Laparoscopic Live Donor Nephrectomy Research Articles

Laparoscopic Living Donor Nephrectomy—Single-Center Initial Experience

(1) Background: Donor nephrectomy for living donor kidney transplantation using minimally invasive techniques is a safe procedure that has been used for more than 20 years with excellent results. The total laparoscopic approach offers decreased postoperative pain, less incisional morbidity, and a shorter recovery time. (2) Methods: We present the results of a series of 43 laparoscopic donor nephrectomies performed in a single center. The procedures were performed in a systematic approach with transperitoneal access using four ports. The main renal artery and vein were ligated using a linear stapler fixed with an alternate triple row of titanium staples. The specimen was extracted in an endoscopic bag through an additional incision. (3) Results: All procedures were performed laparoscopically without conversion to open surgery. The average warm ischemia time was 4.73 min. In all recipients, immediate kidney allograft function was observed. (4) Conclusions: Total laparoscopic living donor nephrectomy is a safe procedure. It was performed successfully in all cases with a short surgical time, low morbidity, and 0% mortality.

Complications After Hand-Assisted Laparoscopic Living Donor Nephrectomy

ObjectiveTo study the complications of hand-assisted laparoscopic living donor nephrectomy (HALLDN) with an emphasis on complications occurring early after hospital discharge up to 120 days after surgery. Patients and MethodsWe retrospectively categorized complications using the Clavien-Dindo classification in 3002 HALLDNs performed at 1 center from January 1, 2000, through December 31, 2019. In addition to overall summaries, modeling was used to identify correlates of complications before and after living donation. ResultsOf these donors, 87% were White, 59% were female, the mean age was 45 years (range, 18-77 years), 30.3% had a body mass index of at least 30, and 36.3% had previous abdominopelvic surgery. There were no deaths related to the surgery. The incidence of major complications (intraoperative complications plus Clavien-Dindo grade ≥III postoperatively) was 2.5% (n=74). The overall complication rate was 12.4% (n=371), including 15 intraoperative, 76 postoperative before discharge, and 280 after discharge to 120 days. Reoperation was required in 1.8% of patients (n=54), and all but 1 of these were incision-related problems. Seventy-six percent of all complications occurred after discharge, including 85% of the reoperations. For major complications, no risk factor was found. Risk factors for any complication included paramedian incision (hazard ratio [HR], 2.54; 95% CI, 1.49 to 4.34; P<.001); a history of abdominopelvic surgery (HR, 1.37; 95% CI, 1.07 to 1.76; P=.01), male sex (HR, 1.37; 95% CI, 1.07 to 1.76; P=.01), non-White race (HR, 1.40; 95% CI, 1.05 to 1.88; P=.02), and early era of the experience. ConclusionMost major complications of HALLDN occur after discharge, suggesting that close follow-up is warranted and that the current literature may underestimate the true incidence.

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.

Uso de clips de polímero (Hem-o-lok®) para el control vascular renal en nefrectomía laparoscópica de donador vivo: 12 años de experiencia en un centro de tercer nivel.

Objective: To describe our experience using polymer clips (Hem-o-lok®) for renal vessel control in laparoscopic living donor nephrectomy (LLDN).&#x0D; Materials and methods: We conducted a retrospective and descriptive analysis from our database of all minimally invasive living donor nephrectomies (hand-assisted and pure laparoscopic) performed from 2008 to 2020 in our institution. We included patients who underwent LLDN using polymer clips (Hem-o-lok®) for vascular control of renal arteries and veins, and whose clinical records were complete.&#x0D; Results: 330 LLDN were performed, 183 (55.5%) were hand-assisted nephrectomies and 147 (44.5%) were pure laparoscopic nephrectomies. Mean warm ischemia time (WIT) was 3.98 minutes and median of estimated blood loss (EBL) was 100±140 ml. Four patients (1.2%) required conversion to an open procedure due to vascular injury. 31 complications (9.3%) were registered, of which 23 (6.9%) were non-life-threatening complications. No deaths nor loss of renal grafts were reported.&#x0D; Limitations: the main drawbacks of this study are its retrospective nature, and that it is limited to only one center.&#x0D; Originality and value: It is a study that questions the contraindication issued by the FDA for the use of polymer clips for vascular control in LLDN, demonstrating its use is a safe and effective option.&#x0D; Conclusion&#x0D; The use of polymer clips, specifically Hem-o-lok®, is a safe method for vascular control of the renal hilum vessels in laparoscopic living donor nephrectomies.

