Comparison of Transperitoneal and Retroperitoneal Laparoendoscopic Single-site Donor Nephrectomy

Abstract Background: Laparoscopic living-donor nephrectomy is the standard technique at high-volume renal transplant centers. Laparoendoscopic single-site donor nephrectomy (LESS-DN) is a relatively novel minimally invasive surgery, which was differed to transperitoneal and retroperitoneal approaches. We present a retrospective analysis of our single-institution donor nephrectomy series comparing the transperitoneal to retroperitoneal LESS-DN with regards to operative outcomes.Materials and Methods: Ten patients who underwent LESS-DN from 2017–2019 were enrolled at our center. The same surgeon performed all cases. The two approaches were compared retrospectively and evaluated for differences in perioperative outcomes, including operation time, console time, blood loss, graft warm ischemia time, postoperative pain, length of stay (LOS), wound size, postoperative pain, and renal function post LESS-DN at less than one year.Results: Total operating time (315 ± 82.69 vs. 191 ± 24.9 min, p = 0.016), console time (224 ± 74.15 vs. 110 ± 19.84 min, p = 0.016), and LOS (8.4 ± 1.82 vs. 4.8 ± 1.10 days, p = 0.013) were significantly longer in the transperitoneal group. The wound size (44 ± 3.81 vs. 68.2 ± 13.5 mm, p = 0.038) was significantly smaller in the transperitoneal group. There was no significant difference in other parameters, including blood loss, warm ischemia time, and postoperative pain from day one to day three.Conclusions: Retroperitoneal LESS-DN results in similar perioperative outcomes as transperitoneal LESS-DN without compromising donor safety, and while providing a faster operation time, console time, shorter LOS, and a trend toward a shorter warm ischemia time.

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Single-Site Sutureless Partial Nephrectomy for Small Exophytic Renal Tumors

Journal of Clinical Medicine ◽

10.3390/jcm9113658 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3658

Author(s):

Ching-Chia Li ◽

Tsu-Ming Chien ◽

Shu-Pin Huang ◽

Hsin-Chih Yeh ◽

Hsiang-Ying Lee ◽

...

Keyword(s):

Partial Nephrectomy ◽

Renal Cancer ◽

Operation Time ◽

Warm Ischemia ◽

Warm Ischemia Time ◽

Single Site ◽

Renal Tumors ◽

Ischemic Time ◽

Intracorporeal Suturing ◽

Ischemia Time

Partial nephrectomy (PN) is the standard procedure for most patients with localized renal cancer. Laparoscopy has become the preferred surgical approach to target this cancer, but the steep learning curve with laparoscopic PN (LPN) remains a concern. In LPN intracorporeal suturing, the operation time is further extended even under robot assistance, a step which prolongs warm ischemic time. Herein, we shared our experience to reduce the warm ischemia time, which allows surgeons to perform LPN more easily by using a combination of hemostatic agents to safely control parenchymal bleeding. Between 2015 and 2018, we enrolled 52 patients who underwent LPN in our hospital. Single-site sutureless LPN and traditional suture methods were performed in 33 and 19 patients, respectively. Preoperative, intra-operative, and postoperative variables were recorded. Renal function was evaluated by estimated glomerular filtration rate (eGFR) pre- and postoperatively. The average warm ischemia time (sutureless vs. suture group; 11.8 ± 3.9 vs. 21.2 ± 7.2 min, p < 0.001) and the operation time (167.9 ± 37.5 vs. 193.7 ± 42.5 min, p = 0.035) were significantly shorter in the sutureless group. In the sutureless group, only 2 patients suffered from massive urinary leakage (>200 mL/day) from the Jackson Pratt drainage tube, but the leakage spontaneously decreased within 7 days after surgery. eGFR and serum hemoglobin were not found to be significantly different pre- and postoperatively. All tumors were removed without a positive surgical margin. All patients were alive without recurrent tumors at mean postoperative follow-ups of 29.3 ± 12.2 months. Single-site sutureless LPN is a feasible surgical method for most patients with small exophytic renal cancer with excellent cosmetic results without affecting oncological results.

