Robot-assisted Laparoscopic Donor Nephrectomy Research Articles

VE23 - Robot-assisted laparoscopic donor nephrectomy in patients with complex hilar vessel anatomy

VE23 - Robot-assisted laparoscopic donor nephrectomy in patients with complex hilar vessel anatomy

Effect of learning curve on the perioperative course of robotic-assisted laparoscopic donor nephrectomy compared with laparoscopic donor nephrectomy.

This study was designed to compare the standard and robotic-assisted laparoscopic donor nephrectomy in terms of perioperative course, short-term postoperative outcome, and to evaluate the effect of surgeon's learning curve on these parameters. This was a prospective randomized study including 60 patients (mean age, 47 years; age, 21-72 years; 26 males, 34 females) who had been planned laparoscopic donor nephrectomies in our clinic. For comparison of standard and robot-assisted techniques and to evaluate the impact of learning curve, patients were randomized into three groups by a computer, each group containing 20 patients. Group 1: standard laparoscopic donor nephrectomies; Group 2: the first 20 patients who underwent robot-assisted laparoscopic donor nephrectomy; and Group 3: the next 20 patients who underwent robot-assisted laparoscopic donor nephrectomy. Operative time was significantly higher in Group 2 (221.0±45.1 min) than both Group 1 (183.5±16.9 min, p=0.001) and Group 3 (186.5±20.6 min, p=0.002). Similarly, time for laparoscopic system setup was significantly higher in Group 2 (39.5±8.6 min), which contained the first cases of robot-assisted laparoscopic donor nephrectomy where surgeon had least experience than Group 1 (19.3±3.7 min, p<0.001) and Group 3 (24.0±9.4 min, p<0.001). On the other hand, duration of operation and time for laparoscopic system setup was similar between Groups 1 and 3. Learning curve extends the operative time and laparoscopic system setup time in robotic-assisted laparoscopic donor nephrectomy, however, after the learning process was completed, these parameters were similar between robotic-assisted and standard laparoscopic nephrectomy.

Introducing robot-assisted laparoscopic donor nephrectomy after experience in retroperitoneal endoscopic living donor nephrectomy approach

Introducing robot-assisted laparoscopic donor nephrectomy after experience in retroperitoneal endoscopic living donor nephrectomy approach

Robot-assisted laparoscopic donor nephrectomy: surgical feasibility and technique

BackgroundLaparoscopic donor nephrectomy (LDN) is currently accepted as the gold standard procedure for living donor nephrectomy. Robot-assisted LDN (RALDN), an evolving procedure, has recently shown potential to ultimately emerge as the preferred procedure. Here, we report our experience and the surgical technique followed for employing RALDN for living donation. MethodsThis retrospective study involved 56 consecutive patients who underwent RALDN between January 2015 and August 2018. Intraoperative and postoperative functional outcomes were analyzed and compared with the 45 patients who underwent hand-assisted LDN (HALDN) between May 2011 and December 2014. ResultsMean procedure time for RALDN was 150 (range 90–210) min, and mean overall intraoperative blood loss was <100 (range 50–200) mL. Mean warm ischemic time recorded was 2 (range 1–5) min. Intraoperative complications, including blood transfusion or open conversion, did not occur in any patient. ConclusionsThe procedural results of RALDN were comparable or superior to HALDN. Our RALDN approach is safe and feasible, and the procedure appears to be significantly easier for the surgeon. We suggest that our findings be externally validated to reassure reproducibility of the measurement in a prospective evaluation.

Robotic-assisted vs. laparoscopic donor nephrectomy: a retrospective comparison of perioperative course and postoperative outcome after 1 year.

Safety is of utmost importance in live donor nephrectomies. In this study, we describe our initial experience with robot-assisted laparoscopic donor nephrectomy (RDN) in comparison with the standard laparoscopic donor nephrectomy (LDN). We retrospectively reviewed 95 patients who either underwent RDN or LDN performed by a single surgeon from 2011 to 2016 at a tertiary institution. Donor perioperative course and postoperative outcome along with recipient outcomes were compared. Of the 95 cases, 73 were classified as LDN and 22 were classified as RDN. There were no significant differences between the two groups in age, sex, BMI, race, and ASA status. Operative times (p<0.001) were longer in the RDN group, but eventually approached LDN times. Warm ischemia (p=0.002) and extraction times (p=0.05) were also longer in the RDN cohort. The donor length of hospital stay, complication rates, and postoperative change in eGFR from baseline were similar in both cohorts up to 1year. Recipient outcomes, including delayed graft function, graft failure, and renal function up to 1year, were also comparable. In this study, we compared the longest postoperative course so far in both donors and recipients between RDN and LDN. Up to 1year, RDN does not negatively impact outcomes. Proficiency with RDN also quickly improved to match LDN, making it a suitable procedure for newer surgeons.

