Standard Laparoscopic Nephrectomy Research Articles

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.

Suprapubic-assisted laparoendoscopic single-site surgery versus standard laparoscopic nephrectomy: A propensity score-based analysis.

To compare suprapubic-assisted laparoendoscopic single-site surgery nephrectomy with standard laparoscopic nephrectomy. A retrospective case-control study comparing three surgeons' experience with 122 suprapubic-assisted laparoendoscopic single-site surgery nephrectomy and 107 standard laparoscopic nephrectomy was carried out. Operative time, estimated blood loss, intraoperative complications, intraoperative conversion, postoperative bowel recovery, postoperative analgesics, postoperative visual analog pain scale score, postoperative length of stay, days before going back to work, postoperative complications and Patient Scar Assessment Questionnaire were compared after propensity score matching. A total of 97 matched pairs were obtained after propensity score matching. There were no statistically significant differences between the suprapubic-assisted laparoendoscopic single-site surgery nephrectomy and standard laparoscopic nephrectomy groups with respect to operative time, estimated blood loss, intraoperative complications, intraoperative conversion, postoperative bowel recovery, length of stay and postoperative complications. Suprapubic-assisted laparoendoscopic single-site surgery nephrectomy group had decreased postoperative analgesics (20.9 vs 23.5, P=0.04), visual analog pain scale score at 24h (4.28 vs 5.28, P=0.000), visual analog pain scale score at discharge (1.01 vs 1.47, P=0.000), days before going back to work (28.4 vs 31.9, P=0.000) and Patient Scar Assessment Questionnaire score (34.0 vs 42.0, P=0.000), compared with the standard laparoscopic nephrectomy group. Suprapubic-assisted laparoendoscopic single-site surgery nephrectomy and standard laparoscopic nephrectomy are equivalent in terms of the safety and efficacy. However, suprapubic-assisted laparoendoscopic single-site surgery nephrectomy confers less postoperative pain, fewer days before going back to work and better cosmetic result when compared with standard laparoscopic nephrectomy.

Robot-assisted laparoscopic partial nephrectomy is a safe and effective option for clinical T2 renal cell carcinoma: a case-series from single-institution.

BackgroundRobot-assisted laparoscopic partial nephrectomy (RAPN) is increasingly used in the treatment of complex renal tumors, but it is still not commonly performed for T2 renal tumors and the reports of RAPN for renal tumors ≥7 cm were limited. Here we report our single-institution outcomes to evaluate the safety and efficacy of RAPN in treating T2 renal tumors.MethodsThis study was designed as a case-series study. We retrospectively reviewed our database and finally identified 16 patients undergoing RAPN for clinical T2 tumors. Seven patients who underwent standard laparoscopic partial nephrectomy (LPN) and 30 patients who were treated by radical nephrectomy(RN) were included as controls. The baseline characteristics, perioperative outcomes, change of renal function, and oncological outcomes were analyzed.ResultsThere was no significant difference between groups in baseline characteristics, intraoperative complications, and long-term oncological outcomes. Both RAPN and LPN had a longer operative time and higher blood loss compared with RN, but they could offer better renal function reservation. Two patients who underwent LPN converted to radical nephrectomy or open partial nephrectomy and no conversions happened in the RAPN group. The ischemia time seemed shorter in RAPN group but did not reach statistical significance (median 20.0 vs. 25.5 min, P=0.118). Except for blood transfusions, no other major complication was detected.ConclusionsRAPN can provide fair preservation of renal function with acceptable major complications and oncological outcomes, therefore it is a safe and effective procedure for renal tumors ≥7 cm. Its advantages over LPN still need to be ascertained by further studies with better design and larger sample sizes.

First Canadian experience with robotic laparoendoscopic single-site vs. standard laparoscopic living-donor nephrectomy: A prospective comparative study.