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The First Assistant Sparing Technique Robot-Assisted Partial Nephrectomy Decreases Warm Ischemia Time While Maintaining Good Perioperative Outcomes

Journal of Endourology ◽

10.1089/end.2012.0129 ◽

2012 ◽

Vol 26 (11) ◽

pp. 1448-1453 ◽

Cited By ~ 7

Author(s):

William T. Berg ◽

Chad R. Rich ◽

Gina M. Badalato ◽

Christopher M. Deibert ◽

Chris O. Wambi ◽

...

Keyword(s):

Partial Nephrectomy ◽

Warm Ischemia ◽

Warm Ischemia Time ◽

Perioperative Outcomes ◽

Robot Assisted ◽

Ischemia Time

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Warm ischemia time does not correlate with recipient graft function in laparoscopic donor nephrectomy

Surgical Endoscopy ◽

10.1007/s00464-002-8860-4 ◽

2003 ◽

Vol 17 (5) ◽

pp. 746-749 ◽

Cited By ~ 21

Author(s):

M. M. Buzdon ◽

E. Cho ◽

S. C. Jacobs ◽

B. Jarrell ◽

J. L. Flowers

Keyword(s):

Graft Function ◽

Warm Ischemia ◽

Donor Nephrectomy ◽

Warm Ischemia Time ◽

Laparoscopic Donor Nephrectomy ◽

Ischemia Time

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Comparison of Outcomes of Open versus Laparoscopic Living Donor Nephrectomy in Nepal

Journal of Institute of Medicine ◽

10.3126/jiom.v42i1.37422 ◽

2020 ◽

Vol 42 (1) ◽

pp. 31-35

Author(s):

Prem R Sigdel ◽

Diwas Gnyawali ◽

Bipendra DK Rai ◽

Pawan Dhital ◽

Purushottam Parajuli ◽

...

Keyword(s):

Hospital Stay ◽

Demographic Data ◽

Graft Function ◽

Length Of Hospital Stay ◽

Warm Ischemia ◽

Donor Nephrectomy ◽

Warm Ischemia Time ◽

Laparoscopic Donor Nephrectomy ◽

Ischemia Time ◽

Living Donor Nephrectomy

Introduction Laparoscopic donor nephrectomy is the gold standard for kidney retrieval in live donors. Until recently, donor nephrectomies were performed only by open technique in Nepal. There is no information on the experience and outcomes of laparoscopic donor nephrectomy in Nepal. The study was done to compare the outcomes among donors undergoing open and laparoscopic nephrectomies, and to compare the graft related outcomes between the two groups receiving these kidneys. MethodsIn this retrospective study, 44 kidney donors from March 2019 to October 2019 were analyzed. Donors were divided into 2 groups: open donor nephrectomy (ODN) and laparoscopic donor nephrectomy (LDN). Parameters for analysis included demographic data, warm ischemia time, surgery time and length of hospital stay. Data on early graft function and complications in recipients till 30th post-operative day were compared. ResultsThere were 22 donors each in the ODN and LDN groups. Baseline characteristics of the donors were comparable between two groups. Mean surgery duration (183.55±43.31 minutes vs 117.73±18.75 minutes) and first warm ischemia time (11.22±4.34 minutes vs 2.3±0.8 minutes) was significantly high in LDN. Hemoglobin drop, post-operative complications in donors, creatinine of donors at discharge, mean hospital stay, graft function at one month and complications in recipients were comparable among ODN and LDN. Pain score in 1st post-operative day was comparable between two groups, however, pain was significantly less in second post-operative day in LDN. ConclusionLaparoscopic donor nephrectomy is feasible in Nepal and associated with acceptable morbidity and graft function when compared to ODN.

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POD-1.02: The Impact of Warm Ischemia Time on Perioperative Outcomes and Creatinine Clearance in Patients Undergoing Laparoscopic Partial Nephrectomy

Urology ◽

10.1016/j.urology.2008.08.141 ◽

2008 ◽

Vol 72 (5) ◽

pp. S29

Author(s):

M. Orvieto ◽

A. Bernstein ◽

M. Katz ◽

M. Eng ◽

K. Zorn ◽

...

