Hand-assisted Laparoscopic Nephrectomy Research Articles

Effectiveness of Postoperative Single-shot and Continuous Transverse Abdominis Plane Block Compared to Conventional Analgesia in Hand-assisted Laparoscopic Live-donor Nephrectomy.

Few studies have evaluated the efficacy of transverse abdominis plane (TAP) block in patients undergoing hand-assisted laparoscopic live-donor nephrectomy (HALN). We aimed to evaluate the analgesic effectiveness of TAP block as part of a multimodal pain management regimen in patients undergoing HALN. We retrospectively reviewed the medical records of living kidney donors at our center between June 2016 and February 2020. HALNs were performed via a transperitoneal approach through a suprapubic incision. Additional laparoscopic ports were used in the upper midabdomen. In consenting donors, TAP block was performed postoperatively under ultrasound guidance with either a single-shot or continuous infusion of long-acting local anesthetic (0.2%-0.5% ropivacaine). All the patients received postoperative around-the-clock ketorolac and acetaminophen. Overall, 72 donors received the block (block group, 38 single-shot, 34 continuous), whereas 86 donors did not receive the block (control group). Baseline characteristics were comparable between the groups except for body weight (control: 71.8 ± 13.3 versus block: 77.8 ± 17.3 kg; P = 0.01) and intraoperative opioid dose (32.1 ± 9.6 versus 26.6 ± 10.7 morphine milligram equivalents; P < 0.001). After adjusting for baseline differences, postoperative opioid requirements were similar between the groups. When the baseline pain scale was adjusted for, there was no difference in the overall pain scale scores between the groups (P = 0.242). Subgroup analyses comparing single-shot or continuous TAP versus control did not show any differences. With the caveat of the retrospective nature of the study, the adjunctive effect of TAP block after transabdominal HALN was limited when other multimodal analgesia was used.

Benefits of Intraoperative Fluorescence and Intelligent Insufflation in Hand-Assisted Laparoscopic Nephrectomy in Living Donor: Initial Experience

Introduction: The innovative technique of hand-assisted laparoscopic nephrectomy, with smaller incisions and greater versatility for the surgeon, along with an intelligent insufflation system, minimizes intraoperative complications, ischemia time, and postoperative morbidity in the donor. The use of Indocyanine Green (ICG) has revolutionized the visualization of blood vessels and renal parenchyma, providing crucial information about perfusion for transplantation purposes. Case Presentation: Surgery was performed on a 36-year-old male following the complete protocol for left kidney donation. The procedure lasted 06 hours and 15 minutes, with insufflation pressure set at 8 mmHg using an intelligent insufflation system. A total of 17.5 milligrams of ICG were administered in three doses. Indocyanine green filter was used for the dissection of Gerota's fascia, ureter, left adrenal vein, left gonadal vein, renal hilum, and ureteral section. Organ extraction achieved a warm ischemia time of only 03 minutes and 28 seconds. The patient was discharged due to clinical improvement after 48 hours. Follow-up on days 10 and 17 revealed no postoperative complications, pain-free status, and expected laboratory parameter evolution. Conclusion: The integration of indocyanine green with the technique of hand-assisted laparoscopic nephrectomy using an intelligent insufflation system proves to be a promising approach, allowing clear identification of anatomical elements and facilitating surgery. This approach not only reduces transoperative risks but also decreases hospitalization time and postoperative morbidity, setting a new standard in renal surgical practice.

