The Evolution of Living Donor Nephrectomy Program at A Hellenic Transplant Center. Laparoscopic vs. Open Donor Nephrectomy: Single-Center Experience

Since its introduction in 1995, laparoscopic nephrectomy has emerged as the preferred surgical approach for living donor nephrectomy. Given the ubiquity of the surgical procedure and the need for favorable outcomes, as it is an elective operation on otherwise healthy individuals, it is imperative to ensure appropriate preoperative risk stratification and anticipate intraoperative challenges. The aim of the present study was to compare peri-and postoperative outcomes of living kidney donors (LD), who had undergone laparoscopic nephrectomy (LDN), with a control group of those who had undergone open nephrectomy (ODN). Health-related quality of life (QoL) was also assessed using the validated SF-36 questionnaire. Data from 252 LD from a single transplant center from March 2015 to December 2020 were analyzed retrospectively. In total, 117 donors in the LDN and 135 in the ODN groups were assessed. Demographics, type of transplantation, BMI, duration of surgery, length of hospital stay, peri- and postoperative complications, renal function at discharge and QoL were recorded and compared between the two groups using Stata 13.0 software. There was no difference in baseline characteristics, nor in the prevalence of peri-and postoperative complications, with a total complication rate of 16% (mostly minor, Clavien–Dindo grade II) in both groups, while a different pattern of surgical complications was noticed between them. Duration of surgery was significantly longer in the ODN group (median 240 min vs. 160 min in LDN, p < 0.01), warm ischemia time was longer in the LDN group (median 6 min vs.2 min in ODN, p < 0.01) and length of hospital stay shorter in the LDN group (median 3 days vs. 7 days in ODN). Conversion rate from laparoscopic to open surgery was 2.5%. There was a drop in estimated glomerular filtration rate (eGFR) at discharge of 36 mL/min in the LDN and 32 mL/min in the ODN groups, respectively (p = 0.03). No death, readmission or reoperation were recorded. There was a significant difference in favor of LDN group for each one of the eight items of the questionnaire (SF1–SF8). As for the two summary scores, while the total physical component summary (PCS) score was comparable between the two groups (57.87 in the LDN group and 57.07 in the ODN group), the mental component summary (MCS) score was significantly higher (62.14 vs. 45.22, p < 0.001) in the LDN group. This study provides evidence that minimally invasive surgery can be performed safely, with very good short-term outcomes, providing several benefits for the living kidney donor, thereby contributing to expanding the living donor pool, which is essential, especially in countries with deceased-donor organ shortage.

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Is Obesity a Risk Factor for Spinal Surgeries? A Retrospective Study in a Specialized Orthopedic Spine Center

Journal of Research in Orthopedic Science ◽

10.32598/jrosj.8.1.759.1 ◽

2021 ◽

Vol 8 (1) ◽

pp. 37-42

Author(s):

Hasan Ghandhari ◽

◽

Ebrahim Ameri ◽

Mohsen Motalebi ◽

Mohamad-Mahdi Azizi ◽

...

Keyword(s):

Retrospective Study ◽

Postoperative Complications ◽

Blood Loss ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Obese Group ◽

Obese Patients ◽

Number Of Patients ◽

Significant Difference ◽

Duration Of Surgery

Background: Various studies have shown the effects of morbid obesity on the adverse consequences of various surgeries, especially postoperative infections. However, some studies have shown that the complications of spinal surgery in obese and non-obese patients are not significantly different. Objectives: This study investigated and compared the duration of surgery, length of hospital stay, and complications after common spinal surgeries by orthopedic spine fellowship in obese and non-obese patients in a specialized spine center in Iran. Methods: All patients who underwent decompression with or without lumbar fusion were included in this retrospective study. These patients were classified into two groups: non-obese (BMI <30 kg/m2) and obese (BMI ≥30 kg/m2). The data related to type and levels of surgery, 30-day hospital complications, length of hospital stay, rate of postoperative wound infection, blood loss, and need for transfusion were all extracted and compared between the two groups. Results: A total of 148 patients (74%) were in the non-obese group and 52 patients (26%) in the obese group. The number of patients that need packed cells was significantly higher in the obese group (51.8% vs 32.6%) (P=0.01). Otherwise, there were not a significant difference between type of treatment (fusion or only decompression) (P=0.78), interbody fusion (P=0.26), osteotomy (P=0.56), duration of surgery (P=0.25), length of hospital stay (P=0.72), mean amount of blood loss (P=0.09), and postoperative complications (P=0.68) between the two groups. Conclusion: Our results suggest that duration of surgery, length of hospital stay, and postoperative complications are not associated with the BMI of the patients.

