Retroperitoneal Laparoscopic Nephrectomy Research Articles

Comparison between Retroperitoneal Laparoscopic Nephrectomy and Traditional Open Nephrectomy to Treat Polycystic Kidney Disease before Kidney Transplantation.

To compare the efficiency and safety between retroperitoneal laparoscopic nephrectomy and traditional open nephrectomy to treat autosomal-dominant polycystic kidney disease before kidney transplantation. A total of 57 patients diagnosed with huge autosomal-dominant polycystic kidney disease between 2000 and 2020 at our center were included in this study. Patients were divided into a retroperitoneal laparoscopic (RL; n=23) group and traditional open (TO; n = 34) group. We retrospectively analyzed and compared preoperative and perioperative variables between the two groups. Patients in the RL group showed a longer operation time (201.09±83.76min) compared to patients in the TO group (113.38 ± 51.84min, p < 0.001). The RL group also showed significantly less intraoperative blood loss (p = 0.025) and less intraoperative blood transfusion volume (p = 0.016) compared to the TO group. Meanwhile, time of gastrointestinal function recovery, bed leave, catheter indwelling and postoperative hospitalization in the RL group were 2.13 ± 0.63, 1.30 ± 1.0, 5.22 ± 2.09, 7.35±2.48 days, respectively, which were significantly shorter than the TO group (p < 0.05). Pain degree of patients during the first 48 hours after operation was similar between the RL and TO groups, but the opioid use percentage in the RL group was 8.70% (2/23) and was lower than the 26.47% (9/34) in the TO group (p = 0.022). Meanwhile, 5 and 23 patients exhibited postoperative complications in the RL and TO groups, respectively (p < 0.001). Both retroperitoneal laparoscopic nephrectomy and traditional open surgery are feasible to treat huge polycystic nephrectomy. However, patients who undergo retroperitoneal laparoscopic nephrectomy experience higher levels of safety and recover more rapidly.

Port Site Recurrence After Laparoscopic Nephrectomy for Renal Cell Carcinoma --Report of Two Cases and Literature review-

A male in his 60s underwent a right transperitoneal laparoscopic partial nephrectomy procedure for a right renal tumor. Rupture of a renal cyst located close to the tumor occurred intraoperatively. The histopathological diagnosis was clear cell renal cell carcinoma (CCRCC), pT1aN0M0, G2, v0, with negative resection margins. At 84 months after surgery, computed tomography (CT) revealed a 10 mm mass in the rectus abdominis muscle at the camera port site used for the partial nephrectomy. An open lumpectomy was then performed and the histopathological diagnosis was CCRCC. One year later, a 40 mm sized mass was detected in the mesentery of the small intestine by CT, which was removed laparoscopically with part of the mesentery and diagnosed as CCRCC. Since that surgery, the patient has been free from recurrence for 8 years. A male in his 60s underwent a left retroperitoneal laparoscopic nephrectomy procedure for a left renal tumor. The histopathological diagnosis was CCRCC, pT1aN0M0, G1, v0, with negative resection margins. At 31 months after surgery, CT revealed a 32 mm mass in the retroperitoneal cavity at the right hand port site used for the laparoscopic nephrectomy. The mass was removed with part of the twelfth rib and erector spinae muscles in a lump, and the histopathological diagnosis was CCRCC. Since that surgery, the patient has been free from recurrence for 19 months. For the treatment of solitary port site recurrence of renal cell carcinoma after a laparoscopic radical/partial nephrectomy, we recommend surgical resection for a good prognosis.

MP009 - Safe and efficient laparoscopic retroperitoneal nephrectomy in the hands of trainee surgeons - a prospective study.

MP009 - Safe and efficient laparoscopic retroperitoneal nephrectomy in the hands of trainee surgeons - a prospective study.