1119 A Scoping Review of Kidney Transplantation in Africa: How Far Have We Come?

Abstract Aim Kidney transplantation is a life-saving treatment for patients with end-stage kidney disease. However, the availability of kidney transplantation in Africa has lagged behind other regions of the world, leading to significant disparities in access to care. In this study, we sought to analyse indications for transplant, demographic characteristics, and outcomes of kidney transplantation in Africa from inception till date. Method The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used in conducting this study. PubMed, Google Scholar, and African Journal Online were searched. Data on procedure done, graft outcomes, donor, prophylaxis given for graft, post-op complications, and survival timelines were pooled together and analysed. Thirty-three studies fully satisfied the eligibility criteria and were used in this review. Results The most common causes of end-stage kidney disease requiring transplant included glomerulonephritis and Nephroangiosclerosis. Overall, open nephrectomy accounted for 95% of the surgical approach used. The other approaches documented were Hand-assisted Laparoscopic Nephrectomy (3.88%), Extraperitoneal approach (0.55%), and Simultaneous Unilateral native nephrectomy (0.12%). In total, 56.3% (4221) of all donors were living donors of which 68.5% were related to the recipient (living-related donor), while 43.7% (3280) patients received transplants from cadaveric donors. The commonest surgical complication was graft rejection (39.44%). In the follow-up period, 60.49% of patients who had a kidney transplant developed hypertension. Conclusions In conclusion, our study not only highlights the potential for kidney transplantation to improve the lives of patients in Africa, but also the need for further research and infrastructure development to make this a more widespread and successful option.

324 The Learning Curves of Major Laparoscopic and Robotic Procedures in Urology: A Systematic Review

Abstract Aim Urology has been at the forefront of adopting laparoscopic and robot-assisted techniques to improve patient outcomes. Defining the learning curves for these procedures enables assessment of trainee performances relative to expected progress and has important implications in research. This systematic review aimed to examine the literature relating to the learning curves of major urological robotic and laparoscopic procedures. Method In accordance with PRISMA guidelines, a systematic literature search strategy was employed across PubMed, EMBASE, and the Cochrane Library from inception to December 2021 for eligible studies alongside a search of the grey literature. Two independent reviewers completed the article screening and data extraction stages, using the Newcastle-Ottawa Scale (NOS) to then undertake quality assessment of the included articles. The review was reported in accordance with AMSTAR guidelines. Results Of 3702 records identified, 97 eligible studies were included for narrative synthesis. 39 studies evaluated robot-assisted laparoscopic prostatectomy (RALP) with the learning curve identified as 10-250 cases for operative time and 250-300 for potency. The shortest learning curve was reported for hand-assisted laparoscopic nephrectomy, involving 4-10 cases. There was considerable variation in the study designs, outcome measures and prior experience of surgeons, with all studies scoring either 5 or 6 on the NOS. Conclusions Standardised reporting of outcomes and performance measures is required to reduce heterogeneity and enable the undertaking of a meta-analysis. Future studies should use multiple surgeons and large sample sizes of cases to identify the currently undefined learning curves for laparoscopic radical cystectomy and for robotic and laparoscopic retroperitoneal lymph node dissection.

Renal artery aneurism and renal autotransplantation: review of surgical technique, preoperative complementary examinations and postoperative follow-up protocol

Introduction: Renal artery aneurysm (RAA) is a rare pathology; however, its incidental diagnosis is increasingly frequent due to the increasing use of imaging techniques. Complex (hilar) RAAs, dependent on the distal renal artery and its branches, constitute a subset of RAAs that present a therapeutic challenge due to their anatomical location and may require extracorporeal arterial repair and autotransplantation. Material and methods: A bibliographic review is carried out to homogenize the management of this pathology, analyzing the indications for surgical treatment, the recommended surgical technique step by step, as well as post-surgical monitoring. Two clinical cases of RAA treated in our center by hand-assisted laparoscopic nephrectomy, ex vivo bench repair and renal autotransplantation are presented. Results: In both cases, a postoperative Doppler ultrasound of the graft was performed 24 hours later, in which a renal graft was observed in the iliac fossa, of normal size and cortical thickness within normality with normal color Doppler signal, and spectral curves without alterations. Both patients presented oligoanuric acute renal failure (injury) during the immediate postoperative period (first 24 hours) with complete resolution at discharge, which occurred on the 11th and 12th postoperative day, respectively. In both patients a diuretic renogram with MAG3 was performed. In case 1, it was performed the third postoperative month and a slightly ectatic right kidney was observed with less perfusion and parenchymal incorporation of the radiotracer, with a reduction in relative renal function (39.47%) and MAG3 clearance (indeterminate renographic pattern). In this patient, a CT scan with the excretory phase was performed simultaneously, in which a grafted right kidney was seen at the level of the right iliac fossa with good contrast elimination in the excretory phase bilaterally and symmetrically. A small non-perfused area is observed in the upper pole. In the second patient, the renogram was performed on the 14th postoperative day, finding the morphofunctional study of the graft within normal parameters without detecting areas of hypoperfusion. The levels of creatinine and glomerular filtration were, respectively, in the first case: 0.86mg/dl and 90.19ml/min/1.73m2 preoperatively and 0.83mg/dl and 90.96ml/min/ 1.73m2 per postoperative month. In the second case, the values were: preoperatively creatinine of 0.66mg/dl and glomerular filtration rate of 97.96ml/min/1.73m2 and 0.81mg/dl and 89ml/min/1.73m2 one month postoperatively. Conclusion: After reviewing the literature, there is no consensus regarding the imaging techniques to be performed after renal autotransplantation and the optimal time frames for performing these for the evaluation of the postoperative graft. There is also no homogeneity in the imaging techniques to be performed in the preoperative assessment. In our experience, open ex vivo surgical repair of complex distal hilar RAAs has been successful with low morbidity and mortality and an acceptable rate of preservation of renal function.

