Mini-incision Donor Nephrectomy Research Articles

Robotic versus open mini-incision living donor nephrectomy: Single centre experience.

Robotic surgery is associated with less tissue manipulation and earlier recovery with minimal incision. The aim of this study was to compare the short-term clinical outcomes between robotic-assisted donor nephrectomy (RDN) and open mini-incision donor nephrectomy (ODN). From 2016 to 2019, 141 cases involving RDN were analysed. Patient outcomes were compared with those of 191 patients who underwent ODN from 2010 to 2015. Demographics, operation factors, perioperative outcomes, and complications were retrospectively reviewed. The RDN group presented with less blood loss than the ODN group (p=0.023). The length of hospital stay was significantly shorter in the RDN group than in the ODN group (p<0.005). The overall rate of complications was low and there was no significant difference in complication rates between the groups. The robotic approach has benefits over the traditional open approach, including shorter length of hospital stay and reduced intraoperative blood loss.

236.9: Robotic Versus Open Mini-Incision Living Donor Nephrectomy: Single Center Experience

Background: A minimally invasive approach is the gold standard for living donor nephrectomy (LDN). While robotic surgery is commonly used for native nephrectomies and urological procedures, robotic LDN is being performed at very few centers worldwide. The robotic platform allows three-dimensional imaging of the surgical site and precise replication of human hand movements scaled down. Robotic surgery is associated with less tissue manipulation and earlier recovery with minimal incision. The aim of this study is to compare the short-term clinical outcomes between robotic-assisted donor nephrectomy (RDN) and open mini-incision donor nephrectomy (ODN) at a single center. Methods: From 2016 to 2019, 141 consecutive cases involving RDN were analyzed at our single center. Patient outcomes were compared with those from a historical cohort of 191 patients who underwent ODN (7-9 cm incision) from 2010 to 2015. Medical records, including demographics, operation factors, perioperative outcomes, and complications were reviewed retrospectively. Results: The RDN and ODN groups had a mean age of 42.8 and 41.4 years old, respectively (p = 0.31) as well as a mean BMI of 27.1 and 27.2, respectively (p = 0.76). Left-sided donor nephrectomy was performed in 102 patients (72.3%) via robotic approach and 88 patients (44.7%) via open approach (p < 0.001). Operative time was similar between both groups (194.0 for RDN vs. 197.8 min for ODN, respectively; p = 0.40). The RDN group presented with less blood loss than the ODN group (37.5 vs. 79.3 ml; p = 0.023). There was no open conversion case in the RDN group. Postoperative creatinine and glomerular filtration rate were not significantly different between two groups (1.28 and 61.68 for RDN vs. 1.28 mg/dL and 64.26 ml/min for ODN; p = 0.996 and 0.098, respectively). Length of hospital stay was significantly shorter in the RDN group than the ODN group (2.34 vs. 3.08 days; p <0.005). The overall rate of complications was low and there was no statistically significant difference in complication rates between the groups. Complications included stump bleeding (3 for RDN vs 1 case for ODN, p = 0.313), urinary retention (1 for RDN vs 3 cases for ODN, p = 0.643), and lymphatic leak (1 for RDN vs. 0 case for ODN, p=0.417). Conclusions: RDN is a safe and minimally invasive technique with excellent clinical outcomes for living donors. The robotic approach has benefits over the traditional open approach, including shorter length of hospital stay and reduced intraoperative blood loss.

Mini-incision Living Donor Nephrectomy and Trans-peritoneal Laparoscopic Nephrectomy: Will There Be a Place for New Evidence?

ObjectivesTo compare mini-incision donor nephrectomy (MDN) with laparoscopic donor nephrectomy (LDN) performed by the same surgical team, regarding short- and long-term outcomes. MethodsThree hundred and five patients, who underwent donor nephrectomy in our institution, through an MDN (n = 141) between January 1998-November 2011 and LDN (n = 164) since June 2010-December 2017, were compared. ResultsThe mean operative time for MDN (120 ± 29 minutes) was not significantly different when compared to LDN (113 ± 34 minutes), but when comparing the first 50 LDN and the 50 most recent, we found a reduction in the duration of the procedure. Laparoscopic donors had a shorter warm ischemia time (229 seconds vs 310 seconds, P = .01), particularly the 50 most recent, hospital stay (4.3 days vs 5.9 days, P < .001), and postoperative complications (P = .03). The incidence of graft acute tubular necrosis (ATN) was superior in the MDN (89% vs 25%, P < .001), although there was no significant difference regarding first-year serum creatinine (SCr) and glomerular filtration rate (GFR) (SCr 1.38 mg/dL vs SCr 1.33 mg/dL and GFR 63.7 mL/min vs 63.1 mL/min) comparing the 2 groups. Long-term graft survival did not significantly differ between groups. There was also no relationship between postoperative ATN events and long-term graft function. ConclusionsWith the growing experience of the high-volume centers and with specialized teams, LDN could be considered the most suitable technique for living donor nephrectomy with better results in short-term results (warm ischemia time, hospital stay, and postoperative complications), without difference in long-term outcomes.