Keyword(s):

Creatinine Clearance ◽

Partial Nephrectomy ◽

Warm Ischemia ◽

Warm Ischemia Time ◽

Laparoscopic Partial Nephrectomy ◽

Perioperative Outcomes ◽

Ischemia Time ◽

The Impact

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Predictors of surgical outcomes of retroperitoneal laparoscopic partial nephrectomy

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2020.3.165 ◽

2020 ◽

Vol 92 (3) ◽

Author(s):

Carmine Sciorio ◽

Pier Paolo Prontera ◽

Salvatore Scuzzarella ◽

Paolo Verze ◽

Lorenzo Spirito ◽

...

Keyword(s):

Blood Loss ◽

Partial Nephrectomy ◽

Surgical Outcomes ◽

Operative Time ◽

Statistical Significance ◽

Tumour Size ◽

Warm Ischemia ◽

Warm Ischemia Time ◽

Ischemia Time ◽

Length Of Hospitalization

Objectives: To evaluate surgical outcomes in a series of laparoscopic retroperitoneal partial nephrectomies.Methods: A total of 147 patients who underwent laparoscopic retroperitoneal partial nephrectomy by a single surgeon were evaluated. Pre-operative parameters (body mass index, ASA score, tumour size, cTNM stage, PADUA score risk, surgeon experience) and intraoperative and postoperative outcomes (operative mean time, warm ischemia time, blood loss, transfusion rate, length of hospitalization, and margin-ischaemiacomplications [MIC] success rate) were considered. Results: For 134 patients (91.1%) the success of the treatment, defined by a MIC = 3, was obtained. When the statistical significance of each of the independent variables was tested, surgeon’s experience added statistical significance to the prediction of operative time (p = 0.000), warm ischemia time (p = 0.000) and blood loss (p = 0.000); tumour size (p = 0.046) to the prediction MIC (p = 0.010), operative time (p = 0.000), warm ischemia time (p = 0.003) and blood loss (p = 0.010); ASA score to the length of hospitalization (p = 0.009). Conclusions: Laparoscopic retroperitoneal partial nephrectomy represents an adequate and safe technique for the treatment of T1 renal cancer. Optimal MIC success rate can be achieved, although intraoperative outcomes tend to be related to the learning curve even in a very experienced laparoscopic surgeon. Length of hospitalization depends on general health condition of patients.

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80 Laparoscopic living donor nephrectomy: Predictors of warm ischemia time and consequences for the transplant

European Urology Supplements ◽

10.1016/s1569-9056(16)60082-9 ◽

2016 ◽

Vol 15 (3) ◽

pp. e80-e80a

Author(s):

T. Benoit ◽

M. Roumiguie ◽

J.B. Beauval ◽

N. Doumerc ◽

F. Sallusto ◽

...

Keyword(s):

Living Donor ◽

Warm Ischemia ◽

Donor Nephrectomy ◽

Warm Ischemia Time ◽

Ischemia Time ◽

Living Donor Nephrectomy

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Preoperative scoring systems used in retroperitoneoscopic partial nephrectomy for T1-T2 renal tumors

Romanian Journal of Medical Practice ◽

10.37897/rjmp.2017.3.3 ◽

2017 ◽

Vol 12 (3) ◽

pp. 141-147

Author(s):

M.V. PIRVUT ◽

◽

N. GRIGORE ◽

I. MIHAI ◽

A. BENCHERKI ◽

...

Keyword(s):