A1091 - How did we improve the model performance of the supervised computer vision model for laparoscopic live donor nephrectomy

A1091 - How did we improve the model performance of the supervised computer vision model for laparoscopic live donor nephrectomy

Long-Term Outcomes of Left versus Right Laparoscopic Living Donor Nephrectomy with Multiple Renal Arteries

Objectives: The objective of this study was to compare the long-term graft outcomes of left-versus-right donor nephrectomy with multiple renal arteries (MRAs), and therefore creating a reference for the expansion of the potential living kidney donor pool. Methods: Laparoscopic live donor nephrectomy cases between May 2010 and October 2020 were included in this retrospective cross-sectional study. The data relating to donor and recipient demographics, surgical and anatomical characteristics, recipient, and graft status were retrieved and compared using nonparametric statistical methods and multivariate regression. Analyses were fit for survival factors. Results: A total of 1,009 recipients were included in this retrospective cross-sectional study with their donors. 16.7% of the donors had been discovered to have more than one renal artery supplying the donated kidney. The acute rejection rate was 12.8%. Death-censored graft survival at postoperative year 5 for single renal artery (SRA) transplants was 89.6%, 89.5% for left-sided MRAs, and 88.2% for right-sided ones. Conclusions: Both right donor nephrectomy and left donor nephrectomy are safe procedures with no significant negatively impacted rates for neither survival nor complications of the recipients in the long-term, compared to SRA ones.

Comparison of ultrasound-guided transversus abdominis plane block and quadratus lumborum block for postoperative analgesia following laparoscopic living donor nephrectomy: A prospective randomized, double-blind study

Comparison of ultrasound-guided transversus abdominis plane block and quadratus lumborum block for postoperative analgesia following laparoscopic living donor nephrectomy: A prospective randomized, double-blind study

Safety and Efficacy of Laparoendoscopic Single-Site Donor Nephrectomy

Purpose: Laparoscopic living-donor nephrectomy is the main technique at high-volume renal transplant centers. Laparoendoscopic single-site donor nephrectomy (LESS-DN) is s an evolutionary minimally invasive surgery, which could be performed by transperitoneal or retroperitoneal approaches. We present a retrospective analysis of our single-institution donor nephrectomy series comparing the transperitoneal to retroperitoneal LESS-DN regarding operative outcomes. Materials and Methods: Seventeen patients who underwent LESS-DN from 2017–2020 were enrolled at our center. The same surgeon performed all cases. The two approaches were compared for the operation time, blood loss, warm ischemia time (WIT), postoperative pain, length of stay (LOS), postoperative wound size, postoperative pain, and the postoperative renal function for twelve months retrospectively. Results: Operating time (257 vs. 180 min, P = 0.016) and LOS (6.5 vs. 5 days, P = 0.013) were significantly longer in the transperitoneal group. The postoperative wound size (47.5 vs. 75 mm, P = 0.038) was substantially smaller in the transperitoneal group. There was no significant difference in other parameters, including blood loss, WIT, complication rate, and postoperative pain from day one to day three. Conclusion: Retroperitoneal LESS-DN results in similar perioperative outcomes as transperitoneal LESS-DN without compromising donor safety and providing a faster operation time, shorter LOS, and a trend toward a shorter WIT. Both approach methods may be safe and effective procedures for living kidney transplantation.

Safety and Intraoperative Results in Live Kidney Donors with Vascular Multiplicity After Hand-Assisted Laparoscopy Living Donor Nephrectomy.