A comparison of surgical practice and operative outcomes between retroperitoneal and transperitoneal laparoscopic nephrectomies – 6 years of data from the BAUS Nephrectomy database

Objectives: While the choice of surgical approach for laparoscopic nephrectomy is broadly split between transperitoneal and retroperitoneal options, the evidence for the impact of this decision on perioperative outcomes is built on relatively small volume data, with often inconsistent findings and conclusions. We aimed to assess the impact of operative approach on perioperative outcomes for laparoscopic radical, partial and simple nephrectomy and nephroureterectomy through analysis of the British Association of Urological Surgeons (BAUS) Nephrectomy database. Patients and methods: All patients added to the BAUS Nephrectomy database with laparoscopic surgery between 2012 and 2017 inclusively were included and subdivided by operation and surgical approach. Preoperative patient and tumour characteristics, as well as intraoperative and post-operative short-term outcomes, were assessed. Results: Overall, 26,682 operations were documented over the review window (81.6% transperitoneal). Small increases in blood loss ( p = 0.001), transfusion rate ( p = 0.02) and operative length ( p = 0.01) were seen for transperitoneal radical nephrectomies and longer hospital stays seen for retroperitoneal procedures (radical nephrectomy p = 0.00l; partial nephrectomy p = 0.04). Retroperitoneal procedures were associated with increased rates of conversion for simple nephrectomy ( p = 0.02), nephroureterectomy ( p = 0.03) and most notably partial nephrectomy (10.5% versus 4.4%; p = 0.001). No further variation in intraoperative complications, post-operative complications, tumour margin positivity rates, unintended ITU admission, or likelihood of death was identified related to surgical approach. Conclusion: Observed variations in perioperative outcomes were generally modest in nature, and little ground is seen to support a change in operative technique for those committed to one approach. A caveat to this exists with open conversion for retroperitoneal partial nephrectomies and requires careful consideration of patient selection by the individual surgeon. Level of evidence: 4

Laparoscopic nephrectomy in children: Does the approach matter?

Laparoscopic nephrectomy (LN) is an established technique for the management of benign non-functioning kidneys in children. It can be performed either by the transperitoneal (TP) or retroperitoneal (RP) approach. The aim of this study was to compare safety and efficacy of TP with RP approach for LN in children. Between 2007 and 2019, 79 consecutive pediatric patients with benign non-functioning kidneys underwent laparoscopic nephrectomy by a single surgeon. Patients were categorized into two groups according to the approach; Group 1 included 41 patients who underwent transperitoneal laparoscopic nephrectomy (TPLN), while Group 2 included 38 patients who underwent retroperitoneal laparoscopic nephrectomy (RPLN). Comparison was done between the two groups regarding the mean operative time, complications, time to resume oral intake, need for postoperative analgesia and postoperative hospital stay. Laparoscopic nephrectomy was successfully completed in 75 of the 79 cases. Four cases were converted to open surgery: 3 from the TPLN group and one from the RPLN group (p=0.34). There was statistically significant difference between the two groups in terms of estimated blood loss (p=0.013), time to resume oral intake (p=0.001) and postoperative hospital stay (p=0.024). Overall, there was no statistically significant difference as regard mean operative time, overall complication rate, and postoperative analgesia need. LN is now an established technique in children and surgeon experience is a limiting factor. This experience should be gained progressively with respect to both TP and RP approaches to deal with different indications by optimal approach. Both TP and RP approaches are excellent approaches and it is up to individual surgeons, based on their experience, which approach they select. In this study, a comparative study was made between both TP and RP approaches for pediatric LN. There was no statistically significant difference between the two approaches as regard success rate, mean operative time, need for postoperative analgesia and overall complication rate. In the meantime, RPLN had the advantage of lower intraoperative blood loss, shorter time to resume oral intake and shorter hospital stay. Laparoscopic nephrectomy in children may be performed by transperitoneal or retroperitoneal approaches, obtaining equal safety and efficacy. The retroperitoneal approach seems to be advantageous in terms of lower intraoperative blood loss, time to resume oral intake and shorter postoperative hospital stay.

