231: Laparoscopic Nephrectomy: Prolonged Diffusion of a Standard of Care

Background Postoperative pain management following donor nephrectomy can prove challenging for immediate discharge on postoperative day 1 or 2. Although the standard for pain control is utilization of opioids, this increases the risk of postoperative ileus and, if continued inappropriately, increases excess opioids circulating in the community. One strategy that proposes to limit postoperative opioids in kidney donors is the continuous infusion of local anesthetics (CILA), though the effect on patient outcomes is unclear. Objective The purpose of this study was to evaluate the effectiveness of postoperative CILA to decrease opioid usage in kidney donors who undergo laparoscopic nephrectomy. Methods A retrospective analysis was conducted of kidney donors who underwent laparoscopic nephrectomy and received CILA (CILA group) compared with kidney donors who received standard-of-care (SOC) postoperative analgesia. The primary outcome was the mean total oral morphine equivalents (OMEs) administered following surgery. Results A total of 176 kidney donors were evaluated, 88 in each group. The mean OME administered in the CILA group was significantly higher than in the SOC group: 194.8 versus 133.5 mg ( P = 0.003). Mean total postoperative administration of acetaminophen was also increased in the CILA group: 3736.9 versus 2611.6 mg ( P = 0.0041). Mean length of stay following surgery was higher in the kidney donors who received CILA, whereas return to bowel function, time to ambulation, and pain scores were not significantly different. Conclusion and Relevance This report demonstrated that CILA is not an effective modality to reduce opioid utilization or improve recovery in kidney donors following laparoscopic nephrectomy.

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DURATION OF SURGERY OF LAPAROSCOPIC NEPHRECTOMY -AN INITIAL EXPERIENCE IN IGMC, SHIMLA

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i3.1807 ◽

2021 ◽

Vol 5 (3) ◽

Author(s):

Bhartendu Nagesh ◽

D.K Verma ◽

R S Jhobta ◽

Sanjiv Sharma ◽

Mehar Chand

Keyword(s):

Operating Time ◽

Standard Of Care ◽

Laparoscopic Nephrectomy ◽

P Value ◽

Dense Adhesion ◽

Medical College ◽

Duration Of Surgery ◽

The Mean ◽

Gandhi Medical College ◽

Hydronephrotic Kidney

Background: Laparoscopic nephrectomy has been established as the standard of care for the management of benign non-functioning kidneys and has gained worldwide popularity over the past decade. Methods- This study was conducted in the Department of General surgery, Indira Gandhi medical college, Shimla on 20 selected patients of benign non functional kidney admitted for elective Laparoscopic Nephrectomy between July 2018 to June 2019 Results: In this study, the mean operating time in success full laparoscopic nephrectomies was 103.7 + 20.6 min in lap converted to open it was 165 .7 +26.99 min and in hand-assisted tame taken was 150 min which is statically not significant with p value =0.1317. Conclusion: The mean time taken for completion of laparoscopic nephrectomy in first 4 cases was 105 min and in next 4 cases was 108 min and in last 4 cases it was 97 min there was definitive learning curve as in last 4 cases operating time was less as compared to initial cases but operating time also depends on other factors like in hydronephrotic kidney due to well maintained plane dissection take less time ,but in pyonephrotic kidney ,tubercular kidney,previously intervension like PCN, there were dense adhesion resulting in more time for disection. Keywords: Laparoscopy, Nephrectomy, Duration of surgery

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The "boatman's knot": a new option for renal hilum ligation during laparoscopic nephrectomy

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502005000300012 ◽

2005 ◽

Vol 20 (3) ◽

pp. 258-261 ◽

Cited By ~ 7

Author(s):

Alexandre C. Bomfim ◽

Cassio Andreoni ◽

Ari Miotto ◽

Mardhen B. Araújo ◽

Valdemar Ortiz ◽

...

Keyword(s):

Renal Artery ◽

Renal Vein ◽

Standard Of Care ◽

The Other ◽

Laparoscopic Nephrectomy ◽

Left Hand ◽

Right Hand ◽

Renal Hilum ◽

Endovascular Stapler ◽

The Right

PURPOSE: The authors present and describe an original adaptation for the use of "boatman's knot" in renal vein ligation during laparoscopic nephrectomy. This procedure may replace the need for the endovascular stapler, which is considered the standard of care, but not available in several institutions in Brazil. The knot presented is also known as the " pig's knot" in several farms in Brazil. METHODS: Fourteen laparoscopic nephrectomies were performed by the same surgeon in a standard fashion in seven female pigs. Both the renal artery and vein were ligated using the "boatman's knot" as the only method for hemostasis with conventional intracorporeal technique. Two knots were applied in each artery and vein; one knot was tied proximally and the other distally. The vessels were then sectioned in between both knots. This technique is based on the intracorporeal confection of two loops by the right hand pair of dissectors with the help of the left hand. The arteries and the veins were then sectioned and the capability to accomplish full hemostasis was observed. RESULTS: All the laparoscopic nephrectomies were performed successfully. The "boatman's knot" was performed by the same surgeon with neither complications nor difficulties during the confection of the knot. In all cases hemostasis was fully achieved using only the "boatman's knot" as the hemostatic method. CONCLUSION: The "boatman's knot" is feasible and safe for hilum control during laparoscopic nephrectomy in pigs and total hemostasis can be achieved using it as the only method of hemostasis. However, the safety and the capacity of others to learn how to apply it should be tested before it may be advised to use it routinely.

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BLOOD LOSS IN LAPAROSCOPIC NEPHRECTOMY -AN INITIAL EXPERIENCE IN IGMC, SHIMLA

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i3.1806 ◽

2021 ◽

Vol 5 (3) ◽

Author(s):

Bhartendu Nagesh ◽

D.K Verma ◽

R S Jhobta ◽

Sanjiv Sharma ◽

Mehar Chand

Keyword(s):

Blood Loss ◽

Standard Of Care ◽

Laparoscopic Nephrectomy ◽

P Value ◽

Dense Adhesion ◽

Medical College ◽

The Mean ◽

Gandhi Medical College ◽

End Stage ◽

Hydronephrotic Kidney

Background: Laparoscopic nephrectomy has been established as the standard of care for the management of benign non-functioning kidneys and has gained worldwide popularity over the past decade. Methods: This study was conducted in the Department of General surgery, Indira Gandhi medical college, Shimla on 20 selected patients of benign non functional kidney admitted for elective Laparoscopic Nephrectomy between July 2018 to June 2019 Results: Less than 100 ml of blood was lost in 3(15%) of the patient. 100 to 200 ml was lost in 9(45%) and in 3(15%) patients 200 to 300 ml blood was lost and 5 (25%) had blood loss more than 300 ml. The mean blood loss in successful laparoscopic nephrectomy was 129 +123 ml and in lap converted to open was 435.7 + 174.9 ml. which is significantly less in successful lap nephrectomy which is statistically significant with a p-value of o.oo3 Conclusion: Mean blood loss in laparoscopic nephrectomy was 145 +144 ml and in converted cases, it was 350+200 ml. mean blood loss in hydronephrotic kidney was 145+ 144.2 ml in pyonephrotic kidney 325+ 318 in end stage nephrolithiasis 350+ 200 ml .There was more blood loss in ESRD and pyonephrotic kidney due to dense adhesion whereas blood loss is less in hydronephrotic kidney due to well maintained plane for dissection . Keywords: Laparoscopy, Nephrectomy, Blood loss

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