Background and PurposeVascular multiplicity is the most frequent anatomic variation in kidney donors. Despite concerns about risks, these allografts are increasingly used to overcome the shortage of kidney donors. The safety and clinical outcomes in living kidney donors were evaluated with vascular multiplicity after hand-assisted laparoscopic living donor nephrectomy (HALDN).Patients and MethodsData from all living kidney donors who underwent HALDN from 2008 to 2021 was retrospectively reviewed. Patients were divided into two groups as single (SRV) and multiple renal vessels (MRV), and a comparative analysis was done. The primary outcomes include operating room time (ORT), days of hospital stay, estimated blood loss, complications, conversion, and re-operations.ResultsMRV were present in 166 out of 612 donors (27.1%). Among those, 10 (1.6%) donors had simultaneous multiple arteries and veins. Additionally, the prevalence of artery and vein multiplicity was 21.8% (n = 134) and 3.5% (n = 22), respectively. Warm ischemia time was significantly different among the two groups but not clinically important. The number of conversions to open technique, the mean ORT, the median blood loss, and days of hospital stay were similar between the SRV and MRV groups, without significant differences. According to the modified Clavien-classification system, no differences were found in the complication rates between the two groups (p = 0.29). Complication rates were 3.3% and 3.6% for the SRV and MRV groups, respectively.ConclusionHALDN is a procedure with safe intraoperative results, even with vascular multiplicity. The presence of multiple renal arteries or veins has no negative impact on the outcome of the donor after living donor nephrectomy.

Laparoscopic Living-Donor Nephrectomy of a Horseshoe Kidney: A Case Report and Review of the Literature

We present the case of a living-donor nephrectomy of a horseshoe kidney. The recipient was a 33-year-old male with a history of end-stage renal disease secondary to IgA nephropathy. The donor was his 33-year-old partner who on preoperative cross-sectional imaging was found to have a horseshoe kidney with a single artery, vein and ureter. The donor operation was performed using a laparoscopic hand-assisted technique with transection of the interpolar fibrotic band using a stapler device. The backtable organ preparation was performed in a standard fashion with addition of a reinforcing hemostatic suture of the stapled fibrotic band. The donated kidney was transplanted extraperitoneally in the right iliac fossa of the recipient. The patient had an unremarkable postoperative course and was discharged home on post operative day 2 with normalizing renal function. To our knowledge, this is the first living donor nephrectomy of a horseshoe kidney performed using a laparoscopic hand-assisted technique.

Is Laparoscopic Technique Suitable for Initial Experience in Live Donor Nephrectomy? Results of The First 51 Cases

Objective: Laparoscopic donor nephrectomy is included in advanced laparoscopic surgical procedures and is the most preferred method for live donor nephrectomy. It is discussed that teams who do not have experience with live donor nephrectomy prefer the laparoscopic method for the first experience in kidney transplantation. The present manuscript is aimed to present the results of laparoscopic live donor nephrectomy who’s the first 51 cases of a surgical team without any experience of open donor nephrectomy. Method: The medical records of donor nephrectomy which laparoscopic surgery was performed between April 2019-August 2020 reviewed retrospectively. Demographic features, routine transplantation preoperative data, donor nephrectomy side and reasons, surgical technique details, operation time, warm ischemia time, postoperative laboratory parameters, hospitalization time, early morbidity results were evaluated in detail. Result: Results of 51 donors between the specified dates were evaluated. The mean age of the patients was 44.6 ± 11.6 (22-69) years. The patients’ K / E ratio was 25/26. The number of patients with BMI⩾30 was 14 (27.4%). Right nephrectomy was performed on ten donors (19.6%). The mean operative time of the patients was 130 min. (120-160), and the mean warm ischemia time was 149 sec. (113-180). Postoperative complications were in 4 patients (7.8%). Conclusion: The laparoscopic method for live donor nephrectomy may be applied in safe from the initial stage by teams with advanced minimally invasive surgery experience.