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.

Safety and Efficacy of Ultrasound-Guided Retrolaminar Block of Multiple Injections in Retroperitoneal Laparoscopic Nephrectomy: A Prospective Randomized Controlled Study

PurposeUltrasound-guided retrolaminar block (RLB) has the potential to provide postoperative analgesia in retroperitoneal laparoscopic surgery. This study was conducted to evaluate the effects of RLB when compared with local infiltration analgesia (LIA) in retroperitoneal laparoscopic nephrectomy.Patients and MethodsOne hundred and fifteen patients scheduled for laparoscopic nephrectomy were divided into two groups: the RLB group (n = 57) received an ultrasound-guided RLB, while the LIA group (n = 58) received LIA. At 2, 4, 6, 24, and 48 hours after operation, the maximal visual analog score (VAS), sufentanil and rescue analgesia consumption, and the utilization of patient-controlled intravenous analgesia (PCIA) were assessed. The incidence rates of postoperative nausea and vomiting (PONV); time of leaving bed (at the first instance); and the levels of plasma β-Endorphin (β-EP), Interleukin-1β (IL-1β), and prostaglandin E2 (PEG2) 30 min after extubation were noted.ResultsPatients in the RLB group had significantly lower VAS scores; lower sufentanil cumulative consumption; lower manual addition frequency of PCIA; lower proportion of using rescue analgesia within 48 hours after operation; lower incidence rate of PONV; shorter resuscitation times; earlier time of leaving the bed; and lower β-EP, IL-1 β, and PEG2 levels.ConclusionUltrasound-guided RLB of multiple injections is both safe and controllable for postoperative analgesia after retroperitoneal laparoscopic nephrectomy. When compared with LIA, RLB has better and longer-lasting analgesic effect, lower incidence rates of PONV, and the potential to reduce the level of postoperative inflammatory factors.Trial RegistrationChina Clinical Trials Registration Center (http://www.chictr.org.cn, No. ChiCTR1800017526, Date of registration: 2018–08-02).

Kết quả phẫu thuật nội soi sau phúc mạc cắt thận mất chức năng do bệnh lý lành tính tại Bệnh viện Đa khoa tỉnh Ninh Bình

Abstract Introduction: Evaluating the result of laparoscopic retroperitoneal nephrectomy for benign nonfunctioning pathology at Ninh Binh General Hospital. Materials and Methods: 20 patients underwent laparoscopic nephrectomy surgery from 08/2016 - 03/2020 at Ninh Binh General Hospital, research with descriptive and prospective method. Results: The average operating time is 100,25 ± 22 minutes (80 - 180 minutes), the average amount of blood loss is 61,5 ± 26,6ml (30 - 100ml), the average amount of drain removal time is 2,5 ± 0,5 day (2 - 3 days), the time of taking analgesic is 3 days, the average amount of time for treatment in the hospital is 4,25 ± 1,1 days (3 - 6 days). During the operations, there is 1 case in which renal abscess and kidney inflammation occur. Therefore, it's difficult to carry out the umbilicus dissection and have to switch to kidney – removal open surgery. There are no adverse medical events or complications after the surgery. Conclusions: Laparoscopic retroperitoneal surgery in kidney removal due to nonfunctioning benign pathology is a safe and effective treatment method. Keywords: Laparoscopic nephrectomy, retroperitoneal laparoscopy.