Anterior vertical mini-incision vs. retroperitoneoscopic nephrectomy in living kidney donation: a prospective study on donors' quality of life and clinical outcome.

A fundamental goal in living kidney donation (LKD) is to maximize donor safety while minimizing post-operative impairments. We evaluated clinical outcome and health-related quality of life (QOL) comparing anterior vertical mini-incision donor nephrectomy (MIDN) and retroperitoneoscopic donor nephrectomy (RPDN). Thirty-eight MIDN and 45 RPDN donors were analyzed. In a subsample (n = 18 MIDN; n = 32 RPDN), QOL was prospectively assessed with the WHOQOL-Bref questionnaire before and three months after LKD. Skin-to-skin time (169 vs. 116 min, p < 0.001) and hospital stay (6.6 vs. 4.9 d, p < 0.001) were significantly shorter in RPDN. In total, 26% of MIDN patients and 13% of RPDN patients developed post-operative complications (p = 0.14). While in MIDN the QOL domains physical health (p = 0.03) and psychological (p = 0.03) and the overall QOL facet (p = 0.003) were significantly lower three months post-LKD compared to baseline, there were no significant QOL decreases in RPDN. However, no significant post-operative QOL differences were found between groups. RPDN donors retrospectively reported significantly less post-operative pain (p = 0.007) and physical strain (p = 0.05) caused by LKD than MIDN donors. It may be possible to further reduce the surgical burden of LKD by introducing RPDN. Post-operative QOL was not significantly different between groups, but the QOL decrease appeared to be less pronounced in RPDN.

Incision-related outcome after live donor nephrectomy: a single-center experience

Live donor nephrectomy is routinely performed. However, little is known regarding the incision-related outcome. The aim of the present study was to evaluate the prevalence of incisional hernias (IH) and to assess body image and cosmesis scores after donation. Questionnaires on IH, body image, and cosmesis were sent to all donors who underwent laparoscopic donor nephrectomy or mini-incision donor nephrectomy between January 2000 and December 2009. In total, 444 replies were received (75 %). Seven donors (1.5 %) had undergone a surgical correction of an IH. Surgical site infection and steroid use appeared to be independent risk factors for the development of an IH (p = 0.001 and 0.021, respectively). Body image and cosmesis scores were excellent. Elderly donors had significantly higher cosmesis scores when compared with young donors (p < 0.001). Donor age of 60 years or higher, correction of an IH, and survival of the recipient appeared to be independent factors associated with a higher score on the cosmesis scale in multivariate analysis. This is the largest study describing the prevalence of IH and cosmetic outcome after donor nephrectomy. The prevalence of IH after live donor nephrectomy is very low, and body image and cosmesis scores are excellent. Consequently, incision-related outcomes pose no barrier to live donor nephrectomy.

Comparing Surgical Complications of Donors and Recipients in Retroperitoneoscopic versus Mini-Incision Donor Nephrectomy: A Single-Center Experience

Anterior vertical mini-incision donor nephrectomy (MIDN) has been used as the standard retrieval procedure in our center. Though the MIDN approach was tolerated very well with low complication rates, there were especially cosmetic reasons, to consider a change of procedure. Hence we switched to a total retroperitoneoscopic donor nephrectomy (RPDN) in 2011. We compared the outcome and surgical complications of donors and recipients of the first 30 RPDNs performed with 30 consecutive MIDN procedures. In both techniques, right and left nephrectomies were carried out. After a very short learning curve, the mean RPDN operation times were shorter compared to the MIDN (109 versus 171 min, P&lt;0.01) and donors were discharged earlier. No major complications occurred in the RPDN group and complications were less frequent compared to MIDN (17% versus 40%). The renal function in the recipients was equivalent in both groups at the time of discharge and after one year. We conclude that RPDN is easy to learn for a surgical team experienced in open retroperitoneal donor nephrectomy. The change of the retrieval technique is safe for the donor and the recipient regarding surgical complications and recipients’ renal function. Donors benefit from RPDN due to earlier hospital discharge and faster recovery.

The mini-incision donor nephrectomy is best suited for Indian patients undergoing live donor nephrectomy: Against the motion

The mini-incision donor nephrectomy is best suited for Indian patients undergoing live donor nephrectomy: Against the motion

Does mini‐incision donor nephrectomy improve quality of life in living kidney donors?