MP10-10 COMPLEXITIES IN ANNOTATING SURGICAL VIDEOS TO BUILD SUPERVISED DEEP LEARNING MODELS FOR LAPAROSCOPIC LIVE DONOR NEPHRECTOMY

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I (MP10)1 Sep 2021MP10-10 COMPLEXITIES IN ANNOTATING SURGICAL VIDEOS TO BUILD SUPERVISED DEEP LEARNING MODELS FOR LAPAROSCOPIC LIVE DONOR NEPHRECTOMY Mahendra Bhandari, Hamid Ali, Mahesh Desai, C. Mallikarjuna, Aneesh Srivastava, Deepak Dubey, Vipin Tyagi, Rajesh Ahlawat, Carolyn Pratt, Gautum Ram Chaudhary, Trevor Zeffiro, and Madhu Reddiboina Mahendra BhandariMahendra Bhandari More articles by this author , Hamid AliHamid Ali More articles by this author , Mahesh DesaiMahesh Desai More articles by this author , C. MallikarjunaC. Mallikarjuna More articles by this author , Aneesh SrivastavaAneesh Srivastava More articles by this author , Deepak DubeyDeepak Dubey More articles by this author , Vipin TyagiVipin Tyagi More articles by this author , Rajesh AhlawatRajesh Ahlawat More articles by this author , Carolyn PrattCarolyn Pratt More articles by this author , Gautum Ram ChaudharyGautum Ram Chaudhary More articles by this author , Trevor ZeffiroTrevor Zeffiro More articles by this author , and Madhu ReddiboinaMadhu Reddiboina More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001983.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Annotating surgical videos is the key step in building computer vision (CV) models to develop real-time surgical tools. Surgical annotation is time intensive and requires combined skill sets of domain knowledge and technical experts. It requires consensus among multiple annotators for labeling rules, methods for conflict resolution, and for addressing errors. We developed a CV model for use in an immersive AR/VR technology to provide surgeons guidance to navigate through opaque surgical tissues in real time during donor nephrectomy. We identified annotation challenges and solutions to improve annotation processes. METHODS: As a part of MICCAI 2018 challenge we built a model on porcine kidney surgery images. The model could successfully identify 8 of 11 objects with a high degree of accuracy. In order to move this towards a useful surgical tool, we trained the model on frames from 22 videos of live donor nephrectomy provided by partner centers which were annotated by three qualified urology and transplant specialists (A1, A2, A3). However, due to discrepancies between annotators as well as inconsistencies in how an individual annotator labeled different frames, the model performed poorly. A consensus meeting took place between the annotators to resolve conflicts. To improve the performance of the model, we focused first on images processed by A1 and cleaned the data. By removing 325 images with clear conflicts between consecutive frames, we identified 1499 images suitable for use. 20% of these images (299) were set aside for testing and the model was trained on the remainder. RESULTS: The model correctly predicted the presence of renal artery in 49 of 91 frames where the annotator labeled it, renal vein in 190 of 207 frames, and spleen in 72 of 75 frames. IOUs for background, renal artery, renal vein, and spleen were 0.959, 0.156, 0.553, and 0.596 respectively (see table). We hope to improve model performance with larger data sets incorporating annotators' consensus. Data from multiple annotators will allow us to automate data cleaning by removing frames with insufficient agreement between annotators. CONCLUSIONS: Accurate CV models are essential to the growth of automation in surgery and require the work of urological surgeons to manually label data in coordination with technical experts. Source of Funding: This material is based upon work supported by the National Science Foundation under SBIR Grant No. 1953822 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e172-e172 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mahendra Bhandari More articles by this author Hamid Ali More articles by this author Mahesh Desai More articles by this author C. Mallikarjuna More articles by this author Aneesh Srivastava More articles by this author Deepak Dubey More articles by this author Vipin Tyagi More articles by this author Rajesh Ahlawat More articles by this author Carolyn Pratt More articles by this author Gautum Ram Chaudhary More articles by this author Trevor Zeffiro More articles by this author Madhu Reddiboina More articles by this author Expand All Advertisement Loading ...

A systematic review of living kidney donor enhanced recovery after surgery.