DONOR AND RECIPIENT OUTCOMES OF RETROPERITONEAL LAPAROSCOPIC DONOR NEPHRECTOMY IN OBESE VERSUS NON OBESE DONORS: A PROSPECTIVE STUDY

Objectives: The objective of the study was to establish the efficacy and safety of Retroperitoneal laparoscopic donor nephrectomy(RLDN) in obese donors. Although initially controversial, obese donors are now widely accepted for living kidney donation provided certain conditions are met. RLDN is considered difficult in obese donors because of abundant retroperitoneal fat. We performed a prospective non-randomised controlled study comparing early donor and recipientoutcomesof RLDN in obese and non-obese kidney donors. Methods: 200 donors underwent RLDN from June 2014 to April 2016,160 were non-obese (group I) and 40 were obese (group II). Preoperative parameters including Body Mass Index, age, gender, and operative parameters including total operative time, warm ischaemia time, and estimated blood loss were recorded. An additional surgical step in obese donors was the deliberate excision of excessive para-renal and peri-renal fat, allowing increased operative space and exposure of the kidney, hilum and ureter. Complications were compared using the Clavien-Dindo classification. Recipient s. creatinine at day 7,15 and 30 was compared between recipients who received grafts from obese and non-obese donors. Results and discussion: Operative time, warm ischaemia time, blood loss, length of hospital stay and complications were similar in the two groups in the two groups and there were no statistically significant differences. There were 17.5% right sided donors in group I and 15% in group II. S. creatinine in the recipients of grafts from the two groups of donors was similar. Our results suggest that transplant surgeons facile with retroperitoneal surgery may safely offer RLDN to obese donors with expectation of operative and post-operative parameters similar to those in non-obese donors. In addition similar recipient outcomes may be expected. The deliberate excision of retroperitoneal fat may be an additional step in this group of donors. Conclusions: Concerns about donor safety and recipient graft function after RLDN in obese donors may be allayed. RLDN is safe and efficacious in obese donors and gives all the benefits of minimal access surgery without compromising on recipient outcomes.

Simultaneous bilateral native nephrectomy by retroperitoneal approach.

ABSTRACTThe indication for simultaneous bilateral native nephrectomy and the choice of surgical technique is of key importance, as these patients are burdened with a large comorbidity. The paper reports our experience of seven successful and completed simultaneous bilateral native nephrectomy procedures with retroperitoneal approach in the patient’s flank position. Seven patients (mean age 34), were indicated for the removal of both kidneys before the planned transplant. Six patients underwent haemodialysis from 48 to 84 months, and one underwent peritoneal dialysis for 60 months. Two patients had undergone graftectomy. The indications were chronic infection or hypertension. The length of the kidneys ranged from 5.8 to 10cm. All procedures were performed by the laparoscopic technique with retroperitoneal approach, with the patient in the flank position. Three trocars were used on each side. The retroperitoneal space created did not require balloon dilatation. The kidneys were removed through the 10mm trocar hole after splitting. The duration of the procedure ranged from 150 to 240 minutes, average 139 minutes and blood loss ranged from100 to 250mL, average 142mL. There were no complications. In 6 patients, the postoperative dialysis was performed at zero-day. One patient continued peritoneal dialysis. Patients were discharged on the 2nd day, except one with peritoneal dialysis, who was discharged on the 3rd day. Retroperitoneal laparoscopic bilateral native nephrectomy is a safe and effective technique, and it can be considered as an ideal approach for native nephrectomy. It allows for the preservation of peritoneal integrity and vessels for future vascular access.

Donor and Recipient Outcomes of Retroperitoneal Laparoscopic Donor Nephrectomy in Obese Versus Nonobese Donors: A Prospective Study

IntroductionObese donors are increasingly accepted for living kidney donation. Obese individuals benefit the most from minimal access surgery; however, laparoscopic donor nephrectomy may be technically challenging in these individuals. Retroperitoneal laparoscopic donor nephrectomy (RLDN) in particular may be hampered by excessive perinephric fat. We performed a prospective nonrandomized controlled study comparing outcomes of RLDN in obese and nonobese kidney donors. AimTo compare operative parameters, donor complications, and recipient outcomes in RLDN performed in obese and nonobese donors. Materials and MethodsFrom June 2014 to April 2016, 200 donors underwent RLDN. Of these, 160 were nonobese (group I), and 40 were obese (group II). Preoperative parameters including body mass index, age, and sex, and operative parameters including total operative time, warm ischemia time, and estimated blood loss were recorded. Complications were compared using the Clavien-Dindo classification. Recipients’ serum creatinine at day 7, 15, and 30 was compared between recipients who received grafts from obese and nonobese donors. ResultsThere were 17.5% right-sided donors in group I and 15% in group II. Operative time, warm ischemia time, blood loss, length of hospital stay, and complications were similar in the 2 groups, and there were no statistically significant differences. Serum creatinine in the recipients was similar on follow-up. ConclusionsRLDN is safe and efficacious in obese donors. It gives all the benefits of minimal-access surgery without compromising on recipient outcomes.