Hand-assisted laparoscopic nephrectomy for the treatment of ureterolithiasis and nephrolithiasis in an adult horse

Hand-assisted laparoscopic nephrectomy for the treatment of ureterolithiasis and nephrolithiasis in an adult horse

Hand-assisted laparoscopic nephrectomy for a kidney transplant: surgical technique—tips and tricks—how we do it?

Hand-assisted laparoscopic nephrectomy for a kidney transplant: surgical technique—tips and tricks—how we do it?

Utilizing the same incision for staged renal transplant in patients with polycystic kidney disease requiring hand-assisted laparoscopic nephrectomy.

Many autosomal dominant polycystic kidney disease (ADPKD) patients undergo nephrectomy and subsequent renal transplantation. We report our outcomes after hand-assisted laparoscopic nephrectomy (HALN) where a Rutherford-Morrison incision is used as a hand-port site and kidney extraction site, as well the future incision site for staged transplantation. A retrospective review was performed on all adult nephrectomies for ADPKD by the Transplant Surgery department at Westmead Hospital between June 2011 and June 2021. Outcomes were compared between HALN, laparoscopic nephrectomy (LN) and open nephrectomy (ON) including operation time, hospital length of stay (LOS), post-operative complications, subsequent transplantation and post-transplantation wound complications. Twenty-two HALN, 8 LN and 5 ON were performed during the study period. Median kidney weights for HALN, LN and ON were significantly different (1575, 403, 3420 g respectively, P= 0.001). There was a significant difference in LOS between the HALN and ON (5.8 versus 9.8 days, P= 0.04), but not between HALN and LN (5.8 versus 5.1, P= 0.06). There was no significant difference for operation time (P= 0.34) and major complication rates (P= 0.58). There were 8 HALN, 5 LN and 2 ON who have had subsequent renal transplantation with one wound complication, an incisional hernia in the HALN group. Our HALN is associated with a shorter LOS and similar complication rate to ON and can be efficiently performed for significantly larger kidneys than LN without a significant difference in operation time or LOS. The same Rutherford-Morrison incision site can be used for transplantation.

Narrated hand-assisted left laparoscopic nephrectomy for kidney transplant.

Narrated hand-assisted left laparoscopic nephrectomy for kidney transplant.

236.11: A Comparison of the Effects of Intravenous vs Oral Hydration on Subclinical Acute Kidney Injury in Laparoscopic Donor Nephrectomy: A Randomised Controlled Trial

