Retroperitoneal Laparoscopic Living Donor Nephrectomy Research Articles

ROBOTIC VERSUS LAPAROSCOPIC LIVING DONOR NEPHRECTOMY: A PROSPECTIVE STUDY

Introduction: Robotic-assisted laparoscopic donor nephrectomy (RALDN) reportedly facilitate better hilar dissection but had associated concerns regarding longer graft retrieval and ischemia times. The aim of this study is to assess safety and efficacy of an initially introduced RALDN when compared to the routine retroperitoneal laparoscopic living donor nephrectomy (RLLDN) at a single institution transplant program. Materials and Methods: Data were collected prospectively from 64 consecutive living kidney donors (12 for RALDN subgroup and 52 RLLDN subgroup) at our hospital from May 2018 to August 2019. All donors were approved by our Government Hospital Renal Transplantation Council according to Amsterdam Guidelines. Patient demographics, radiology findings, surgery results and complications were recorded. Primary endpoints were peri-operative parameters, postoperative outcomes and complications. The surgeons were experienced retroperitoneoscopic using three ports and robotic surgeons using the Da Vinci Si System with three arm robotic ports. Results: For the entire group, mean age ± SD was 51.7 ± 8.9 years, and 58% were females. Mean BMI was 22.5 ± 2.3 (15.6 - 27.3). There were 54 (84%) left kidneys. Preoperatively, there were no significant differences between the two patient groups including age, gender, BMI, kidney side, hilar anatomy and ASA status. For perioperative outcomes, there was no significant differences (P>0.05) comparing RALDN and RLLDN respectively for warm ischemic time (4.75 ± 1.54vs. 4.75 ± 1.38 minutes), operative time (233 ± 46 vs. 216 ± 41 minutes), hemoglobin (g/L) drop (9 ± 5.6 vs. 8.6 ± 7.2), postoperative complications (All Clavien) (16.7% vs. 9.6%), the donor blood creatinine at one month (1.1 ± 0.2 vs. 1.2 ± 0.3 mg/dL), and the recipient blood creatinine at one month (1.2 ± 0.3 vs. 1.4 ± 0.4 mg/dL). There were no open conversions or delayed graft functions in both groups. Conclusion: This study showed that RALDN can be safely introduced into living donor program experienced in laparoscopic donor nephrectomy. This allows the program to utilize the operative advantages including better optics and instrument dexterity of the platform in all or selected cases.

Safety and Efficacy of Right Retroperitoneal Laparoscopic Live Donor Nephrectomy: A Retrospective Single-Center Study.

BackgroundThe aim of this study was to investigate the efficacy and safety of right retroperitoneal laparoscopic live donor nephrectomy (LDN) in 81 cases of living-related renal transplant.Material/MethodsWe retrospectively reviewed all living-related donors who underwent right retroperitoneoscopic living donor nephrectomy between June 2010 and December 2017 at the First Hospital of Jilin University and their corresponding recipients. Demographic and clinical data were collected from the hospital’s electronic clinical data system. Data on preoperative renal retention parameters, operative time, and donor kidney warm ischemia time, the trimmed length of the renal artery and vein of donor kidney, and the time to extubation were recorded. Complications in both donors and recipients were recorded.ResultsWe included 81 donors who underwent successful right-sided retroperitoneoscopic LDN, with 31 males and 50 females and a mean age of 47.1 years (range 21–63 years). There was no intraoperative conversion to open donor nephrectomy. The mean operative time was 120.68±29.8 min. The mean warm ischemic time was 49.26±3.86 s. The estimate blood loss was 54.32 mL (range 50–400 mL). The median length of hospital stay was 7 days (range 4–13 days). There was neither intraoperative complication such as hemorrhage or lymph fistula nor kidney graft injury. There was no graft renal vein thrombosis and ureteral stricture or other complications. No graft rejection occurred.ConclusionsRight retroperitoneal laparoscopic live donor nephrectomy is safe and effective for renal transplant in living-related renal transplant by laparoscopic excision and extraction of the right kidney with vena cava flap.

