Back-to-back comparison of mini-open vs. laparoscopic technique for living kidney donation

Introduction: Laparoscopic living donor nephrectomy is the standard of care at high-volume renal transplant centres, with benefits over the open approach well-documented in the literature. Herein, we present a retrospective analysis of our single-institution donor nephrectomy series comparing the mini-open donor nephrectomy (mini-ODN) to the laparoscopic donor nephrectomy (LDN) with regards to operative, donor, and recipient outcomes.Methods: From 2007‒2011, there were 89 cases of mini-ODN, at which point our centre transitioned to LDN; 94 cases were performed from 2011‒2014. In total, 366 patients were reviewed, including donor and recipient pairs. Donor and recipient demographics, intraoperative data, postoperative donor recovery, recipient graft outcomes, and financial cost were assessed comparing the surgical approaches.Results: We demonstrate a reduced estimated blood loss (347.83 vs. 90.3 cc), lower intraoperative complication rate (4 vs. 11) and shorter length of hospital stay (2.4 vs. 3.3 days) for patients in the LDN group. Operative time was significantly longer for the LDN group (108.4 vs. 165.9 minutes), although this did not translate to a longer warm ischemia time (mean 2.0 minutes for each group). The rate of delayed graft function and recipient 12-month creatinine were comparable for ODN and LND. Overall cost of LDN was $684 higher for an uncomplicated admission.Conclusions: Despite a longer surgical time and higher upfront cost, our study supports that LDN yields several advantages over the mini-ODN, with a lower estimated blood loss, fewer intraoperative complications, and shorter length of hospital stay, all while maintaining excellent renal allograft outcomes.

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Mini-open thoracoscopic-assisted spinal thoracotomy for traumatic injuries: A technical note

Surgical Neurology International ◽

10.25259/sni_435_2020 ◽

2020 ◽

Vol 11 ◽

pp. 265

Author(s):

Vikas Tandon ◽

Abhinandan Reddy Mallepally ◽

Ashok Reddy Peddaballe ◽

Nandan Marathe ◽

Harvinder Singh Chhabra

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Operating Time ◽

Length Of Hospital Stay ◽

Neurological Status ◽

Technical Note ◽

Single Level ◽

Estimated Blood Loss ◽

Multiple Variables ◽

Mini Open

Background: Mini-open thoracoscopic-assisted thoracotomy (MOTA) has been introduced to mitigate disadvantages of conventional open anterior or conventional posterior only thoracoscopic procedures. Here, we evaluated the results of utilizing the MOTA technique to perform anterior decompression/fusion for 22 traumatic thoracic fractures. Methods: There were 22 patients with unstable thoracic burst fractures (TBF) who underwent surgery utilizing the MOTA thoracotomy technique. Multiple variables were studied including; the neurological status of the patient preoperatively/postoperatively, the level and type of fracture, associated injuries, operative time, estimated blood loss, chest tube drainage (intercostal drainage), length of hospital stay (LOS), and complication rate. Results: In 22 patients (averaging 35.5 years of age), T9 and T12 vertebral fractures were most frequently encountered. There were 20 patients who had single level and 2 patients who had two-level fractures warranting corpectomies. Average operating time and blood loss for single-level corpectomy were 91.5 ± 14.5 min and 311 ml and 150 ± 18.6 min and 550 ml for two levels, respectively. Mean hospital stay was 5 days. About 95.45% of cases showed fusion at latest follow-up. Average preoperative kyphotic angle corrected from 34.2 ± 3.5° to 20.5 ± 1.0° postoperatively with an average correction of 41.1% and correction loss of 2.4%. Conclusion: We concluded that utilization of the MOTA technique was safe and effective for providing decompression/fusion of traumatic TBF.

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Laparoscopic nephrectomy: Moroccan experience of 68 cases

African Journal of Urology ◽

10.1186/s12301-021-00175-5 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Abdoulazizi Bilgo ◽

Amine Saouli ◽

Tarik Karmouni ◽

Khalid El Khader ◽

Abdellatif Koutani ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Intraoperative Complications ◽

Operating Time ◽

Length Of Hospital Stay ◽

Upper Urinary Tract ◽

Laparoscopic Nephrectomy ◽

Reliable Technique ◽

Average Hospital ◽

Estimated Blood Loss

Abstract Background The aim of this study was to analyze the feasibility and the safety of laparoscopic nephrectomy in the treatment of pathologies of the upper urinary tract through the experience of the Urology B department. Methods We have retrospectively and monocentrally selected patients who underwent laparoscopic nephrectomy from January 2017 to December 2019. The collection was carried out on archived files, based on demographic, clinical and perioperative data. The primary endpoint was the occurrence of complications and secondarily the length of the operation and the length of hospital stay. The statistical analysis was carried out using the SPSS software. Results A total of 68 patients were included in our series. The average age of our patients was 57.8 years. There was a slight female predominance: 39 female patients (57.4%) for 29 male patients (42.6%). Indications for nephrectomy were dominated by renal tumor (33.82%) followed by lithiasis (16.17%) and non-functioning kidney (16.17%) at the same rank. During the study period, 31 (45.6%) simple nephrectomy, 26 (38.2%) total nephrectomy, 1 (1.5%) partial nephrectomy and 10 (14.7%) nephroureterectomy were performed in our department. In our series, the average operating time was 180 min. Estimated blood loss averaged 321.8 ml with extremes of a few milliliter to 1100 ml. Intraoperative complications were reported in 10 (14.7%) patients; conversion was necessary in 6 cases (8.82%). The postoperative follow-up was straightforward in 53 (77.94%) patients with an average hospital stay of 3.6 days. The rate of postoperative complications according to Clavien–Dindo was 22.1%. Histological examination of the nephrectomies carried out in our department revealed mainly chronic non-specific pyelonephritis in 24 (35.3%) patients, followed by renal cell carcinoma in 23 (33.82%) patients and urothelial carcinoma in 9 (13.2%) patients. Conclusion Laparoscopic nephrectomy appears to be an efficient and reliable technique. This technique has led to a significant improvement in operative morbidity, mainly represented by the length of hospital stay, operating time and blood loss.

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The Self-Retaining Barbed Suture for Parenchymal Repair in Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-Analysis

Surgical Innovation ◽

10.1177/1553350619856167 ◽

2019 ◽

Vol 26 (6) ◽

pp. 744-752

Author(s):

Hailun Zhan ◽

Chunping Huang ◽

Tengcheng Li ◽

Fei Yang ◽

Jiarong Cai ◽

...

Keyword(s):

Renal Function ◽

Blood Loss ◽

Hospital Stay ◽

Partial Nephrectomy ◽

Operative Time ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

The Self ◽

Barbed Suture ◽

Estimated Blood Loss

Objectives. The warm ischemia time (WIT) is key to successful laparoscopic partial nephrectomy (LPN). The aim of this study was to perform a meta-analysis comparing the self-retaining barbed suture (SRBS) with a non-SRBS for parenchymal repair during LPN. Methods. A systematic search of PubMed, Scopus, and the Cochrane Library was performed up to March 2018. Inclusion criteria for this study were randomized controlled trials (RCTs) and observational comparative studies assessing the SRBS and non-SRBS for parenchymal repair during LPN. Outcomes of interest included WIT, complications, overall operative time, estimated blood loss, length of hospital stay, and change of renal function. