Complication Rates of the 720 Video-Assisted Minilaparotomy Living Donor Nephrectomies: Supplementing Clavien Classification

Video-assisted parathyroidectomy (VAP) is a new approach to parathyroid exploration for primary hyperparathyroidism (PH). We examined the VAP learning curve and hypothesized that compared with conventional minimally invasive parathyroidectomy (MIS), VAP has similar complication rates and the added benefit of a shorter hospital length of stay. Using a case-control study design, patients with PH with single-focus imaging results undergoing VAP or MIS were compared during a 5-year VAP implementation period. VAP was possible in 18 per cent of patients undergoing initial parathyroid exploration. In comparing 125 VAP cases with 95 MIS control subjects, patients undergoing MIS had higher mean preoperative levels of calcium ( P = 0.007) and parathyroid hormone ( P = 0.008), greater mean adenoma weight ( P < 0.001), and increased long-term mortality (4% MIS vs 0% VAP, P = 0.03). Mean operative time, in-house analgesia use, and operative complications did not differ. The rate of conversion from VAP to MIS was 14 per cent. Patients undergoing VAP were less likely to require an overnight hospital stay ( P = 0.01). VAP is a safe surgical option for selected patients with PH, offering improved cosmesis with operative times comparable to conventional MIS. VAP can be done with a low conversion rate even during implementation and allows the added benefit of shorter hospital stay.

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Video-Assisted Thoracoscopic Surgery Lung Resection in United States Veterans: Trends and Outcomes versus Thoracotomy

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0041-1728707 ◽

2021 ◽

Author(s):

Michael A. Napolitano ◽

Andrew D. Sparks ◽

Gregor Werba ◽

Ethan S. Rosenfeld ◽

Jared L. Antevil ◽

...

Keyword(s):

Thoracoscopic Surgery ◽

Lung Resection ◽

Veterans Affairs ◽

Complication Rates ◽

Health Administration ◽

Improvement Project ◽

Video Assisted ◽

Pulmonary Surgery ◽

Video Assisted Thoracoscopic Surgery ◽

Over Time

Abstract Background Video-assisted thoracoscopic surgery (VATS) offers reduced morbidity compared with open thoracotomy (OT) for pulmonary surgery. The use of VATS over time has increased, but at a modest rate in civilian populations. This study examines temporal trends in VATS use and compares outcomes between VATS and OT in the Veterans Health Administration (VHA). Methods Patients who underwent pulmonary surgery (wedge or segmental resection, lobectomy, or pneumonectomy) at Veterans Affairs centers from 2008 to 2018 were retrospectively identified using the Veterans Affairs Surgical Quality Improvement Project database. The cohort was divided into OT and VATS and propensity score matched, taking into account the type of pulmonary resection, preoperative diagnosis, and comorbidities. Thirty-day postoperative outcomes were compared. The prevalence of VATS use and respective complications over time was also analyzed. Results A total of 16,895 patients were identified, with 5,748 per group after propensity matching. VATS had significantly lower rates of morbidity and a 2-day reduction in hospital stay. Whereas 76% of lung resections were performed open in 2008, nearly 70% of procedures were performed using VATS in 2018. While VATS was associated with an 8% lower rate of major complications compared with thoracotomy in 2008, patients undergoing VATS lung resection in 2018 had a 58% lower rate of complications (p < 0.001). Conclusions VATS utilization at VHA centers has become the predominant technique used for pulmonary surgeries over time. OT patients had more complications and longer hospital stays compared with VATS. Over the study period, VATS patients had increasingly lower complication rates compared with open surgery.

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Single-Center Analysis of Living Donor Nephrectomy: Hand-Assisted Laparoscopic, Pure Laparoscopic, and Traditional Open

Progress in Transplantation ◽

10.1177/152692480201200309 ◽

2002 ◽

Vol 12 (3) ◽

pp. 208-211 ◽

Cited By ~ 7

Author(s):

Douglas P. Slakey ◽

Julie Cauvin Hahn ◽

Ethan Rogers ◽

Philippe M. Gauthier ◽

Gilberto Ruiz-Deya ◽

...