Spigelius' line incision as a successful route to extract the kidney during retroperitoneal laparoscopic live-donor nephrectomy

Objective To introduce the advantages, incision designing methods and surgical procedures of spigelius’ line incision in retroperitoneal laparoscopic living donor nephrectomy. Methods Among the 114 donors, 39 were obtained by spigeliu’line incision (13 males and 26 females), with an average age of 35 years, 35 left kidneys and 4 right kidneys. Gibson incision was performed in 75 patients (28 males and 47 females), with an average age of 31 years, 73 left kidneys and 2 right kidneys.The clinical data of 114 donors undergoing retroperitoneal laparoscopic living donor nephrectomy from September 2012 to July 2017 were analyzed retrospectively. The operation was performed by laparoscopic surgery to separate the ureter, renal vessels and perirenal fat. Finally, the renal vessels were removed and the kidneys were removed with hand-assistant. 75 cases were taken out of the kidney through the inguinal parallel incision(Gibson incision), while the other 39 cases used the spigelius’ line incision(Through the linea pararectalis, the anterior sheath is cut opened at the margin of the rectus sheath (spigelius’ line) and the lateral peritoneum is pushed into the midline between the arcuate line and the inferior abdominal vessels to expose the retroperitoneal space). The intraoperative data were collected. Results All the operations were not converted to open surgery. The incision length of the spigelius’ line incision group was (6.8±0.6)cm, and the incision length of the Gibson incision group was (7.0±0.4)cm, P=0.02. The blood loss of the operation of the spigelius’ line incision group was (59.2±33.4)ml, while the Gibson incision group was(80.7±32.8)ml, P=0.002. The warm ischemia time of the spigelius’ line incision group was (2.8±1.1)min, while the Gibson incision group was(3.1±1.7)min, P=0.31. The operation time of the spigelius’ line incision group was (160.8±30.7)min, while the Gibson incision group was(162.5±28.1)min, P=0.77. There was no significant difference between the two groups in the warm ischemia time and the operation time. No incisional hernia was found in these two groups. Conclusions Compared with Gibson incision, the spigelius’ line incision is safe. It can completely avoid to cut the abdominal muscles, and effectively avoid the abdominal nerves injury. Without damaging the integrity of the peritoneum, it can avoid abdominal organ injury. Key words: Living donor kidney transplantation; Retroperitoneal laparoscopes; Living donor nephrectomy; Incision

Experience with 750 consecutive retroperitoneal laparoscopic living donor nephrectomy

Experience with 750 consecutive retroperitoneal laparoscopic living donor nephrectomy

Retroperitoneal laparoscopic left living donor nephrectomy: report of 35 cases

Objective To report our experience of 35 retroperitoneal laparoscopic left living-related donor nephrectomies.Methods A total of 35 related donors underwent retroperitoneal laparoscopic living donor nephrectomy from November 2011 to February 2013.The operation was performed through 3 lumbar ports.After the kidney was liberated fully and the ureter was severed 7-8 cm under the lower pole of kidney,a 5-6 cm incision was made below the rib,from the anterior auxiliary line to the umbilical.The left hand of the operator held the kidney and vessels,renal artery and vein were blocked with Hem-o-lok separately and then severed.Then the kidney was taken out quickly from the donor and infused immediately.Results The 35 cases accepted the operation successfully.Two kidneys had 3 arteries,and 6 had 2 arteries.The mean operative time was (98±25) min (70-186 min).Warm ischemia time was (2.7±0.8) min (1.8-4.5 min).And the estimated blood loss was (65±30) ml (20-350 ml).No patient needed blood transfusion.Complications appeared in 3 cases,including lumbar vein injury in 1 patient,hematoma of renal subcapsule in 1 patient and short term lymphatic leakage in 1 patient.No further treatment was required.Hospital stay after operation was (6.5±1.5) d.All the 35 donors were followed up for 7 (1-15) months,and all of them were healthy.One recipient showed delayed graft function recovery,whose level of creatinine declined to normal within 3 weeks.And the level of creatinine declined to normal within 2 weeks in the other 34 recipients.Conclusion Retroperitoneal laparoscopic living relatives donor nephrectomy is a safe and reliable procedure,which can replace the traditional open surgery. Key words: Laparoscopes ; Directed tissue donation ; Living donor; Nephrectomy ; Kidney transplantation

Hand-assisted retroperitoneal laparoscopic living donor nephrectomy with a modified technique