We aimed to compare the outcomes of robotic laparoendoscopic single-site living donor nephrectomy (R-LESS LDN) vs. standard laparoscopic living donor nephrectomy (LLDN). Between October 2013 and November 2015, 39 patients were allocated to either standard LLDN (n=25) or R-LESS LDN (n=14). Patient demographics, perioperative outcomes, analgesic requirement, visual analogue scale of pain at postoperative days 1, 3, 7, and 30, and a health-related quality of life and body image questionnaire were prospectively collected. There were no significant differences in demographics and intraoperative outcomes between the two cohorts. The R-LESS LDN cohort had lower analgesic requirement (p=0.002) and lower visual pain scores on days 1 and 3 (p=0.001). Additionally, body image and satisfaction scores in the R-LESS group were also superior compared to the LLDN cohort (p=0.008). There was no significant difference in the postoperative complications according to the Clavien-Dindo system. Recipient graft functional outcomes were equivalent. This is the first evidence that R-LESS LDN is safe and associated with comparable surgical and early functional outcomes compared to LLDN, while pain, donor body image, and satisfaction scores were improved compared to LLDN.

New Hybrid Mini-laparoendoscopic Single-site Partial Nephrectomy With Early Unclamped Technique for Renal Tumors With Intermediate PADUA Score (IDEAL Phase 2a)

To evaluate a new hybrid technique, which we defined as mini-laparoendoscopic single-site partial nephrectomy (MILESS-PN), for renal masses presenting an intermediate PADUA score. Forty consecutive cases of MILESS-PN performed between April 2013 and November 2015 were included in this study. Mini-laparoendoscopic single-site surgery consisted of the simultaneous use of two 3-mm pararectal trocars and an umbilical SILS trocar; the sequence of steps of MILESS-PN was comparable with standard laparoscopic partial nephrectomy. Demographic data and the main perioperative and oncological outcome parameters were gathered and analyzed. The median operative time was 134.6 (interquartile range [IQR] 110-180) minutes with a median warm ischemia time of 12.1 (IQR 9.5-15.5) minutes. Postoperatively, 4 early complications were recorded and the median hospital stay was 4.2 (IQR 3.5-6.0) days. The median renal tumor size was 3.6 (IQR 2.4-5.3) cm with a median PADUA score of 8.3 (IQR 8-9). The definitive pathologic results revealed a renal cell carcinoma in 32 cases (80%), an angiomyolipoma in 3 cases (7.5%), and an oncocytoma in 5 cases (12.5%). All tumors were removed with negative surgical margins, and at the median follow-up of 34.5 (IQR 24-48) months, all patients were alive without evidence of tumor recurrence or port-site metastasis. A statistically significant decrease in the estimated glomerular filtration rate (eGFR) was observed postoperatively (postoperative vs preoperative median eGFR: 87.6 [IQR 70.4-101.8] and 104.7 [IQR 82.7-123.3], P <.0001) and at 6 months (6 months vs preoperative eGFR 93.6 [IQR 79.1-110.2] and 104.7 [IQR 82.7-123.3], P <.0001). MILESS-PN for renal tumors with an intermediate PADUA score in well-selected patients is not associated with increased risks for the patients, presenting excellent oncological and functional results at the midterm follow-up. Mini-laparoendoscopic single-site surgery could represent a valid alternative to laparoendoscopic single-site surgery or minilaparoscopy because of its higher surgical reproducibility.

A Novel and Simple Modification for Management of Distal Ureter During Laparoscopic Nephroureterectomy Without Patient Repositioning: A Bulldog Clamp Technique and Description of Modified Port Placement.

To describe a novel and pure laparoscopic approach using a custom-made bulldog clamp with modified port placement for management of distal ureter during laparoscopic nephroureterectomy. Between October 2013 and December 2014, 31 patients found to have upper tract urothelial carcinoma were treated using this technique. After finishing a standard laparoscopic transperitoneal nephrectomy in a 45° to 60° recumbent position, an additional 12-mm trocar was inserted at the lower abdomen to allow the surgeon to continue dissecting the ureter caudally toward the bladder wall without repositioning the patient. The intramural ureter was separated from the surrounding detrusor muscle and down to the bladder mucosa, until a tent-shaped bladder cuff and intramural ureter could be formed by retraction in the superior and lateral directions. Then, a custom-made laparoscopic bulldog clamp was placed at the bottom of the tent-shaped structure to prevent urine spillage, and the bladder was closed by two-layer running closure using a barbed suture. All surgeries were completed uneventfully. The mean operative time and estimated blood loss were 146.6 minutes and 47.3 mL, respectively. The median duration of the postoperative hospital stay was 6 days. No complications were noted. There were no positive margins in any specimen. No patients experienced stone formation or local or bladder recurrence during the 10.5-month follow-up period. Our novel technique fully replicates the open excision technique and conforms to the strictest oncologic principles while avoiding patient repositioning and the use of staplers (EndoGIA or Hemolock) to prevent stone formation.