Enhanced recovery after surgery (ERAS) reduces complications and shortens hospital stay without increasing readmission or mortality. However, its role in living donor nephrectomy (LDN) has not yet been defined. Medline, Embase, CINAHL, PsycINFO, and Cochrane Central were searched prior to 08/01/21 for all randomized controlled and cohort studies comparing ERAS to standard of care in LDN. The study was registered on PROSPERO (CRD: CRD42019141706). One thousand, three hundred seventy-seven patients were identified from 14 studies (698 patients with ERAS and 679 patients without). There were considerable differences in the protocols used, and compliance with general ERAS recommendations was poor. Meta-analysis of laparoscopic procedures (including hand- and robot-assisted) revealed that duration of stay was significantly reduced by 0.98days with ERAS (95% CI=0.36-1.60, P=.002) and opiate requirement by 32.4mg (95% CI=1.1-63.7, P=.04). There was no significant difference n readmission rates or complications. Quality of evidence was low to moderate assessed using the GRADE tool. This review suggests there is a positive benefit of ERAS in laparoscopic LDN. However, there was considerable variation in ERAS protocols used, and the quality of evidence was low; as such, a guideline for ERAS in LDN should be developed and validated.

P0332 - Complexities in annotating surgical videos for building supervised deep learning models for critical steps of laparoscopic live donor nephrectomy

P0332 - Complexities in annotating surgical videos for building supervised deep learning models for critical steps of laparoscopic live donor nephrectomy

Evaluation of a multimodal analgesic regimen on outcomes following laparoscopic living donor nephrectomy.

Postoperative pain is a significant source of morbidity in patients undergoing living donor nephrectomy (LDN) and a deterrent for candidates. We implemented a standardized multimodal analgesic regimen, which consists of pharmacist-led pre-procedure pain management education, a combination transversus abdominis plane and rectus sheath block performed by the regional anesthesia team, scheduled acetaminophen and gabapentin, and as-needed opioids. This single-center retrospective study evaluated outcomes between patients undergoing LDN who received a multimodal analgesic regimen and a historical cohort. The multimodal cohort had a significantly shorter length of stay (LOS) (days, mean±SD: 1.8±0.7 vs. 2.6±0.8; p<.001) and a greater proportion who were discharged on postoperative day (POD) 1 (38.6% vs. 1.5%; p<.001). The total morphine milligram equivalents (MME) that patients received during hospitalization were significantly less in the multimodal cohort on POD 0-2. The outpatient MME prescribed through POD 60 was also significantly less in the multimodal cohort (median [IQR]; 180 [150-188] vs. 225 [150-300]; p<.001). The mean patient-reported pain score (PRPS) was significantly lower in the multimodal cohort on POD 0-2. The maximum PRPS was significantly lower on POD 0 (mean±SD: 7±2 vs. 8±1, respectively; p=.02). This study suggests that our multimodal regimen significantly reduces LOS, PRPS, and opioid requirements and has the potential to improve the donation experience.

Use of Bipolar Electrosurgical Device for Sealing of Ureter During Laparoscopic Live Donor Nephrectomy: Single-center Experience

Use of Bipolar Electrosurgical Device for Sealing of Ureter During Laparoscopic Live Donor Nephrectomy: Single-center Experience

Đánh giá kết quả phẫu thuật nội soi lấy thận ghép sau phúc mạc và xuyên phúc mạc tại Bệnh viện Trung ương Huế

