscopic Single-site Donor Nephrectomy and Conventional Laparoscopic Donor Nephrectomy: Donor and Recipient Outcomes

To present a comparison of perioperative donor outcomes and recipient graft function in a series of patients undergoing laparoendoscopic single-site donor nephrectomy (LESS-DN) versus conventional laparoscopic donor nephrectomy (LDN). Data were collected for 50 consecutive LESS-DN patients and a matched cohort of 50 LDN patients. The donor outcomes analyzed included operative time, estimated blood loss, complications, visual analog pain scores, and recovery time. The recipient outcomes analyzed included serum creatinine at discharge and follow-up and the incidence of delayed graft function. The mean total operative time was shorter in the LDN group than in the LESS-DN group (P < .0001). Linear regression analysis of the LESS-DN operative times relative to case number showed a significant decrease in the operative time with increasing case number (r(2) = 0.19, P = .002). No statistically significant differences were found in estimated blood loss, warm ischemia time, length of stay, or visual analog pain scores between the 2 groups. However, the surgical incision was significantly smaller in the LESS-DN group (P < .0001). After discharge, the patient-reported time to complete recovery was faster in the LESS-DN group (P = .01). The incidence of complications was similar in both groups; however, major complications only occurred in the LDN group. No differences were found in the recipient serum creatinine values or the incidence of delayed graft function. Our initial experience with LESS-DN is encouraging. This retrospective matched-pair comparison between LESS-DN and LDN suggests that the single-port approach might be associated with quicker convalescence. Longer operative times in the LESS-DN group could simply represent the learning curve of a novel procedure.

Editorial Comment

At an institution where an impressive 85 laparoendoscopic single-site donor nephrectomies (LESS-DNs) have been performed, this report focuses on the 6 right-sided LESS procedures, with a matched comparison to standard laparoscopy for allograft function. 1 Afaneh C. Ramasamy R. Leeser D.B. et al. Is right-sided laparoendoscopic single-site donor nephrectomy feasible. Urology. 2011; 77: 1365-1369 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar One of these was transitioned to hand-assisted laparoscopy. The main take-home message is a cautionary note: LESS-DN is a technically demanding endeavor that challenges experienced laparoscopic surgeons. With all standard caveats applicable (small sample size, surgeon administered nonvalidated questionnaires), the authors are to be congratulated for completing right LESS-DN in 5 patients using currently available instruments. Is Right-sided Laparoendoscopic Single-site Donor Nephrectomy Feasible?UrologyVol. 77Issue 6PreviewTo present our initial experience with right-sided laparoendoscopic single-site donor nephrectomy (LESS-RDN). Laparoendoscopic single-site (LESS) donor nephrectomy, although in its infancy, represents a potential exciting advancement over conventional laparoscopic donor nephrectomy (LDN). Almost all of the reported cases thus far have been left-sided kidneys. Full-Text PDF

Is Right-sided Laparoendoscopic Single-site Donor Nephrectomy Feasible?

To present our initial experience with right-sided laparoendoscopic single-site donor nephrectomy (LESS-RDN). Laparoendoscopic single-site (LESS) donor nephrectomy, although in its infancy, represents a potential exciting advancement over conventional laparoscopic donor nephrectomy (LDN). Almost all of the reported cases thus far have been left-sided kidneys. Between August 2009 and June 2010, a total of 85 consecutive LESS DN were performed. Of these, 6 (7%) were LESS-RDN. Donor outcomes analyzed included operative time, estimated blood loss, complications, visual analog pain scores, and recovery time. Renal vein lengths were measured on preoperative computed tomography scans. Recipient outcomes analyzed included recipient creatinine at discharge and at 1 and 3 months. All data were prospectively accrued in an institutional review board-approved database. Five LESS-RDN were successfully performed. One case was converted to hand-assisted laparoscopy to optimize hilar dissection. The mean (± SE) operative time until allograft extraction was 89 ± 5.1 minutes, total operative time was 146 ± 12.8 minutes, warm ischemia time was 3.9 ± 0.2 minutes, and estimated blood loss was 92 ± 27 mL. The mean renal vein length was 2.7 ± 0.3 cm. There were no perioperative complications. All allografts functioned after transplantation. When compared with a matched cohort of LESS-LDN, there was no difference in allograft function at discharge and at 1 and 3 months. Although technically challenging, LESS-RDN in experienced hands can be performed safely and should be considered as an alternative if it is the preferred kidney for transplantation.