Living kidney donation helps to avoid or reduce the time period of dialysis and on waiting lists in patients requiring a new organ. Mini-incision donor nephrectomy (MIDN) shows to result in better clinical outcome in comparison with traditional open donor nephrectomy (ODN). This study was performed to evaluate the impact of different surgical procedures on the quality of life (QoL) in patients that underwent donor nephrectomy. The aim of the study was to detect differences in QoL assessed with the Short Form-36 Version 2 (SF-36v2) questionnaire between MIDN (n = 34) and ODN (n = 36). Furthermore, the development of QoL from prior to surgery until one yr afterwards, as well as outcomes of QoL in comparison with norm-based scores was investigated. Sixty-one of 70 patients, which is 87% (MIDN: 86%, ODN: 88%) resent a whole set questionnaires. QoL was similar at all time-points (prior to surgery, one wk, three months and one yr) in both groups. A tendency of better QoL in MIDN (Bodily Pain) after one wk was detectable (p = 0.075). Physical Component Summaries (PCS) significantly decreased from prior to surgery until one wk after surgery (p = 0.001) and improved significantly until three months (MIDN: p = 0.006, ODN: p = 0.001) and also until one yr after surgery (p = 0.002). Mental Component Summaries (MCS) were stable throughout the whole investigated time period. In comparison with norm-based scores, MIDN (p = 0.005) and ODN (p = 0.001) showed significantly higher PCS prior to, lower scores one wk after (p = 0.001), similar scores three months after and better scores (MIDN: p = 0.023, ODN: 0.015) one yr after surgery. Mental Component Scores were similar in both prior to and one wk after surgery. After three months and one yr scores were significantly better in MIDN (three months: p = 0.049, one yr: p = 0.037) and ODN (three months: 0.020, one yr: 0.073). Quality of life after living donor nephrectomy is not influenced by the surgical technique. Nevertheless the standardized instrument of the SF-36v2 Health Survey is a useful, practicable and universally interpretable tool to gain and estimate recovery from surgical procedures in the perioperative period and its development thereafter.

Psychosocial and Physical Impairment After Mini-Incision Open and Laparoscopic Donor Nephrectomy: A Prospective Study

The aim of the present study was to prospectively investigate how mini-incision donor nephrectomy (MIDN) and laparoscopic donor nephrectomy (LDN) affected the donor's quality of life and fatigue. Forty-five donors underwent MIDN and 55 donors underwent LDN. Quality of life and fatigue were recorded preoperatively and four times during one year follow-up on the Short-Form 36 (SF-36) and Multidimensional Fatigue Inventory-20 (MFI-20), respectively. One-year response rates were 89% and 95% following MIDN and LDN, respectively. After MIDN, all dimensions of the SF-36 significantly declined. Most dimensions returned to preoperative values at three months except for "vitality" (six months) and "bodily pain" (12 months). After LDN, the scores of the SF-36 dimensions returned to preoperative values at three months, except for "vitality" and "role physical" (both six months). Between-groups analysis revealed significantly better scores of the SF-36 dimensions "physical function" (P = 0.03) and "bodily pain" (P = 0.04) following LDN at one month postoperatively. Fatigue scores did not significantly differ between the groups at any point in time. General and physical fatigue (MFI-20) remained affected up to one year after either type of surgery. After MIDN, 4% of the donors had returned to work at four weeks postoperatively versus 28% after LDN (P = 0.04). Return to preoperative activity level was not significantly different between groups. Both procedures clearly impact quality of life and fatigue. The beneficial effect on the quality of life and the earlier return to work encourage us to advocate LDN as the surgical approach to be preferred.

Laparoscopic Versus Open Donor Nephrectomy

With great interest we read the article by Kok and colleagues published on March 27, 2006 in Transplantation (1). The authors compared laparoscopic and the mini-incision muscle splitting open donor nephrectomy as two minimal invasive methods to perform a donor nephrectomy and conclude that there are no significant differences. The high conversion rate and perioperative morbidity rate of the total laparoscopic group can be held responsible for that. Perry et al. demonstrated that the mini incision donor nephrectomy is inferior to the laparoscopic approach in many domains (2). The open nephrectomy is especially associated with delayed resumption of normal activities such as return to full activity and driving, and with a diminished quality of life. Unfortunately, these aspects that are especially important for a healthy donor were not included in the analysis by Kok et al. A mini-incision ranging up to 15 cm cannot be considered a mini-incision anymore and but must be counted as a conversion to a formal laparotomy. This in concordance with the definition of a conversion in laparoscopic surgery such as when the intended incision must be enlarged. In the search for the best minimal invasive method for donor nephrectomy, did the authors considered the hand-assisted laparoscopic donor nephrectomy? Various studies demonstrated the advantages of the hand-assisted modality as compared to the total laparoscopic approach. The hand-assisted approach leads to a shorter operation time, shorter warm ischemic time, lower conversion rate, and increased donor safety (3, 4). In addition, we are concerned about the high urological complication rate of over 20% in both groups as described by Kok et al. Recently, two meta-analysis demonstrated that a splinted ureterocystostomy is superior to a nonsplinted anastomosis and that the urological complication rate with a routine splinting policy should be in the 2–3% target range (5). Did the authors use splinted anastomoses and did they harvest the ureter together with the gonadal vein, because this is also demonstrated to reduce the urological complication rate? Mirza M. Idu Ron Balm Willem A. Bemelman Department of Vascular and Transplant Surgery Academic Medical Center Amsterdam, the Netherlands