Objective To evaluate the safety,feasibility and results of the hand-assisted retroperitoneal laparoscopic living donor nephrectomy ( HRPLDN ) with a modified technique. Methods Living donors (n =32) were divided into HRPLDN group (n =16) and open group (n =16) according to surgical technique.Operative data and postoperative outcomes including operative time,estimated blood loss,warm ischemia time,length of hospital stay and complication rate,were collected. Results All procedures were completed successfully.In HRPLDN group,the mean operative time was 101.3 ± 21.2 min (range from 70 to 150 min),with an estimated blood loss of 53.8 ±25.5 ml (range from 20 to 100 ml) and warm ischemia time of 2.4 ± 0.6 min ( range from 1.5 to 3.5 min).No living donor needed conversion to open surgery and the urine volume of transplanted kidney after first 24 hours was 5036 ml (range from 3500 -6500 ml).The mean postoperative on bed time were (2.8 ± 0.7 ) d (ranging from 2 -4 d).All parameters of HRPLDN were significantly better than that of open groups. Conclusion Living donor nephrectomy with HRPLDN is a safe and reliable surgical technique. Key words: Laparoscopy ; Hand-assisted; Kidney transplantation ; Nephrectomy

Retroperitoneal Laparoscopic Live-Donor Nephrectomy: Introduction of Simple Hand-Assisted Technique (Without Hand Port)

Objective Compared with the transperitoneal approach, retroperitoneal laparoscopic live-donor nephrectomy offers a substantial advantage. However, retroperitoneal access is more difficult because of the limited working space. The objective of this study was to report our experience with hand-assisted retroperitoneal laparoscopic live-donor nephrectomy without a hand port. Materials and Methods Intraoperative and immediate postoperative surgical outcomes were reviewed for 23 modified retroperitoneal laparoscopic live-donor nephrectomies performed from May 2009 to January 2010. All kidneys were from living related donors. No prisoners or organs from prisoners were used in this study. Results Retroperitoneal laparoscopic live-donor nephrectomy was successfully completed in all patients, without conversion to open surgery. Mean (range) operative was 114 (98–130) minutes; warm ischemia time was 1.6 (1.3–2.1) minutes; estimated blood loss was 20 (10–50) mL; and postoperative hospital stay was 6.9 (5–10) days. No serious complications such as massive bleeding or bowel injury occurred. In 1 patient, a hematoma of renal fossa developed, which was successfully treated at repeat operation. All kidneys demonstrated good primary function except 1 that exhibited delayed graft function. Conclusions Retroperitoneal laparoscopic live-donor nephrectomy combines the benefits of both hand assistance and the retroperitoneal approach, to minimize the risk of short- and long-term complications associated with the transabdominal approach. The technique could be a cost-effective procedure suitable for use in developing countries.

Retroperitoneal laparoscopic live donor nephrectomy: Report of 105 cases

Retroperitoneal laparoscopic live donor nephrectomy offers an intrinsic advantage over conventional transperitoneal laparoscopic nephrectomy because of the potentially lower risk for early and late donor intraperitoneal complications. Herein we presented our experience performing retroperitoneal laparoscopic live donor nephrectomy in 105 donors. All donor nephrectomy was successful. There were no donor deaths and no conversion to open surgery. Mean operation time was 112 min (range, 70-200 min). Intraoperative blood loss was 10-150 mL with an average of 30 mL. Warm ischemia time was 1.3 to 6 min with an average of 3.1 min. Postoperative retroperitoneal hematoma occurred in only one case and there were no other surgical complications. Donors were discharged from the hospital 5 to 10 days postoperation. Average postoperative hospital stay was 6.4 days. One graft was removed due to acute rejection. Delayed graft function occurred in two recipients but renal function returned to normal within four weeks. The other recipients had normal renal function in two weeks except three recipients in four weeks. We believe that retroperitoneal laparoscopic live donor nephrectomy is safe, reliable, and less invasive.