Transumbilical laparoendoscopic single-site donor nephrectomy: Without the use of a single port access device

Introduction:Laparoendoscopic single-site donor nephrectomy (LESS-DN) is a procedure in evolution. Currently described techniques utilize single port access devices and articulating, flexible, and bent working instruments. We describe a modified technique of transumbilical LESS-DN with conventional laparoscopic instruments in five kidney donors.Materials and Methods:Three standard laparoscopic ports (10 mm × 1, 5 mm × 2) were placed through a 4.5 cm vertical transumbilical incision. A 10 mm 45°, long bariatric lens (Karl Storz) was used. Renal mobilization was performed using conventional rigid laparoscopy instruments. A port closure needle loaded with a blunt plastic needle cap was used for traction. After hilar clamping, an incision was made connecting the three ports, and the kidney was extracted using a preplaced suture over the lower pole fat. All data were prospectively recorded.Results:LESS-DN was performed successfully in all five patients. The mean operative time was 157.2 minutes (range, 134–184) and the mean warm ischemia time was 3.2 minutes (range, 3–4). All donors were discharged on postoperative day 3 and were able to resume normal physical activity by 2 weeks after the procedure. All donors had an excellent cosmetic outcome. The mean serum creatinine (recipient) at discharge was 1.14 mg% (range, 0.9–1.4).Conclusions:Transumbilical LESS-DN can be cost-effectively performed using conventional laparoscopy instruments and without the need for a single port access device. Warm ischemia times with this technique are comparable with that during conventional multiport laparoscopic donor nephrectomy.

2074 A NOVEL BRIDGING HAND-ASSISTED LESS DONOR NEPHRECTOMY TECHNIQUE AND COMPARISON TO CONVENTIONAL HAND-ASSISTED LAPAROSCOPIC DONOR NEPHRECTOMY

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation, Vascular Surgery I1 Apr 20102074 A NOVEL BRIDGING HAND-ASSISTED LESS DONOR NEPHRECTOMY TECHNIQUE AND COMPARISON TO CONVENTIONAL HAND-ASSISTED LAPAROSCOPIC DONOR NEPHRECTOMY Ryan Bowman, Kamyar Ebrahimi, Paymohn Mahdavi, Forrest Jellison, Chris Tenggardjaja, and D. Duane Baldwin Ryan BowmanRyan Bowman More articles by this author , Kamyar EbrahimiKamyar Ebrahimi More articles by this author , Paymohn MahdaviPaymohn Mahdavi More articles by this author , Forrest JellisonForrest Jellison More articles by this author , Chris TenggardjajaChris Tenggardjaja More articles by this author , and D. Duane BaldwinD. Duane Baldwin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2134AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recently, laparoendoscopic single-site surgery (LESS) has been employed to decrease the morbidity of kidney donation. Concerns have been raised about the increased surgical complexity, learning curve, and warm ischemia times. In an attempt to circumvent the complexity of LESS, we have developed a bridging hand-assisted-LESS (BLESS) technique that allows the surgeon to gain experience with single incision surgical techniques in the setting of traditional hand-assisted laparoscopy. The purpose of this study is to present the BLESS technique and to compare the outcomes of this technique with conventional hand-assisted laparoscopic donor nephrectomy (HALDN). METHODS Similar to LESS, the BLESS technique employs a single periumbilical incision. Enlargement of the fascial incision to 7 cm facilitates placement of a Gelport device and allows some triangulation of the three ports inserted through the hand-assist device. Parts or all of the case may be performed with single incision techniques. At the surgeon's discretion, placement of a single additional 5 mm port allows the surgeon to convert to a hand-assisted technique with additional ports placed through the Gelport to perform the dissection. A retrospective comparison of five BLESS donors to 20 consecutive HALDN patients performed by the same surgeon was performed. Preoperative, perioperative and postoperative variables were compared. RESULTS Compared to HALDN patients, BLESS patients had similar preoperative characteristics including age (p=0.881), sex (p=0.858) and preoperative creatinine (p=0.790), but had lower BMI (21.6 vs. 26.3; p=<0.001). The estimated blood loss (p=0.08), incision length (p=0.20) postoperative creatinine (p=0.052) and warm ischemia time (p=0.254) were similar between groups. BLESS patients had longer operative times compared to conventional HALDN patients (278 vs 247 min; p=0.02) but had shorter post-operative hospital stay (1.4 vs. 3.0 days; p = <0.001). There were no conversions or complications in the BLESS patients and all BLESS recipient kidneys functioned immediately. CONCLUSIONS The BLESS technique is less invasive than HALDN and allows the surgeon to develop experience with single incision techniques with an increased margin of safety. The ultimate benefits of this technique will need to be confirmed in a prospective randomized study. Loma Linda, CA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e806 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan Bowman More articles by this author Kamyar Ebrahimi More articles by this author Paymohn Mahdavi More articles by this author Forrest Jellison More articles by this author Chris Tenggardjaja More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...