Keyword(s):

Kidney Function ◽

Living Donor ◽

Graft Function ◽

Laparoscopic Group ◽

Donor Nephrectomy ◽

Laparoscopic Technique ◽

Complication Rates ◽

Living Donor Nephrectomy

Context Laparoscopic living donor nephrectomy has been shown to be a safe method for removing kidneys for transplantation, but concerns have been raised regarding safety and long-term kidney function. Objective To compare safety and long-term kidney function in hand-assisted laparoscopic, pure laparoscopic, and traditional open living donor nephrectomy. Method The charts of 48 patients with more than 1 year follow-up were reviewed. Thirty-four consecutive patients underwent laparoscopic live donor nephrectomy, and 14 had open donor nephrectomy. All kidneys functioned immediately at transplantation. In the laparoscopic group, 11 had the pure laparoscopic technique, and 23 patients had hand-assisted laparoscopic nephrectomy. Results Total operative and warm ischemic times were reduced with the hand-assisted technique when compared with pure laparoscopy. Operative and warm ischemic times were similar in open nephrectomy and hand-assisted laparoscopy. Long-term follow-up of serum creatinine levels revealed no significant differences between the 3 groups. Complication rates in the 3 groups were similar. Conclusion Laparoscopic donor nephrectomy appears to be comparable to open donor nephrectomy in terms of safety and long-term graft function.

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Video-assisted Living Donor Lateral Segmentectomy and Left Hepatectomy Through a Reduced Upper Midline Incision for Liver Transplantation

Journal of Surgical Research ◽

10.1016/j.jss.2011.11.208 ◽

2012 ◽

Vol 172 (2) ◽

pp. 198

Author(s):

M. Shinoda ◽

M. Tanabe ◽

S. Kawachi ◽

O. Itano ◽

H. Obara ◽

...

Keyword(s):

Liver Transplantation ◽

Assisted Living ◽

Living Donor ◽

Left Hepatectomy ◽

Midline Incision ◽

Video Assisted

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Renal allograft implantation in respect of atypical vascular procedures

Acta chirurgica iugoslavica ◽

10.2298/aci0304073b ◽

2003 ◽

Vol 50 (4) ◽

pp. 73-77 ◽

Cited By ~ 3

Author(s):

Dragoslav Basic ◽

Jovan Hadzi-Djokic ◽

Drago Milutinovic ◽

Marica Basic ◽

Milan Djokic

Keyword(s):

Renal Transplantation ◽

Living Donor ◽

Renal Allograft ◽

Graft Loss ◽

Vascular Complications ◽

Anastomotic Site ◽

Complication Rates ◽

Bypass Grafting ◽

Cadaveric Donor ◽

Living Related

In minority of renal transplants it is unevitable to perform atypical vascular procedures of renal allograft implantation, which increases the risk of vascular complications, graft loss and lethality. In the presenting study, we retrospectively evaluated kinds of atypical vascular procedures in renal allograft implantation by donor type and the transplants outcome related to these procedures. From 1980 to 1998, a total of 463 patients (mean age 36.2?10.3), underwent renal transplantation (319 from living donor and 144 from cadaveric donor) at the Institute of Urology&Nephrology in Belgrade. Atypical vascular procedures of renal allograft implantation were representative for the some of the following cohorts: bypass grafting, endarterectomy, end to side both arterial and venous anastomotic site. A total of 45 patients (9.72%) underwent some of atypical vascular procedures (41 from living donor and 4 from cadaveric donor) (p<0.01). Among analyzed procedures, bypass grafting was patients (319 from living related donor and 144 from cadaveric donor) undergoing renal transplantation were analyzed retrospectively in respect of vascular surgical complications (standard procedures vs. atypical). Atypical vascular procedures following renal allograft implantation are associated with high complication rates.

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