Comparison of effect between retroperitoneal laparoscopic living donor nephrectomy and open surgery

Objective To study the advantage of retroperitoneal laparoscopic living donor nephrectomy through comparative study on postoperative care between retroperitoneal laparoscopic living donor nephrectomy and open surgery. Methods During the period from August 2007 to December 2009, living donor nephrectomy were divided into 25 cases of retroperitoneal laparoscopic surgery and 20 cases of open surgery. The nursing characteristics were compared. Results The operation and recovery of all patients are successful. The drainage tube indwelling days, urinary catheter indwelling days, postoperative bed time, days of absolute diet and hospitalization in retroperitoneal laparoscopic surgery group were significantly shorter than those in open surgery group(P <0. 01). Conclusions Retroperitoneal laparoscopic living donor nephrectomy has the advantages of minimally invasive, rapid recovery and fewer hospital days, Worth being popularized in clinical otolaryngology application Key words: Retroperitoneal laparoscopic liviny donor nephrectomy; Open surgery; Nursing

Retroperitoneal Laparoscopic Live Donor Nephrectomy: A Cost-effective Approach

To establish a modified cost-effective and safe approach of retroperitoneal laparoscopic live donor nephrectomy (RPLLDN). Between December 2003 and December 2008, total of 109 living related renal donors underwent consecutive three-port RPLLDNs. The initial retroperitoneal space was created by insertion of a rubber catheter attached to a saline-filled midfinger of a glove. The renal hilum and ureter were circumferentially mobilized. The tributaries of renal vessels were divided by harmonic scalpel without any clips. In laparoscopy, the ureter was sheared with scissors. A longitudinal 6-8 cm skin incision was enlarged form the primary trocar distally to retrieve the graft. The main renal vessels were controlled, using 2 Hem-o-lok clips placed at each proximal ends. The graft was retrieved manually through the skin incision. All the 109 RPLLDNs were carried out successfully. The mean operation time and mean warm ischemic time was 129.7 +/- 42.6 and 3.6 +/- 1.2 minutes, respectively. The mean blood loss was 73.6 +/- 53.7 mL. No blood transfusion or open conversion was required. No major complication occurred in the donors, and only 5% of the donors suffered from minor complications. A total of 3% and 4% of the recipients developed major and minor complications, respectively, and 12.8% of the donors required analgesics. The mean level of postoperative serum creatinine of the donors was 1.31 +/- 0.22 mg/dL and the mean level of postoperative serum creatinine of the recipients at the first month was 1.59 +/- 0.91 mg/dL. The modified approach of RPLLDN could be a cost-effective and safe alternative for developing countries.

UP-1.166: Simplified Technique for Retroperitoneal Laparoscopic Living Donor Nephrectomy in Cho Ray Hospital, Ho Chi Minh City, Vietnam

UP-1.166: Simplified Technique for Retroperitoneal Laparoscopic Living Donor Nephrectomy in Cho Ray Hospital, Ho Chi Minh City, Vietnam

Right retroperitoneal versus left transperitoneal laparoscopic live donor nephrectomy

Objectives To describe our preferred method of right laparoscopic live donor nephrectomy (LDN) using a retroperitoneoscopic approach to determine the indications for, and overall rate of, right LDN and to compare the donor and recipient early outcomes of right retroperitoneal LDN to those of left transperitoneal LDN in a consecutive single-institution series. Methods At our institution, LDN for allotransplantation was performed in 143 consecutive patients. The indications for right LDN (n = 29) included multiple left renal vessels (n = 18), early branching of the left renal artery (n = 1), left renal vein anomaly (n = 2), right renal arterial fibromuscular dysplasia (n = 2), right renal cyst (n = 3), mild right hydronephrosis with delay on renal scan (n = 1), or right nephrolithiasis (n = 2). Results Right LDN was performed in 29 (20.3%) of 143 patients using a retroperitoneal approach in all but the first case. Right retroperitoneal LDN was associated with decreased blood loss and operative time compared with left transperitoneal LDN. The hospital stay, analgesic use, and donor serum creatinine at discharge were similar in both groups. Despite a statistically significantly increased warm ischemia time and decreased renal vein length, right retroperitoneal LDN was associated with recipient functional outcomes at 5 and 30 days after transplant that were no different from those after left transperitoneal LDN. Conclusions Right retroperitoneal laparoscopic LDN provides similar donor and recipient outcomes when compared with the left transperitoneal approach and obviates most of the technical challenges encountered with a right transperitoneal approach.