LAPAROSCOPIC LIVING DONOR NEPHRECTOMY WITH TRANSVAGINAL GRAFT EXTRACTION

This article describes the fi rst experience of laparoscopic donor nephrectomy with transvaginal kidney graft extraction. The surgical technique and long-term results are shown. The advantage of surgery is the absence of pain in the early postoperative period and good cosmetic results compared to standard laparoscopic nephrectomy. However, candidates for this operation should be carefully selected to maintain donor safety and graft viability.

Hybrid Transvaginal Nephrectomy: Development of Our Technique

To evaluate the development of natural orifice transluminal endoscopic surgery (NOTES) transvaginal nephrectomy and present the initial experience. Thirty-eight female patients were submitted to hybrid NOTES transvaginal nephrectomy for tumor (n=23) and nonfunctioning renal unit (n=15) in 2 academic medical centers. Patients underwent surgery from July 2010 to June 2012 and none of them were candidates for partial nephrectomy (clinical stage T1b or higher). The procedure was performed by the use of multi-instrument ports or flexible cannulas inserted through umbilical and vaginal incisions. A 30° lens extra-long camera and combinations of conventional laparoscopic and prebent instruments were used. Specially designed extra-long, prebent straight instruments were found to be particularly useful for transvaginal manipulations. Prospective data regarding patient demographics, intraoperative and postoperative course of the patients, and pathology results were collected. Average tumor diameter was 6 cm (range, 4.9-7.5 cm). Average operative time was 114.1 minutes (range, 90-190 minutes). Estimated blood loss ranged between 50 and 150 mL (average, 80 mL). Intraoperatively, 2 bladder perforations occurred and were treated by suturing. Postoperatively, 2 patients suffered from fever of unknown origin and 2 patients required transfusions due to bleeding. Average hospital stay was 3.3 days (range, 3-5 days). Positive surgical margins were not detected. Hybrid NOTES transvaginal nephrectomy is a feasible and safe alternative to standard laparoscopic nephrectomy in selected patients. Difficulties arising from limitations in current instrumentation have been addressed by the use of specially designed instruments. Further clinical studies are required to ascertain this approaches' place among nephrectomy techniques.

Standard laparoscopic vs laparoendoscopic single-site nephrectomy for benign nonfunctioning kidney: a comparison of therapeutic outcomes

Objective To compare the therapeutic outcomes of standard laparoscopic and laparoendoscopic single-site(LESS)nephrectomy for benign nonfunctioning kidney.Methods From September 2009 to August 2013,a single urologist group in our center performed 72 transperitoneal laparoscopic nephrectomies for benign nonfunctioning kidney,with 50 undergoing LESS(group A)and 22 undergoing standard laparoscopic surgery(group B).The clinical data of the two groups were analyzed and the therapeutic outcomes were compared between the two groups.Results The operation was successfully performed in all cases,with no conversion to open surgery.Compared with standard laparoscopic group,the LESS group had significantly lower postoperative pain score(4.3±1.0vs 3.7±0.8,P=0.015),quicker bowel function recovery([58.1±16.1]h vs[49.2±14.0]h,P=0.032),shorter drainage duration([3.9±1.5]d vs[2.8±1.1]d,P=0.003),shorter postoperative hospital stay([7.3±3.1]d vs[6.3±3.4]d,P=0.048),and a better cosmetic satisfaction score(7.4±0.9vs8.0±0.6,P=0.001).The operative time and intraoperation blood loss were not significantly different between the two groups.Conclusion Compared to standard laparoscopic nephrectomy,transumbilical LESS nephrectomy offers a quicker recovery of bowel function,shorter drainage duration,a better postoperative pain control,and a better cosmetic satisfaction for benign nonfunctioning kidney,but its long-term therapeutic effect needs to be further verified.