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.

RETROPERITONEALS SINGLE INCISION LAPAROSCOPIC NEPHRECTOMY: MINI-INVASIVE TECHNICAL, SAFETY AND COSMETIC

Objective: Outcome of 45 retroperitoneal single incision laparoscopic nephrectomy of benigns nonfunction kidneys at Hue Central Hospital. Patients and method: A prospective study was perform on 45 patients with benign nonfuncion kidney, treated by retroperitoneal single incision laparoscopic nephrectomy at Department of General Surgery - Hue Central Hospital from May 2015 to August 2018. Results: Success: 42/45 patients. Mean operating time 87.5mins (50 - 155 mins), postoperative hospital stay 5-7 days. SILS Port of Covidien was inserted by 2.5 cm skin transverse incision, standard straight laparoscopic instruments were used instead of roticular instruments. Conclusion: This is a mini-invasive technical, safety and cosmetic Keywords: retroperitoneal single incision laparoscopic nephrectomy, single port nephrectomy.

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

Living Related Renal Transplantation Using a Saphenous Vein Graft: A Case Report

We report a case of living related renal transplantation that used the recipient's saphenous vein as a graft to extend the length of the right donor renal vein.A 41-year-old woman underwent ABO-incompatible living related renal transplantation from her 74-year-old mother in November 2014.A retroperitoneal laparoscopic right donor nephrectomy was performed, because the right kidney showed a cyst on preoperative computed tomography.As the right kidney after donor nephrectomy had a short renal vein and the kidney was large at 280 g, anastomosis with the external iliac vein was difficult. Therefore, we obtained the recipient's 15-cm-long right saphenous vein and created a 1 cm saphenous vein graft. We anastomosed 1 side of the saphenous vein graft to the allograft renal vein in bench surgery and performed end-to-side anastomosis of the other end to the recipient's external iliac vein. The allograft renal artery was used to perform end-to-end anastomosis to the recipient's internal iliac artery. Allograft kidney function was good after transplantation.When the longer axis of the renal graft vein is short, as in the right kidney, a saphenous vein graft may be useful.

Polymer Ligating Clips in Urologic Laparoscopic Surgery

Introducing polymer ligating clips (PLC) or Hem-o-lok clips was a useful alternative to titanium clips in order to perform a safe, efficient and rapid ligation of the vascular structures during laparoscopic and/or conventional surgical procedures. In urologic surgery they are useful during ablative laparoscopic surgery for renal tumor, urothelial tumors, non-functional kidney, bladder tumors and prostate tumors. Polymers� properties depend on the structure of molecules and vary from flexible substances to expandable rigid materials. They have a high resistance to shock, considerable abrasion resistance and precise durability. Polymers can easily take the desired shape, due to different processing modes. They also have the property of resistance to sustainable action of external forces. The aim of this paper is to evaluate the efficacy and safety of PLC used during renal pedicle ligation in retroperitoneal laparoscopic nephrectomy for renal tumors, high urothelial tumors and nonfunctional kidney.

Risk Factors Related with Retroperitoneal Laparoscopic Converted to Open Nephrectomy for Nonfunctioning Renal Tuberculosis.