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Hand-assisted retroperitoneoscopic living donor nephrectomy superior to laparoscopic nephrectomy

Transplantation Proceedings ◽

10.1016/s0041-1345(03)00041-1 ◽

2003 ◽

Vol 35 (2) ◽

pp. 782-783 ◽

Cited By ~ 15

Author(s):

J Wadström ◽

P Lindström ◽

B.-M Engström

Keyword(s):

Living Donor ◽

Donor Nephrectomy ◽

Laparoscopic Nephrectomy ◽

Living Donor Nephrectomy

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Mini-incision Living Donor Nephrectomy and Trans-peritoneal Laparoscopic Nephrectomy: Will There Be a Place for New Evidence?

Transplantation Proceedings ◽

10.1016/j.transproceed.2019.01.044 ◽

2019 ◽

Vol 51 (5) ◽

pp. 1555-1558

Author(s):

Diogo Nunes-Carneiro ◽

André Marques-Pinto ◽

Isaac Braga ◽

João Ferreira Cabral ◽

Manuela Almeida ◽

...

Keyword(s):

Living Donor ◽

Donor Nephrectomy ◽

Laparoscopic Nephrectomy ◽

Living Donor Nephrectomy ◽

New Evidence ◽

Mini Incision

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Safe Initiation of a Laparoendoscopic Single Site Living Donor Nephrectomy Program in a Small-volume Transplant Center

Urology ◽

10.1016/j.urology.2013.03.045 ◽

2013 ◽

Vol 82 (2) ◽

pp. 352-357 ◽

Cited By ~ 3

Author(s):

Shih-Chieh Jeff Chueh ◽

Bashir R. Sankari ◽

Lorie Lipscomb ◽

Alice M. Jones ◽

J. Stephen Jones

Keyword(s):

Living Donor ◽

Small Volume ◽

Donor Nephrectomy ◽

Single Site ◽

Laparoendoscopic Single Site ◽

Living Donor Nephrectomy ◽

Transplant Center

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LAPAROSCOPIC LIVING DONOR NEPHRECTOMY IN INDONESIA

Indonesian Journal of Urology ◽

10.32421/juri.v21i2.28 ◽

2014 ◽

Vol 21 (2) ◽

Author(s):

Chaidir Arif Mochtar ◽

Irfan Wahyudi ◽

Bagus Baskoro

Keyword(s):

Blood Loss ◽

Return To Work ◽

Hospital Stay ◽

Living Donor ◽

Left Kidney ◽

Donor Nephrectomy ◽

Female Ratio ◽

Living Donor Nephrectomy ◽

Post Surgery ◽

Estimated Blood Loss

Objective: To evaluate and analyze variables related to the surgical and direct post-operative outcomes of our initial experience of laparoscopic living donor nephrectomies (LLDN). Material & methods: This retrospective analysis describes the first 10 laparoscopic nephrectomies in living donors performed in Cipto Mangunkusumo Hospital. All surgeries were performed by the same surgical team. Variables related to the surgical and post-operative outcome and complications in donors were evaluated and analyzed.Results: The average age of the donors was 31.8 years with male : female ratio of 7 : 3. Thirty percent of them were family related to the recipient. The left kidney was extracted from all patients and multiple renal vessels were found in one cases. The mean operation time was 321.9 ± 27 min, first warm ischemia time was 9.37 ± 3.34 min and estimated blood loss was 270 ± 182.87ml. The hospital stay was 4.1 ± 1.3 days, VAS in the first day post surgery was 3 ± 1 with epidural analgesia needed for 1.8 ± 0.6 days, and drain was kept in for 2.8 ± 1.2 days while urethral cathether for 2.4 ± 1.2. Time to return to work was 16 ± 8.4 days. Conclusion: LLDN results in acceptable blood loss,less post-operative pain, short hospital stay and short time to return to work for the donors, therefore promising to be the gold standard among living donor nephrectomy surgical options.Keywords: Laparoscopic living donor nephrectomy,renal transplantation, Indonesia.