Importance: Laparoscopic and laparoscopic assisted donor nephrectomy is the most common method of donor nephrectomy. Despite improving the outcome for donors by reducing post-operative pain and speeding up recovery, the technique exposes the kidney to additional haemodynamic stresses in terms of extreme position and pneumoperitoneum. Any intervention that could protect the kidney may further improve the residual function of both donated and remaining kidney. Objective: To determine if preoperative intravenous fluids given overnight, prior to morning kidney donation will result in a measurable improvement in intraoperative haemodynamics and a decrease in subclinical acute kidney injury. Trial Design: A single centre, prospective single-blinded randomised controlled trial. Participants: All adult patients aged >18 years of age undergoing live donor laparoscopic hand-assisted nephrectomy eligible to participate. Interventions: Intervention group: The evening prior to surgery, between midnight and 8am, patients in this group will receive three litres of crystalloid solution, IV, in addition to unrestricted oral fluid. Control group: Patients in this group will also be admitted on the evening prior to surgery but will not be given intravenous fluids. They will only receive unrestricted oral fluids. Main Outcomes: The primary outcome will be a rise in, serum biomarker for acute kidney injury, neutrophil-gelatinase associated lipocalin (N-GAL). Secondary outcomes include donor and recipient renal function, DGF, intraoperative haemodynamics, perioperative complications. Results: A total of 76 patients (median [IQR] age, 50 [42-57], 44[57%] male) were randomised (36 to preoperative intravenous fluids and 40 to no intravenous fluids) and followed up for 1 year. Serum N-GAL was significantly lower immediately post laparoscopic donation in the intervention group (median [95% CI] intravenous fluids, 95ng/ml [68-133] vs control, 131ng/ml [103-156]; P<.036) but not significantly different at day one post operatively. There was no significant difference between groups in renal function of donors at 6 weeks and 1 year post donation. Intraoperative urine output was significantly higher in the intervention group, but all haemodynamic parameters demonstrated a similar trend between both groups with no significant differences. Conclusions: Intravenous hydration prior to laparoscopic donor nephrectomy statistically reduces serum N-GAL post operatively but is unlikely to be clinically significant. Therefore, patients undergoing laparoscopic kidney donation would not seem to benefit from admission the day prior to surgery, for intravenous fluid hydration, and could be admitted the day of surgery in keeping with the principles of enhanced recovery protocols.

Robotic versus hand-assisted laparoscopic living donor nephrectomy: comparison of two minimally invasive techniques in kidney transplantation

Robot-assisted donor nephrectomy (RDN) is increasingly used due to its advantages such as its precision and reduced learning curve when compared to laparoscopic techniques. Concerns remain among surgeons regarding possible longer warm ischemia time. This study aimed to compare patients undergoing robotic living donor nephrectomy to the more frequently used hand-assisted laparoscopic nephrectomy (HLDN) technique, focusing on warm ischemia time, total operative time, learning curve, hospital length of stay, donor renal function and post-operative complications. Retrospective study comparing RDN to HLDN in a collaborative transplant network. 176 patients were included, 72 in RDN and 104 in HLDN. Left-sided nephrectomy was favored in RDN (82% vs 52%, p < 0.01). Operative time was longer in RDN (287 vs 160 min; p < 0.01), while warm ischemia time was similar (221 vs 213 secs, p = 0.446). The hospital stay was shorter in RDN (3.9 vs 5.7 days, p < 0.01).Concerning renal function, a slightpersistent increase of 7% of the creatinine ratio was observed in the RDN compared to the HLDN group (1.56 vs 1.44 at 1-month checkup, p < 0.01). The results show that RDN appears safe and efficient in comparison to the gold-standard HLDN technique. Warm ischemia time was similar for both techniques, whereas RDN operative time was longer. Patients undergoing RDN had a shorter hospital stay, this being possibly mitigated by differences in center release criteria. Donor renal function needs to be assessed on a longer-term basis for both techniques.

Comparison of modified hand-assisted retroperitoneoscopic laparoscopic nephrectomy and open nephrectomy in patients with benign inflammatory non-functioning kidney diseases.