Abstract Introduction: Laparoscopic living donor nephrectomy (LLDN), which is standard technique, has more advantages than open nephrectomy. Today, there are two approachs in LLDN, including retroperitoneal and transperitoneal. We evaluate results of modified retroperitoneal and transperitoneal laparoscopic living donor nephrectomy, give selection criteria as well as the advantages and disadvantages of each approach. Materials and Methods: Prospective study of 84 voluntary living kidney donors who underwent modified retroperitoneal and transperitoneal laparoscopic living donor nephrectomy (RPLDN) and (TPLDN) in Transplant Center, Hue Central Hospital, between 1/2018 and 6/2020. Results: The difference in BMI among two groups was roughly 2 (Kg/m2) (p&lt;0,05). The perioperative, postoperative complication rate and the conversion rate to open surgery were similar between the two groups. The surgical time and blood loss was significantly lower in RPLDN (139,38 ± 24,73 min, 46,35 ± 13,32 ml) than in TPLDN (174,39 ± 40,86 min, 67,92 ± 30,76 ml) (p&lt;0,05). Comparing characteristics such as warm ischemic time, hospital stays, flatulence time, removal time of drainage and urinary catheter indicated that they were similar between the two groups (p&gt;0,05). Conclusion: Both RPLDN and TPLDN are safe and effective procedures. RPLDN should be conducted in patients with low BMI (&lt; 23 kg/m2), previous abdominal operations and wide flank space. Moreover, modified RPLDN has shorter operative time, less blood loss and good esthetic aspect comparing to TPLDN. Key word: Retroperitoneal laparoscopic, transperitoneal laparoscopic, nephrectomy living donor. Tóm tắt Đặt vấn đề: Phẫu thuật nội soi (PTNS) lấy thận ghép trên người hiến sống được xem là phương pháp có nhiều ưu điểm hơn so với mổ mở kinh điển. Hiện nay, có 2 phương pháp tiếp cận chính là sau phúc mạc (RPLDN) và xuyên phúc mạc (TPLDN). Chúng tôi đánh giá kết quả PTNS sau phúc mạc có cải biên và phẫu thuật xuyên phúc mạc để lấy thận ghép trên người hiến sống, đưa ra các tiêu chuẩn chọn lựa cho mỗi phương pháp và ưu nhược điểm của mỗi phương pháp. Phương pháp nghiên cứu: Nghiên cứu tiến cứu 84 người bệnh (NB) hiến thận tự nguyện được phẫu thuật lấy thận nội soi sau phúc mạc cải biên và xuyên phúc mạc tại Trung tâm Ghép tạng, Bệnh viện Trung ương Huế từ tháng 1/2018 đến tháng 6/2020. Kết quả: Chỉ số BMI có sự khác biệt giữa 2 nhóm RPLDN và TPLDN khoảng 2 (Kg/m2) (p&lt;0,05). Tỷ lệ biến chứng trong mổ, tỷ lệ biến chứng sau mổ là tương đương nhau giữa 2 nhóm. Thời gian phẫu thuật và lượng máu mất của phương pháp nội soi sau phúc mạc là thấp hơn (139,38 ± 24,73 phút, 46,35 ± 13,32 ml) đáng kể so với xuyên phúc mạc (174,39 ± 40,86 phút, 67,92 ± 30,76 ml) (p&lt;0,05). Thời gian thiếu máu nóng, thời gian hậu phẫu, thời gian có trung tiện, thời gian rút ống dẫn lưu, thời gian rút sonde tiểu, nghiên cứu của chúng tôi cũng cho thấy sự tương đồng giữa 2 nhóm (p&gt;0,05). Kết luận: PTNS sau và xuyên phúc mạc là 2 phương pháp an toàn và hiệu quả trong lấy thận ghép trên người hiến sống. Nội soi sau phúc mạc nên áp dụng cho các ca hiến có chỉ số BMI thấp (&lt; 23 kg/m2), khoảng hông lưng rộng hay có phẫu thuật vùng bụng trước đó. PTNS sau phúc mạc cải biên có thời gian phẫu thuật nhanh hơn, ít mất máu hơn nhưng ít thẩm mỹ hơn xuyên phúc mạc. Từ khóa: Nội soi sau phúc mạc, nội soi xuyên phúc mạc, lấy thận người hiến sống.

Reducing Opioid Dependence and Improving Patient Experience for Living Kidney Donors with Transversus Abdominis Plane Block