Position of laparo-endoscopic single-site surgery nephrectomy in clinical practice and comparison (matched case-control study) with standard laparoscopic nephrectomy

IntroductionOne way how to reduce morbidity and improve cosmesic of kidney surgery is single site laparoscopy. Relatively well described concept but without defined position in clincal practise.AimTo report of institutional experience with laparoendoscopic single-site surgery (LESS) nephrectomy (NE) and compare (matched case-control study) it with that of standard laparoscopic NE (LNE).Material and methodsIn the period 8/2011 to 10/2013, we performed 183 mini-invasive NE (132 tumours, 51 benign aetiology); 45 of them (24.6%) were LESS, the rest LNE. The main but not absolute indications for LESS were: non-obese men, and less advanced tumours. In 13 patients undergoing LESS-NEs (28.9%) there was a transumbilical approach. For the rest, a pararectal incision was performed and an accessory port was added in 31.1% (14) – 2/22 (9.1%) left sided, 12/23 (52.2%) right sided. Twenty-four LESS-NE were performed by a more experienced surgeon (mean operation time (MOT) 73.1 min), 21 LESS-NE by 4 other surgeons (MOT 132.8 min). These 24 were compared with 43 LNE done by the same surgeon before the period of LESS (1/2007–8/2011) and with similar characteristics of cases (body mass index (BMI) ≤ 35 kg/m2, less advanced tumour).ResultsWe found no statistically significant differences in any of the parameters studied. The MOT 73.1 min vs. 75.0 min (p = 0.78), BMI 27.4 kg/m2 vs. 29.2 kg/m2 (p = 0.08), blood loss 54.7 vs. 39.2 (p = 0.47). Complications (4.2% vs. 11.6%) were only of internal character in origin. No conversion in either group. In LESS-NE, staplers were used more frequently (more expensive than clips) for division of renal hilar vessels (70.8% vs. 51.2%). The mean price of LESS-NE was €367 higher.ConclusionsThe LESS NE performed by an experienced surgeon is a safe and efficient method for the surgical treatment of both malignant and benign renal conditions in patients with BMI < 30 kg/m2 and with low-stage tumours. The LESS NE is more expensive compared to LNE.

C10 Position of LESS (Laparoendoscopic Single-site Surgery) nephrectomy in clinical practice and comparison with standard laparoscopic nephrectomy

C10 Position of LESS (Laparoendoscopic Single-site Surgery) nephrectomy in clinical practice and comparison with standard laparoscopic nephrectomy

Néphrectomies laparoscopiques avec extraction vaginale chez la patiente obèse ou en surcharge pondérale : la fin des complications pariétales ?

To study the feasibility and to present results of laparoscopic nephrectomy with vaginal extraction in overweight or obese patients. Three patients having BMI>28 kg/m(2) underwent surgery. Median age was 56 years, median BMI was 44.4. Medical history included for the three patients type 2 diabetes mellitus and arterial hypertension. Two of the three patients were multiparous, one was nulliparous. Patients underwent standard laparoscopic nephrectomy with vaginal extraction of the specimen through a short incision of the posterior vaginal fornix. Feeding was normal on the first operating day. No morphine was prescribed during hospitalization stay. No intraoperative complication occurred. Mean procedure time was 224 min. Mean blood loss was 140 mL. Postoperative period was uneventful and walking was normal on the first operating day. Hospitalization stays were 2, 3 and 5 days. One month follow up found no complication including normal sexual activity. Laparoscopic nephrectomy with vaginal extraction is a feasible technique in obese or overweight patients. Wound morbidity (infection, hernia) is reduced due to the small abdominal incisions.

Laparoendoscopic Single-site Plus One Trocar Donor Nephrectomy Using the GelPort: Initial Clinical Experience

To achieve better cosmesis, less invasiveness, and less morbidity in donor nephrectomy without using specialized instruments, which is usually required in the laparoendoscopic single-site (LESS) procedure, we performed laparoendoscopic plus one trocar donor nephrectomy (LEPODN). From October 2010 to December 2011, 20 living renal transplantation donors underwent the LEPODN procedure. Their mean age, body mass index (BMI), and preoperative creatinine clearance were 55.7 years, 23.2, and 118.4 mg/min, respectively. The GelPort laparoscopic system was inserted through a 5-6 cm pararectal incision at the umbilicus level. A subcostal 5-mm right-hand working trocar was placed under the left costal arch. The graft kidney was extracted using a retrieval bag. A 5-mm diameter drain was placed via a right-hand working trocar. Operative data of LEPODN were retrospectively compared to those of standard laparoscopic donor nephrectomy (standard-LDN, n = 27) previously performed at our hospital. The procedure was technically successful in all 20 patients. The mean operative time in the LEPODN group was significantly shorter than that in the standard-LDN group (229.1 vs 249.8 minutes, P = .033). Mean blood loss and warm ischemic time in the LEPODN group were 39.4 mL and 272.4 seconds, respectively. The mean serum creatinine concentrations of the recipients 7 and 30 days after operation were 1.57 and 1.13 mg/dL, respectively. These results were not significantly different from those in the standard-LDN group. The LEPODN procedure was feasible and performed without specialized instruments by surgeons experienced in only standard laparoscopic nephrectomy.