Blood Loss ◽

Partial Nephrectomy ◽

Operative Time ◽

Warm Ischemia ◽

Warm Ischemia Time ◽

P Value ◽

Ischemia Time ◽

Contralateral Kidney ◽

Risk Patients ◽

The Mean

Introduction. P.A.D.U.A. (The preoperative aspects and dimensions used for anatomic), R.E.N.A.L. (radius exophytic/endophytic nearness anterior/posterior location) and zonal NePhRO scoring were developed in an effort to predict the intraoperative (warm time ischemia, blood loss) and postoperative complications in patients undergoing partial nephrectomy, with an important role on surgical decision-making (2-4). Materials and methods. Between January 2014 and July 2017, 37 patients(p) underwent retroperitoneoscopic nephro-sparing surgery at our center for clinically localized renal tumor. All patients had a normal contralateral kidney. The selection of patients for nephro-sparing surgery was based on preoperative CT scan, location of the tumor, the individual general health status of the patient and individual surgeon preferences. A chart review was carried out, including age, sex, anatomic preoperative scoring system (P.A.D.U.A., R.E.N.A.L. nephrometry and zonal NePhRO), operative time (skin opening to skin closing), estimated blood loss (EBL), warm ischemia time (WIT), hospital stay. Results. The mean age of patients with partial nephrectomy was 54.3±9.1 years. Mean preoperative serum creatinine level for the patient group was 0.97±0.14 mg/dl. All patients had normal contralateral kidney. Average tumor diameter in this group was 3.6± 0.86 cm. When using P.A.D.U.A. score to predict warm time ischemia p value was of 0.001, even if the mean warm ischemia time is higher in medium risk patients than in high risk patients 24.3 min vs. 23.2 min. R.E.N.A.L. nephrometry score was able to predict the warm ischemia time according to the risk groups (17.6 vs. 23.9 vs. 31 min) with a p value under 0.001. Zonal NePhRO score was statistically correlated with total operative time, blood loss, warm ischemia and renal function decrease, all with a p value < 0.05. Conclusion. P.A.D.U.A. score, R.E.N.A.L. nephrometry score and Zonal NePhRO score have proved to be reliable preoperative tools in order to evaluate surgical complexity and to predict outcomes such as warm time ischemia, blood loss, postoperative estimated GFR and complications rate.

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A Comparison of Laparoscopic Enucleation with Preoperative Selective Arterial Embolization (SAE) and Non-SAE for Renal Angiomyolipoma: A Meta-Analysis

10.21203/rs.3.rs-313199/v1 ◽

2021 ◽

Author(s):

Jiaqi Kang ◽

Yuxuan Song ◽

Shangren Wang ◽

Jia Tian ◽

Li Liu ◽

...

Keyword(s):

Blood Loss ◽

Web Of Science ◽

Meta Analysis ◽

Arterial Embolization ◽

Warm Ischemia ◽

Warm Ischemia Time ◽

Renal Angiomyolipoma ◽

Ischemia Time ◽

Selective Arterial Embolization ◽

Laparoscopic Enucleation

Abstract Background: To compare the outcomes of laparoscopic enucleation with preoperative selective arterial embolization (SAE) and non-SAE for renal angiomyolipoma (RAML), we performed this systematic review and meta-analysis. Methods: We searched Web of Science, PubMed, EMBASE, the Cochrane Library, the Web of Science Core Collection, ClinicalTrials.gov, and China National Knowledge Infrastructure up to May 2019. Pooled relative ratio (RR) and standardized mean difference (SMD) with their 95% confidence intervals (CIs) were used to estimate the perioperative outcomes assessing the effectiveness and safety of laparoscopic enucleation with SAE and non-SAE.Results: A total of 4 studies were incorporated. The results showed that SAE group had a shorter operative time (SMD -2.15, 95% CI: -2.85 to -1.46, P < 0.001) , less blood loss (SMD -1.77, 95% CI: -2.06 to -1.47, P < 0.001), shorter warm ischemia time (SMD -2.57, 95% CI: -3.04 to -2.10, P < 0.001), and lower postoperative complication rate (RR 0.29, 95% CI: 0.08 to 0.98, P = 0.047), compared with the Non-SAE group. However, there was no significant difference in length of stay after operation (SMD -0.82, 95% CI: -3.26 to 1.63, P = 0.512), postoperative serum creatinine (SMD -0.59, 95% CI: -1.35 to 0.18, P =0.133), and GFR (SMD 0.59, 95% CI: -0.15 to 1.32, P =0.116) between the two groups. Sensitivity analysis showed that the results of our meta-analysis were robust, and deleting anyone study had no significant effect on the pooled results.Conclusions: Laparoscopic enucleation with preoperative SAE can shorten the operation time and warm ischemia time, decrease blood loss, preserve the renal function, and reduce the incidence of complications, which is a good option for the treatment of large RAMLs.

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