BackgroundTo assess the validity and feasibility of the modified hand-assisted retroperitoneoscopic laparoscopic nephrectomy (MHARLN) in patients with benign inflammatory non-functioning kidney diseases.MethodsWe retrospectively compared the data of 223 patients who underwent an MHARLN (n=142) or an open nephrectomy (ON) (n=81) with benign inflammatory non-functioning diseases between January 2014 and October 2019 at our hospital. Patients’ demographic data, perioperative outcomes, preoperative and postoperative inflammatory data, and postoperative complications were reviewed.ResultsThe basic demographic data of patients were similar between the 2 groups. The mean operative times for the MHARLN and the ON were 135 and 143 minutes (P=0.181), respectively. The first time at which postoperative ambulation occurred, the visual analog pain scale (VAS) score before discharge and the postoperative complication rate were similar in both groups. However, compared to the MHARLN, the ON was associated with a more severe inflammatory response on the first day after surgery (P=0.045), higher estimated blood loss (309.8 vs. 139.6 mL; P=0.036), more peritoneal ruptures (19.8% vs. 9.2%; P=0.024), higher intraoperative transfusion (14.82% vs. 4.93%; P=0.011), higher VAS scores 24 hours after surgery (5.9 vs. 5.2; P=0.002), additional analgesic use (35.8% vs. 21.8%; P=0.024), and longer hospital stays (5.3 vs. 4.6 days; P=0.048). Before a liquid diet was commenced in the MHARLN and ON groups, the mean time was 1.2 and 1.5 days, respectively (P=0.004).ConclusionsWhen performed by a skilled laparoscopic surgeon, the use of the MHARLN in patients with benign inflammatory non-functioning kidney diseases is reliable and safe. The MHARLN may help to treat challenging cases and result in less trauma successfully.

Comparison of laparoscopic and hand-assisted laparoscopic nephrectomy for inflammatory renal disease: which is the preferred approach?

Aims:Management of inflammatory renal disease (IRD) can still be technically challenging for laparoscopic procedures. The aim of the present study was to compare the safety and feasibility of laparoscopic and hand-assisted laparoscopic nephrectomy in patients with IRD.Patients and methods:We retrospectively analyzed the data of 107 patients who underwent laparoscopic nephrectomy (LN) and hand-assisted laparoscopic nephrectomy (HALN) for IRD from January 2008 to March 2020, including pyonephrosis, renal tuberculosis, hydronephrosis, and xanthogranulomatous pyelonephritis. Patient demographics, operative outcomes, and postoperative recovery and complications were compared between the LN and HALN groups. Multivariable logistic regression analysis was conducted to identify the independent predictors of adverse outcomes.Results:Fifty-five subjects in the LN group and 52 subjects in the HALN group were enrolled in this study. In the LN group, laparoscopic nephrectomy was successfully performed in 50 patients (90.9%), while four (7.3%) patients were converted to HALN and one (1.8%) case was converted to open procedure. In HALN group, operations were completed in 51 (98.1%) patients and conversion to open surgery was necessary in one patient (1.9%). The LN group had a shorter median incision length (5 cm versus 7 cm, p < 0.01) but a longer median operative duration (140 min versus 105 min, p < 0.01) than the HALN group. There was no significant difference in blood loss, intraoperative complication rate, postoperative complication rate, recovery of bowel function, and hospital stay between the two groups. Multivariable logistic regression revealed that severe perinephric adhesions was an independent predictor of adverse outcomes.Conclusion:Both LN and HALN appear to be safe and feasible for IRD. As a still minimally invasive approach, HALN provided an alternative to IRD or when conversion was needed in LN.

Laparoscopic Nephrectomy for Massive Kidneys in Polycystic Kidney Disease.

Background and Objectives:Laparoscopic nephrectomy is now considered a feasible surgical approach, even for large kidneys. In the case of massive kidneys, laparoscopy can be problematic, so that some authors suggest an open approach. However, previous studies have shown that hand-assisted laparoscopic nephrectomy (HALN) may represent a useful compromise.We describe our hand-assisted laparoscopic technique for nephrectomy of large kidneys (> 2500 g) to encourage the use of laparoscopy for nephrectomy in autosomal dominant polycystic kidney disease.Methods:We retrospectively analyzed data from 26 nephrectomies in 17 patients who underwent HALN for ADPKD and compared them to a group of 22 nephrectomies in 18 patients with open surgical technique.Results:The duration of the procedure was significantly longer in the laparoscopic group, with a median of 180 minutes versus 90 minutes for the unilateral nephrectomies, and 240 minutes versus 122 minutes for the bilateral procedures. The median kidney weight in the open group was 2500 g (range 1300 – 4500 g), while the median weight in the HALN group was 2375 g (range 1000 – 4700 g). The median hospital stay was comparable. No significant differences were recorded in the intra- and postoperative complication rate.Conclusion:Hand-assisted laparoscopic nephrectomy can be considered a technique of choice for patients suffering from ADPKD requiring nephrectomy, also with massive kidneys weighing more than 3500 g. Compared to open nephrectomy, HALN can be performed safely, with reasonably longer operating times and without major complications, and offers a significant reduction in hospitalization time, pain and postoperative discomfort.