604 Serum N-glycan profiling predict antibody mediated rejection in patients undergoing living kidney transplantation

INTRODUCTION AND OBJECTIVES: With the development of living donor nephrectomy in recent years, the surgical management of nephrectomy has also evolved. Standard laparoscopic donor nephrectomy (SLDN) has been largely developed, nevertheless the robotassisted approach is not widespread in this indication. The objective of this study was to compare perioperative outcomes between SDN and robot-assisted laparoscopic donor nephrectomy (RALDN). METHODS: Between 2003 and 2015, in two academic centres, all patients who underwent a donor nephrectomy by SLDN (group A) or RALDN were compared. We assessed patient’s characteristics and perioperative outcomes including: type of surgery, operating time, warm ischemia time, complications and hospital length of stay. Comparison betweens groups were performed using c2 test and Fisher exact test for discrete variables and Mann-Whitney test for continuous variables. RESULTS: We included 277 patients, 226 in the SLDN group and 51 in the RaLDN. Mean age was similar in both groups (51 years vs. 52 years, p1⁄40.59), as mean BMI (25.1 kg/m2 vs. 25.6kg/m2; p1⁄40.39). Groups were also comparable for ASA score (ASA 1: 79% vs. 82%; p1⁄40.66), side of nephrectomy (Left in 94% vs. 88%; p1⁄40.12) in group A and B respectively. Study of perioperative outcomes, revealed a longer operating time in the RaLDN (143 min vs. 233min; p<0.001), and a longer warm ischemia time (3.5 min vs. 6.2min; p<0.001). Hospital length of stay was shorter in the RaLDN group (5.7 days vs. 5.1 days; p1⁄40.006). Complications rate was similar in both groups (p1⁄40.66). Only one hemorrhagic complication occurred in group B (surgeon at the beginning of the learning curve) requiring a transfusion. CONCLUSIONS: Robot-assisted laparoscopic living donor nephrectomy is feasible, operating time and warm ischemia time are longer but hospital length of stay is shorter. Complications rate is similar with SDN, nevertheless it is necessary to perform this procedure once the learning curve of robotic surgery passed. Long-term data on the receiver are needed to confirm the feasibility of RALDN.

85 Living donor nephrectomy: A multicentric comparative study between standard laparoscopic and robot-assisted laparoscopic donor nephrectomy

85 Living donor nephrectomy: A multicentric comparative study between standard laparoscopic and robot-assisted laparoscopic donor nephrectomy

Robot-Assisted Laparoscopic Donor Nephrectomy vs Standard Laparoscopic Donor Nephrectomy: A Prospective Randomized Comparative Study

The goal of this randomized controlled trial was to compare the outcomes of robot-assisted laparoscopic donor nephrectomy (RDN) with standard laparoscopic donor nephrectomy (LDN). Forty-five voluntary kidney donors (27 for right subgroup and 18 for left subgroup) who met inclusion and exclusion criteria were randomized into 2 groups, RDN and LDN in 1:2 ratio. Primary endpoints were visual analogue scale (VAS) pain scores, analgesic requirement, and hospital stay of donors. Secondary endpoints were donor's intraoperative and postoperative parameters, graft outcomes, and donor surgeon's difficulty scores. All procedures were completed without any intraoperative complications. VAS pain scores at 6, 24, and 48 hours (p = 0.00), analgesic requirement (p = 0.00), and hospital stay (p = 0.00) were less in RDN than in LDN. Longer graft arterial length could be preserved with robotic approach on right side (p = 0.03) but not on left side (p = 0.77). The RDN group required more number of ports (p = 0.00), longer retrieval time (p = 0.00), and warm ischemia time (WIT) (p = 0.01). Total operative time (p = 0.14), hemoglobin drop (p = 0.97), postoperative donor complications (p = 0.97), and the recipient estimated glomerular filtration rate at 9 months (p = 0.64) were similar in both groups. Difficulty scores of console surgeon were less in most steps on right side but not on left side. Patient-side surgeon in RDN had higher difficulty scores for retrieval. RDN is safe and is associated with better morbidity profile than LDN. Robotic approach provides technical ease and facilitates preservation of longer length of renal artery on right side. Left RDN is associated with longer WIT; however, this does not translate into poor graft outcome.

Robot-Assisted Laparoscopic Donor Nephrectomy in 12 Steps

Abstract Introduction: Robot-assisted laparoscopic donor nephrectomy (RALDN) is an emerging minimally invasive technique for procuring living renal allografts for transplantation. As an alternative to traditional laparoscopy, robotics provides optical magnification and instrument articulation, which can be used in intricate dissection of the vessels and obtaining maximum length for the graft. We provide a reproducible 12-step instruction on our standard left RALDN and results of our initial experience. Methods: The patient is placed in the right lateral decubitus position and the robotic ports are placed. The 12 steps of our standard left RALDN include medial reflection of the descending colon, complete mobilization of the spleen, exposure of the gonadal and renal vein, ligation of the adrenal, gonadal, and lumbar vein, mobilization of the kidney laterally and posteriorly, dissection of the adrenal off the upper pole/superior mobilization, dissection of the renal hilum, medial rotation of the kidney and p...