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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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Donor Complications Following Laparoscopic Compared to Hand-Assisted Living Donor Nephrectomy: An Analysis of the Literature

Journal of Transplantation ◽

10.1155/2010/825689 ◽

2010 ◽

Vol 2010 ◽

pp. 1-10 ◽

Cited By ~ 19

Author(s):

Whitney R. Halgrimson ◽

Jeffrey Campsen ◽

M. Susan Mandell ◽

Mara A. Kelly ◽

Igal Kam ◽

...

Keyword(s):

Postoperative Complications ◽

Assisted Living ◽

Living Donor ◽

Intraoperative Complications ◽

Laparoscopic Approach ◽

Donor Nephrectomy ◽

Laparoscopic Donor Nephrectomy ◽

Living Donor Nephrectomy ◽

Significant Difference ◽

Large Center

There are two approaches to laparoscopic donor nephrectomy: standard laparoscopic donor nephrectomy (LDN) and hand-assisted laparoscopic donor nephrectomy (HALDN). In this study we report the operative statistics and donor complications associated with LDN and HALDN from large-center peer-reviewed publications.Methods. We conducted PubMed and Ovid searches to identify LDN and HALDN outcome studies that were published after 2004.Results. There were 37 peer-reviewed studies, each with more than 150 patients. Cumulatively, over 9000 patients were included in this study. LDN donors experienced a higher rate of intraoperative complications than HALDN donors (5.2% versus. 2.0%, ). Investigators did not report a significant difference in the rate of major postoperative complications between the two groups (LDN 0.5% versus HALDN 0.7%, ). However, conversion to open procedures from vascular injury was reported more frequently in LDN procedures (0.8% versus 0.4%, ).Conclusion. At present there is no evidence to support the use of one laparoscopic approach in preference to the other. There are trends in the data suggesting that intraoperative injuries are more common in LDN while minor postoperative complications are more common in HALDN.

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Feasibility of laproscopic appendectomy in appendicities and appendicular perforation

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v18i3.15268 ◽

2016 ◽

Vol 18 (3) ◽

pp. 13

Author(s):

RK Sah ◽

S Bishokarma

Keyword(s):

Postoperative Complications ◽

Hospital Stay ◽

Laparoscopic Appendectomy ◽

Therapeutic Option ◽

Operating Time ◽

Length Of Hospital Stay ◽

Normal Diet ◽

Frequent Use ◽

Duration Of Surgery ◽

Feasible Option

Introduction: The advent and rapid acceptance of laparoscopic surgery led to the idea of performing laparoscopic appendectomy (LA). In 1983 Semm, a German gynecologist performed the first LA. More than three decades later, the benefits of LA are still controversial. The objective of this study is to assess the feasibility of laproscopic appendectomy in appendicitis and appendicular perforation.Methods: Thirty five patient undergoing laproscopicappendectomy for appendicitis from 14th feb 2015 to 11th feb 2016 in Grande international hospital were included in the study. Duration of surgery, requirement of analgesia, time to normal diet and regular activity as well as length of hospital stay and postoperative complications were studied.Results: A total of 35 patients underwent laparoscopic appendectomy during the study period.Ten patients have peri-appendicular pus collection of which six patients have perforation. Median duration of surgery was 59±8.64 minutes. Mean Post operative pain score was 4.71±0.71. Mean intravenous fevastin requirement was 3.31±0.9 gm and intravenous ketorolac was 94±27mg while oral diclofenac was 731±172.81mg. Postoperative complications were 9%. Mean time to normal diet resumption was 1.17±0.47 days and time to normal activities was 10.5±2.44 days. Median length of hospital stay was 1.9±0.96 days.Conclusion: Laproscopic appendectomy is a feasible option for appendicitis as well as appendicular perforation. More frequent use of this procedure may lead to reduction in operating time. Continuation of laproscopic appendectomy as a therapeutic option for patients with appendicitisas well as appendicular perforation need evaluation in large study scale.

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