Comparison of the impact of propofol versus sevoflurane on early postoperative recovery in living donors after laparoscopic donor nephrectomy: a prospective randomized controlled study

BackgroundEnhancing postoperative recovery of the donor is important to encourage living kidney donation. We investigated the effects of anesthetic agents (intravenous [IV] propofol versus inhaled [IH] sevoflurane) on the quality of early recovery of healthy living kidney donors after hand-assisted laparoscopic nephrectomy (HALN) under analgesic intrathecal morphine injection.MethodsThis single-center, prospective randomized controlled study enrolled 80 living donors undergoing HALN from October 2019 to June 2020 at Seoul St. Mary’s Hospital. Donors were randomly assigned to the IV propofol group or IH sevoflurane group. To measure the quality of recovery, we used the Korean version of the Quality of Recovery-40 questionnaire (QoR-40 K) on postoperative day (POD) 1, and ambulation (success rate, number of footsteps) 6–12 h after surgery and on POD 1. The pain score for the wound site, IV opioid requirement, postoperative complications including incidences of nausea/vomiting, and length of in-hospital stay were also assessed.ResultsThe global QoR-40 K score and all subscale scores (physical comfort, emotional state, physical independence, psychological support, and pain) were significantly higher in the IV propofol group than in the IH sevoflurane group. The numbers of footsteps at all time points were also higher in the IV propofol group. Donors in the IV propofol group had a lower incidence of nausea/vomiting, and a shorter hospitalization period.ConclusionsTotal IV anesthesia with propofol led to better early postoperative recovery than that associated with IH sevoflurane.Trial registrationClinical Research Information Service, Republic of Korea (approval number: KCT0004351) on October 18, 2019.

Outcomes and surgical complications following living-donor renal transplantation using kidneys retrieved with trans-peritoneal or retro-peritoneal hand-assisted laparoscopic nephrectomy.

The best minimally invasive procedure for living-donor kidney retrieval remains debated. Our objective was to assess trans-peritoneal (TP) and retro-peritoneal (RP) hand-assisted laparoscopic donor nephrectomy (HALDN). In this single-center retrospective study, we analyzed results from 317 living-donor renal transplants (RT) performed between 2008 and 2016. Donor and recipient outcomes were compared between TP-HALDN (n=235) and RP-HALDN (n=82). Conversion to open nephrectomy (0.4% vs 0%; P=1.000), intra-operative complications (1.7% vs 1.2%; P=1.000), and 1-year overall post-operative complications (11.9% vs 17.1%; P=.258) rates were similar in TP-HALDN and RP-HALDN. Overall surgical site infections were higher in RP-HALDN (6.1% vs 1.7%; P=.053), whereas incisional hernias were only recorded following TP-HALDN (3.4% vs 0%; P=.118). The duration of the procedure was 11-minute shorter for TP-HALDN than RP-HALDN (P<.001) but extraction time was equivalent (2, IQR 1.5-2.5minutes; P=1.000). RT following TP-HALDN and RP-HALDN showed comparable one-year death-censored allograft survival (97% vs 98.8%; P=.685), primary non-function (0.4% vs 0%; P=.290), delayed graft function (1.3% vs 4.9%; P=.077), and urological complications (2.6% vs 4.9%; P=.290) rates. In our series, donor and recipient outcomes were not substantially affected by the approach used for donor nephrectomy. TP-HALDN and RP-HALDN were both safe and effective.

Transmuscular quadratus lumborum block reduces opioid consumption and prolongs time to first opioid demand after laparoscopic nephrectomy

BackgroundRobotic and hand-assisted laparoscopic nephrectomies are often associated with moderate to severe postoperative pain. The aim of the current study was to investigate the analgesic efficacy of the transmuscular quadratus...

Safety and oncological outcomes for large (stage ≥T2b) and locally advanced renal cell carcinoma: comparison between laparoscopic and modified hand-assisted laparoscopic radical nephrectomy.