Clinical application of transperitoneal laparoendoscopic single-site nephrectomy

Objective To verify the safety and feasibility of applying transperitoneal laparoendoscopic single-site surgery (LESS) nephrectomy in the treatment of kidney malignant and benign diseases.Methods From Nov.2010 to Jun.2012,we had used LESS nephrectomy technique treated four kidney tumors,one renal pelvic tumor and one atrophic kidney. Quadport was introduced into abdominal cavity through a paraumbilical incision. Conventional laparoscopic instruments,prebent laparoscopic instruments and flexible tip 5mm laparoscope were used. The standard laparoscopic transperitoneal nephrectomy technique was then performed.We evaluated this technique in respects of operative time,estimated blood loss,intraoperative complications,1st post-operative day pain (VAPS),drainage time,post-operative hospital stay and pathological results. Results The 6 procedures in this group were completed successfully with LESS nephrectomy. There was no additional trocar added,no conversion to conventional laparoscopic or open surgery.Application of Quadport and prebent instruments reduced the clash of instruments,both intracorporally and extracorporally.The average operative time were 181.7 (145.0 -235.0) min,average estimated blood loss were 78.3 (20.0 - 150.0) ml.There was no severe intraoperative complication.The average VAPS in the first post - operative day was 1.7 ( 1.0 - 2.0).The average drainage time was 2.8 ( 1.0 -4.0) d,post-operative hospital stays was 6.8 ( 1.0 - 10.0) d.There was no secondary bleeding or wound infection.Pathological results showed 3 cases of renal clear cell carcinoma,1 case of chromophobic carcinoma,1 case of high-grade urothelial carcinoma and 1 case of atrophic kidney.All the specimens in this group were surgical margin negative. Conclusions LESS nephrectomy is a safe and feasible treatment option for the treatment of kidney surgical diseases. Key words: Kidney neoplasm; Renal pelvic tumor; Renal atrophy; Laparoendoscopic single site surgery; Nephrectomy

Minimally Invasive Suprapubic Laparoscopic Donor Nephrectomy

Abstract Introduction: There is an increasing discrepancy between the number of patients awaiting transplantation and the number of available transplantable organs. To increase the donor pool, live...

A Matched-Pair Comparison of Laparoendoscopic Single-Site Surgery and Standard Laparoscopic Radical Nephrectomy by a Single Urologist

The aim of this study is to compare the perioperative outcomes after transumbilical laparoendoscopic single-site (LESS) radical nephrectomy (LESS-RN) performed by a surgeon during his learning curve of this novel procedure with the outcomes after standard laparoscopic radical nephrectomy (LRN) for patients with a solitary renal tumor. Using this information, we examined whether LESS exhibits any objective advantages over standard laparoscopy. Twenty patients who underwent LESS-RN for a solitary cT(1)N(0)M(0) renal mass (group 1) were matched and compared with 33 patients who underwent standard LRN (group 2) for tumors of similar sizes. Patient and surgical data, pathologic outcomes, and follow-up information, including patient responses regarding cosmetic satisfaction, were analyzed. The minimum duration of follow-up was 6 months for both groups. Patients in group 1 had significantly (P<0.05) quicker recoveries of bowel function, shorter postoperative analgesic time, and lower pain scores during their hospital stay. At the time of the last follow-up, all patients remained symptom free, and no evidence of recurrence was detected. Compared with that of standard LRN patients, LESS-RN patients exhibited better cosmetic satisfaction scores postoperatively at least to 6 months (P=0.013). Transumbilical LESS-RN is a feasible, safe, and efficacious procedure with favorable perioperative outcomes that results in significantly improved control of postoperative pain, more rapid recovery of bowel function, and increased cosmetic satisfaction. Additional research, including randomized controlled trials and long-term follow-ups, however, will be needed to draw solid conclusions regarding the relative efficacy of this procedure compared with standard approaches.