The present study was designed to investigate the risk factors affecting the conversion to open surgery in retroperitoneal laparoscopic nephrectomy of nonfunctioning renal tuberculosis (TB). The records of 144 patients who underwent a retroperitoneal laparoscopic nephrectomy procedure by a single surgeon were retrospectively reviewed. The following factors, including age, sex, body mass index (BMI), diabetes status, hypertension status, side of kidney, size of kidney, degree of calcification, mild perirenal extravasation, contralateral hydronephrosis, the time of anti-TB, and surgeon experience were analyzed. Univariate and multivariate logistic regression analyses were used for statistical assessment. Twenty-three patients were converted to open surgery and the conversion rate was 15.97%. In univariate analysis, BMI ≥35 kg/m2 (p = 0.023), hypertension (p = 0.011), diabetes (p = 0.003), and kidney size (p = 0.032) were the main factors of conversion to open surgery. Sex, age, side, anti-TB time, calcification, mild extravasation, and surgeon experience were not significantly related. In multivariate regression analysis, BMI ≥35 kg/m2, hypertension, diabetes, and enlargement of kidney were the most important factors for conversion to open surgery. Depending on the results achieved by a single surgeon, BMI ≥30 kg/m2, diabetes, hypertension, and enlargement of kidney significantly increased the conversion risk in retroperitoneal laparoscopic nephrectomy for nonfunctioning renal TB.

Micro-anatomic distribution of peri-arterial renal sympathetic nerves

Objective To investigate the distribution of sympathetic nerves around human renal arteries. Methods We collected 25 renal arteries from the patients who had a retroperitoneal laparoscopic nephrectomy and bilateral renal arteries from 7 human autopsy subjects. Each artery was equally divided into segments, which were made into paraffin sections. We examined the distribution of nerves around renal arteries and manually counted nerves by using optical microscope. Results A total of 3 065 nerves were identified from 258 sections. About 98% of all nerves existed within the renal arterial adventitia and the outside tissue. The mean number of nerves between the ventral, doirsal, superior, and inferior region of surgical specimens was 4.7±1.3, 1.4±0.7, 3.1±1.3, and 2.1±1.2, respectively. The mean number of nerves in the ventral region was greater compared with the doirsal region (P=0.000), the mean number of nerves in the superior region was also greater compared with the inferior region (P=0.005). The mean number of nerves in the middle segments was obviously greater compared with the distal segments (14.5±4.4 and 8.3±3.0, P=0.000). The mean number of nerves between the ventral, doirsal, superior, and inferior region of autopsy specimens was 5.4±1.4, 1.5±0.7, 3.1±0.8, and 2.8±1.0, respectively. The mean number of nerves in the ventral region was greater compared with the doirsal region(P=0.000), whereas the mean number of nerves was similar between the superior and inferior region (P=0.440). The mean number of nerves among the proximal, middle, and distal segments was 11.2±4.4, 17.6±4.4, and 8.5±2.2. It was obvious that the mean number of nerves in the middle segments was greater compared with the proximal and diatal segments (P=0.000). The distribution of sympathetic nerves around the left renal arteries was not considerably different compared with the right renal arteries (Psurgical=0.100, Pautopsy=0.916). Conclusion The mean number of nerves in the ventral region is greatest and least in the doirsal region. Along the renal artery, the distribution of nerves is relatively greater in the middle segments. Nerve anatomic distribution around the left renal arteries was not considerably different compared with the right renal arteries. Key words: Renal sympathetic denervation; Resistant hypertension; Renal artery; Sympathetic nerves; Anatomic distribution

Effect of preoperative intravenous oxycodone administration on sufentanil consumption after retroperitoneal laparoscopic nephrectomy.