ObjectiveTo compare the operative and oncologic outcomes between hand-assisted laparoscopic radical nephrectomy (HALRN) and laparoscopic radical nephrectomy (LRN) for large (stage ≥T2b) and locally advanced renal cell carcinoma.MethodsWe retrospectively collected data from patients who underwent HALRN or LRN for stage ≥T2b renal cell carcinoma from January 2011 to January 2018 in our institution. The patients’ demographics, perioperative parameters, and postoperative follow-up data were compared between the two groups. The survival outcome was estimated using the Kaplan–Meier method.ResultsThe HALRN group comprised 78 patients, and the LRN group comprised 63 patients. The median operative duration was significantly shorter in the HALRN than LRN group. The two groups were equivalent in terms of the incision length, blood loss, complication rate, and duration of hospitalization. In the HALRN and LRN groups, the 5-year overall survival rates were 69.4% and 73.1%, the 5-year cancer-specific survival rates were 80.0% and 83.3%, and the 5-year progression-free survival rates were 66.4% and 74.7%, respectively, with no significant differences.ConclusionsCompared with LRN, HALRN may offer a shorter operative duration and equivalent surgical outcomes without sacrificing oncological efficacy. In addition, HALRN has specific advantages for extremely large and complicated renal tumors.

Simultaneous Hand-assisted Laparoscopic Bilateral Native Nephrectomy and Kidney Transplantation for Patients With Large Polycystic Kidneys

To describe our technique of simultaneous hand-assisted laparoscopic bilateral native nephrectomy (BNN) and kidney transplantation (KT) in patients with autosomal dominant polycystic kidney disease and present our experience. We retrospectively reviewed a cohort of adult ESRD patients with symptomatic autosomal dominant polycystic kidney disease who underwent a hand-assisted laparoscopic BNN at the time of KT. We reviewed patients' and donor characteristics, and perioperative and postoperative outcomes. A total of 52 patients underwent hand-assisted laparoscopic BNN at the time of KT from January 2014 to October 2019. The median age of the recipients was 53.4 years, 57.7% were males, and the median body mass index was 29.0 kg/m2. All but one received a kidney from a living donor and the majority (86.5%) were pre-emptive. One patient required a small bowel resection due to an intraoperative small bowel injury. There was no solid organ injury during the procedure. All patients showed immediate allograft function and a steady decline in serum creatinine. The median decline in the creatinine and hemoglobin on day 1 was 1.2 mg/dL (inter quartile range 0.6-2.3) and 2.2 g/dL (inter quartile range 1.4-3.0), respectively. Simultaneous hand-assisted laparoscopic bilateral nephrectomy with KT through a modified Gibson incision is feasible and safe in the hands of an experienced laparoscopic surgeon without compromising allograft function.

Hand-assisted laparoscopic nephrectomy in morbidly obese patients.

Prevalence of obesity is 30% in the Czech Republic and is expected to increase further in the future. This disease complicates surgical procedures but also the postoperative period. The aim of our paper is to present the surgical technique called hand-assisted laparoscopic nephrectomy (HALS), used in surgical management of kidney cancer in morbid obese patients with BMI &gt;40 kg/m2. The basic cohort of seven patients with BMI &gt;40 undergoing HALS nephrectomy was retrospectively evaluated. Demographic data were ana-lyzed (age, gender, body weight, height, BMI and comorbidities). The perioperative course (surgery time, blood loss, ICU time, hospital stay and early complications), tumor characteristics (histology, TNM classification, tumor size, removed kidney size) and postoperative follow-up were evaluated. The patient age was 3867 years; the cohort included 2 females and 5 males, the body weight was 117155 kg and the BMI was 40.3501kg/m2. Surgery time was 7398 minutes, blood loss was 20450 ml, and hospital stay was 57 days; incisional hernia occurred in one patient. Kidney cancer was confirmed in all cases, 48-110 mm in diameter, and the largest removed specimen size was 210×140×130 mm. One patient died just 9 months after the surgery because of metastatic disease; the tumor-free period in the other patients currently varies between 1 and 5 years. Conclusion: HALS nephrectomy seems to be asuitable and safe surgical technique in complicated patients like these morbid obese patients. HALS nephrectomy provides acceptable surgical and oncological results.