Quality of life following living donor nephrectomy comparing classical flank incision and anterior vertical mini-incision

In this study we focused on the quality of life and satisfaction of living kidney donors comparing traditional lumbar (LDN) and mini-incision donor nephrectomy (MIDN). From May 1996 to December 2002, 174 donor nephrectomies including 127 cases of LDN and 47 cases of MIDN were performed. Donors were evaluated using the SF-36 quality-of-life survey as well as a questionnaire dealing with donors' attitude towards kidney donation, financial burdens, pain, cosmetic satisfaction and duration of sick leave. Our donors achieved comparable or even higher scores in all the SF-36 categories in comparison to the general US population. Following MIDN, quality of life tended to be superior compared to that of LDN donors; however, statistical significance was reached only in one of the eight categories. Duration of sick leave following surgery was in favor of MIDN compared to LDN donors. Statistically significant differences favoring MIDN were observed regarding postoperative hospital stay and cosmetic satisfaction. The procedure would be again undergone by 94 of LDN and 97% of MIDN donors. Open-donor nephrectomy is a safe and cost-effective procedure. Introduction of the here-described MIDN has led to comparable or even improved results compared to LDN.

Subcostal Versus Transcostal Mini Donor Nephrectomy: Is Rib Resection Responsible for Pain Related Donor Morbidity

Conventional donor nephrectomy is associated with significant postoperative morbidity. Whether this morbidity is associated with rib resection or a long incision is not clear. We designed a prospective randomized study of subcostal and transcostal mini incision donor nephrectomy and compared the results. We performed 82 donor nephrectomies in the study period of December 2000 to July 2001. Open donor nephrectomies were randomized to subcostal (25) or transcostal (24) mini incision techniques. Results were compared and analyzed using the independent t test. The subcostal and transcostal groups were comparable in terms of patient age, body mass index, nephrectomy side, number of renal vessels and incision length (9.32 vs 9.72 cm). Patients in the subcostal group had a lesser postoperative analgesic requirement (304 +/- 49.8 vs 487 +/- 74.1 mg, p = 0.0001), shorter hospital stay (2.36 +/- 0.7 vs 3.71 +/- 0.81 days, p = 0.0001) and early convalescence (26.56 +/- 4.06 vs 37.46 +/- 6.05 days) compared with the transcostal group. Warm ischemia time and recipient outcome were similar in the groups. Rib sparing, subcostal mini incision donor nephrectomy has significantly less morbidity and a shorter hospital stay compared with the rib resection transcostal technique.

Quality of Life, Pain and Return to Normal Activities Following Laparoscopic Donor Nephrectomy Versus Open Mini-Incision Donor Nephrectomy

We evaluated pain, convalescence and health related quality of life in patients undergoing laparoscopic and open mini-incision donor nephrectomy. We compared the records of consecutive patients who underwent laparoscopic and mini-incision open donor nephrectomy from our donor nephrectomy data base in retrospective fashion using 2 questionnaires. The first questionnaire evaluated postoperative pain, return to functioning time and satisfaction. The second questionnaire was the RAND 36-Item Health Survey, version 2, a standardized and validated health survey quality of life assessment tool. Mean patient sex, age and followup were similar for the 2 groups. All data were analyzed using the 2-tailed t test for independent variables with commercially available statistical analysis software. Pain in the laparoscopic group was significantly less than in the mini-incision group at all followup time points (p <0.05). Statistically significant differences demonstrated that laparoscopy led to more rapid recovery time in certain categories, including walking, discontinuation of prescribed oral pain relievers, return to driving, and resumption of normal work and home daily activities. More subjective questions in the survey showed high levels of acceptance for the 2 procedures. Using the RAND 36-Item Health Survey, version 2 health related quality of life was significantly higher in the laparoscopy group in 3 domains that measure bodily pain, physical functioning and emotional role functioning. However, each group scored at or above age matched American averages in all domains. The laparoscopy group had significantly less postoperative pain and required less time to return to normal functional activities than the mini-incision group. In addition, the laparoscopic group showed significantly higher quality of life scores than the mini-incision group in 3 domains.