Off‐clamp versus complete hilar control laparoscopic partial nephrectomy: comparison by clinical stage

Study Type--Therapy (case series). Level of Evidence 4. What's known on the subject? And what does the study add? Minimizing renal ischemia and reperfusion injury is an area of active investigation and is particularly significant in cases of laparoscopic renal surgery where the kidney experiences warm ischemia. Reports of partial clamping, early unclamping, and off-clamp laparoscopic partial nephrectomy have demonstrated potential technical modifications that can offer a protective role in preserving renal function. We investigated off-clamp laparoscopic partial nephrectomy for tumours with varying clinical stage to determine feasibility, perioperative outcomes, and renal functional changes when compared to a contemporary cohort of standard laparoscopic partial nephrectomy with complete hilar clamping performed by a single surgeon. • To compare the operative outcomes and oncological efficacy of off-clamp (OC) laparoscopic partial nephrectomy (LPN) vs complete hilar control (HC) LPN for stage T1a-T2 renal cell carcinoma. • Retrospective review of all LPNs between June 2006 and March 2010 was performed, stratifying 390 patients by clinical T stage (cT1a = 313, cT1b = 62, cT2 = 15). • Perioperative and postoperative parameters were analysed comparing patients who underwent OC LPN (n= 126) with those who had HC LPN (n= 264) collectively and within each clinical stage cohort. • There was no significant difference in the proportion of OC LPN for cT1a tumours compared with cT1b and cT2, P= 0.21. • OC vs HC LPN patients had a greater estimated blood loss (EBL) but with no significant difference in perioperative blood transfusion rates. • When compared by clinical stage, EBL was greater only for clinical stage T1a disease (P= 0.02) but not cT1b (P= 0.91) or cT2 (P= 0.42) tumours. • There was no difference in the operative time or length of hospitalization between OC and HC LPN by stage: cT1a (P= 0.77 and P= 0.17), cT1b (P= 0.77 and P= 0.07) and cT2 (P= 0.42 and P= 0.66), respectively. • In our series, one case (0.3%) of HC LPN had a positive margin on final pathology, one case was converted to open partial nephrectomy (0.3%), and two cases of OC LPN (1.6%) were intraoperatively converted to HC LPN. • OC LPN is a feasible surgical option for patients with cT1-T2 renal cell carcinoma that completely avoids renal ischaemic injury with the benefits of minimally invasive surgery. • LPN can be performed OC in patients with larger, more complex renal tumours without compromising the operative time, blood loss requiring transfusions, length of hospitalization, complication rates, or positive surgical margin rates compared with HC LPN.

First Prize: Standard Laparoscopic Donor Nephrectomy Versus Laparoendoscopic Single-Site Donor Nephrectomy: A Randomized Comparative Study

The purpose of this study was to compare in a randomized fashion the clinical outcomes following standard laparoscopic and laparoendoscopic single-site (LESS) donor nephrectomies. Fifty voluntary renal donors who met the inclusion and exclusion criteria were randomized to standard laparoscopic (group A) and LESS (group B) donor nephrectomies. The primary end point of the study was patients' postoperative pain. The clinical outcomes, patient's quality of life, body image, and cosmetic scores on follow-up were also compared. The operating times were similar in both groups (175.83 ± 47.57 vs. 172.20 ± 38.33 minutes, p = 0.38). The surgeon's difficulty as measured using a visual analog scale was significantly more in group B in 4 of 10 defined steps. The postoperative patient pain scores were similar till 48 hours following surgery (3.84 ± 1.68 vs. 3.68 ± 0.75, p = 0.33), but following which the patients in group B had improved pain scores (2.08 ± 0.91 vs. 1.24 ± 0.72, p = 0.0004). Analgesic requirements were similar in both groups (p = 0.47). The warm ischemia times in group B (5.11 ± 1.01 vs. 7.15 ± 1.84 minutes, p < 0.0001) were longer but the total ischemia times in both groups were similar (62.55 ± 9.46 vs. 62.71 ± 12.14 minutes, p = 0.48). All grafts had on-table urine output in the recipient. Intraoperative (8% vs. 16%, p = 0.2) and postoperative complications (20% vs. 16%, p = 0.99) in both groups were comparable. The patients in group B had shorter hospital stay (4.56 ± 0.82 vs. 3.92 ± 0.76 days, p = 0.003). There was no graft loss in either group except for one recipient in group A who sustained sudden cardiac death. The estimated glomerular filtration rates of recipients at 1 year were comparable for both groups (80.87 ± 22.12 vs. 81.51 ± 29.01 mL/minute, p = 0.46). The donor's quality of life, body image, and cosmetic scores were comparable for both groups. In this select group of donors, LESS donor nephrectomy, although challenging to the surgeon with longer warm ischemic times, gave early pain relief with shorter hospital stay and comparable graft function.