The aim of this study was to evaluate the efficacy of preoperative intravenous oxycodone administration on postoperative sufentanil consumption in patients undergoing retroperitoneal laparoscopic nephrectomy. Fifty patients scheduled for retroperitoneal laparoscopic nephrectomy were enrolled and randomly assigned to two groups- patients in Group O (n = 25) received intravenously 0.1 mg kg⁻¹ oxycodone; while the patients in Group C (n = 25) received 0.1 mL kg⁻¹ normal saline for 2 min, 10 min before the operation. All of the participants received intravenous sufentanil patient-controlled analgesia (PCA) after extubation, using a PCA device. The sufentanil consumption, rescue analgesia, Ramsay sedation scale (RSS) and visual analogue scale (VAS) scores at rest and during cough, the overall satisfaction and undesired events were all assessed. Cumulative sufentanil consumption delivered by PCA was significantly lower in Group O at all time points. VAS scores at rest and during coughing at 1, 2, 4, 8 and 12 hours after extubation of the patient were significantly lower in Group O than in Group C. There were no significant differences between the two groups according to the number of patients administered tramadol, RSS and the incidence of side effects. The degree of patients' satisfaction was higher in Group O. Preoperative intravenous oxycodone can reduce postoperative cumulative sufentanil consumption and postoperative pain intensity without an increase in side effects.

Use of Nonmuscle Cutting Lumbotomy Incision for Single Site Laparoscopic Retroperitoneal Donor Nephrectomy: A Novel Approach

Introduction: Laparoscopic donor nephrectomy has become the standard method of retrieval of donor kidneys from living donors. However, it has the disadvantage of breaching the peritoneal cavity with attendant risks of injury to intraperitoneal organs as well as long-term risk of adhesive intestinal obstruction. Retroperitoneal laparoscopic donor nephrectomy (RPLDN) is not popular, as it requires a muscle cutting incision for retrieval of donor kidney, thereby minimizing the benefits of laparoscopy. However, a single port RPLDN performed through lumbotomy can provide a nearly ideal approach to donor kidneys.1 This study provides the first experience in the literature of performing a single port RPLDN through lumbotomy incision. Methods: Between November 2014 and December 2015, 231 patients underwent laparoscopic donor nephrectomy at our institute. Of the 231 patients, 50 voluntary kidney donors were offered translumbar RPLDN. And 12 of the 50 patients consented for single port translumbar RPLDN. Mean donor age was 39.6±7.7, M:F 3:9, left: right 10:2, and mean body mass index was 21.86±2.64. Technique of nephrectomy—Kidney was approached through 6 cm curved lumbotomy incision nearly parallel to sacrospinalis muscle with donor in lateral position. Alexis® port with rubber glove was used as a single port with two 10 mm and two 5 mm ports placed in the finger of gloves.2 Renal vessels and ureter were ligated with double Hemolok® clips as a standard policy for all donors at our institute. Kidney was taken out through the Alexis retractor after removing the glove. Visual analogue score (VAS) was used to evaluate severity of pain in the postop period. Results: RPLDN was effectively carried out in all patients. No patient required conversion to open or transperitoneal approach. An additional port for retraction was required in the two of the first three cases. No special angulated instruments were required. Only one patient had double renal artery (8.3%) and all patients had single renal vein and ureter. No intra/perioperative complications were encountered. Mean operating time was 200.7+65 minutes (range 130–322). There was significant reduction in operative time after the initial experience. Mean warm ischemia time was 5+1.28 minutes (range 3–8 minutes). Average blood loss during surgery was 55.4+18 mL (range 30–100 mL). Mean graft kidney weight was 129.5+25 g (range 85–168 g). Mean analgesic requirement (tramadol) in postoperative period was 281.8+189.4 mg (range 100–800 mg). Mean VAS on postop day (POD) 0 and POD 1 was 5.6+1.5 and 3.9+0.9, respectively. Mean hospital stay was 2.5 days (range 2–3 days). All recipients had good initial renal function and the mean creatinine at discharge was 1.34+0.4 mg/dL. Conclusions: Single site translumbar RPLDN is a feasible alternative approach to donor surgery and can avoid inherent risks associated with the transperitoneal technique. A larger comparative study is required to know the potential benefits of this route over the transperitoneal approach. No competing financial interests exist. Runtime of video: 9 mins 58 secs