Rapid recovery after laparoscopic living donor nephrectomy (LLDN) for kidney donation is highly desirable for living kidney donors. To uphold rapid recovery, good analgesia with minimal adverse effects, including those related to opioid dependence, is essential. A pre-operative transversus abdominis plane (TAP) block with liposomal bupivacaine can effectively aid in perioperative pain management, while reducing opioid requirements. We conducted a single-center retrospective study involving patients 18 years and older who underwent LLDN to determine whether a TAP block with liposomal bupivacaine is efficacious in pain management after LLDN, while reducing opioid use. The study group comprised of patients who received a preoperative TAP block with liposomal bupivacaine in place of hydromorphone patient-controlled analgesia (PCA) and the control group included patients who received hydromorphone PCA post-operatively. Both groups were supplemented with oral and intravenous analgesics for breakthrough pain, as needed. The primary endpoint was reduction in post-operative opioid use in morphine milligram equivalents (MME). Secondary endpoints included: post-operative pain scores, postoperative length of stay, and re-hospitalizations within 7 days of discharge. Sixty-six patients were included in our study, with 33 in each group. Patients in both groups were well matched demographically. The study group who received TAP block demonstrated a significant reduction in post-operative opioid use (92.05 MME vs. 53.98 MME, p &lt; 0.05) when compared to the control group who received hydromorphone PCA. Both groups achieved similar analgesia with comparable pain scores. There was no difference between postoperative hospital lengths of stay for both groups. Two patients in the control group were re-admitted due to small bowel obstruction within seven days of discharge. In conclusion, TAP block with liposomal bupivacaine significantly reduced postoperative opioid use, while also proving to be safe, efficacious and feasible in patients undergoing LLDN.

Comparison of Long-Term Outcomes of Standard and Transvaginal Kidney Extraction in Laparoscopic Living Donor Nephrectomy.

Background: A limited number of publications are available in the literature regarding laparoscopic living donor nephrectomy with vaginal extraction (LLDN-VE) for kidney transplantation. The aim of this study was to compare long-term recipient outcomes of standard laparoscopic living donor nephrectomy (S-LLDN) and LLDN-VE. Methods: A total of 652 patients [119 LLDN-VE (18.3%) and 533 S-LLDN (81.7%)] were included in this retrospective cross-sectional study. The data related to donor and recipient demographics, surgical and anatomical characteristics, and recipient and graft status were retrieved and compared using nonparametric statistical methods. Kaplan-Meier and Cox proportional hazards regression analyses were applied to compute survival according to the surgical technique. Results: The mean follow-up duration was 73.0 ± 25.4 months for S-LLDN and 69.8 ± 20.4 months for LLDN-VE recipients. The main determinants of long-term outcomes were the serum creatinine (SCr) levels, death-censored graft survival, and recipient survival at the end of the post-op 5th year. LLDN-VE recipients' discharge SCr was found to be statistically lower (P = .049) than S-LLDN patients. Graft survival rates censored for death were 93.8% for the S-LLDN and 93.3% for the LLDN-VE recipients. Cox regression analysis showed significance for younger donor age (P = .010) with the application of 17 parameters, indicating better graft survival outcomes for kidney recipients with younger donors. Conclusions: Compared with the standard method, the long-term results of LLDN-VE are in accordance with or could even be more advantageous than S-LLDN in certain aspects. LLDN-VE appears to be a feasible, safe, and cosmetically superior approach with no negative postoperative sexual or morbid effects on the donor.

Safe transition from open to pure laparoscopic donor nephrectomy: Approach and results.

Introduction:Laparoscopic living donor nephrectomy (LLDN) offers many advantages compared to open living donor nephrectomy. However, the perceived difficulty in learning LLDN has slowed its wider implementation. Herein, we describe the evolution of LLDN at a single center, emphasizing the approach and technical modifications and its impact on outcome.Methods:The series included a 2½-year period and three different surgeons. We started with two-stage plan for establishing LLDN at the institute (introduction and consolidation). Data of laparoscopic donor nephrectomy performed at the institution were prospectively evaluated regarding donor and recipient outcome.Results:From December 2016 to April 2019, 221 donors underwent LLDN. Three donors required conversion to open surgery. The mean operation time was 96.4 (62–158) min and the mean warm ischemia time was 186 (149–423) s. The complications were observed in 11.6% of donors from LLDN group and all complications were Class I and Class II only (Clavien–Dindo classification). No Class III and Class IV complications occurred. In the present study, there was some learning curve effect observed only in operative time (OT) with longer OT in initial cases. However, the overall operative complications were minimal, showing that this learning curve had no deleterious effects on donor safety.Conclusion:The present study demonstrates that with proper planning, team approach, and a few technical modifications, the transition from open to LLDN could be safe and effective.