Do we need a cosmetic effect for radical nephrectomy? Laparoendoscopic single-site surgery would help to answer this question

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Chłosta P, Drewa T, Obarzanowski M, Antoniewicz A, Borówka A. Do we need a cosmetic effect for radical nephrectomy? Laparoendoscopic single-site surgery would help to answer this question. Videosurgery and Other Miniinvasive Techniques. 2011;6(1):1-4. doi:10.5114/wiitm.2011.20985. APA Chłosta, P., Drewa, T., Obarzanowski, M., Antoniewicz, A., & Borówka, A. (2011). Do we need a cosmetic effect for radical nephrectomy? Laparoendoscopic single-site surgery would help to answer this question. Videosurgery and Other Miniinvasive Techniques, 6(1), 1-4. https://doi.org/10.5114/wiitm.2011.20985 Chicago Chłosta, Piotr, Tomasz Drewa, Mateusz Obarzanowski, Artur Antoniewicz, and Andrzej Borówka. 2011. "Do we need a cosmetic effect for radical nephrectomy? Laparoendoscopic single-site surgery would help to answer this question". Videosurgery and Other Miniinvasive Techniques 6 (1): 1-4. doi:10.5114/wiitm.2011.20985. Harvard Chłosta, P., Drewa, T., Obarzanowski, M., Antoniewicz, A., and Borówka, A. (2011). Do we need a cosmetic effect for radical nephrectomy? Laparoendoscopic single-site surgery would help to answer this question. Videosurgery and Other Miniinvasive Techniques, 6(1), pp.1-4. https://doi.org/10.5114/wiitm.2011.20985 MLA Chłosta, Piotr et al. "Do we need a cosmetic effect for radical nephrectomy? Laparoendoscopic single-site surgery would help to answer this question." Videosurgery and Other Miniinvasive Techniques, vol. 6, no. 1, 2011, pp. 1-4. doi:10.5114/wiitm.2011.20985. Vancouver Chłosta P, Drewa T, Obarzanowski M, Antoniewicz A, Borówka A. Do we need a cosmetic effect for radical nephrectomy? Laparoendoscopic single-site surgery would help to answer this question. Videosurgery and Other Miniinvasive Techniques. 2011;6(1):1-4. doi:10.5114/wiitm.2011.20985.

The Evolution of Laparoscopic Right Donor Nephrectomy: Progression to Single Site Surgery

Background: Laparoscopic donor nephrectomy represents a significant source of allografts to patients with end- stage renal disease. Given the increasing wait-list and limited number of deceased donors, utilization of the right kidney is necessary to maximize the donor pool. Materials: We retrospectively reviewed 122 right-sided kidney donors; 73 hand-assisted laparoscopic donor nephrectomies (R-HAL-DN), 36 standard laparoscopic donor nephrectomies (R-LAP-DN), and 13 laparoendoscopic single site donor nephrectomies (R-LESS-DN). We compared these groups to matched left donors and each other, analyzing various parameters including operative times, warm ischemia time (WIT), estimated blood loss (EBL), incision length, length of stay (LOS), convalescence data and complications. Results: Right and left donors demonstrated no difference in analysis parameters in all 3 procurement techniques. When comparing all right donors total operative time and allograft extraction time were lowest in the R-LAP-DN group (p=0.003 & p=0.04, respectively). The R-LESS-DN group had the lowest EBL (p=0.06) and shortest incision length (p<0.0001). The LOS was shortest in the R-LAP-DN group (p=0.03). WIT, donor convalescence, and recipient allograft function were similar in all 3 groups. Conclusion: Our data demonstrates the safety and reproducibility of procuring the right kidney. Donor safety and allograft function have continued through evolution of the technique.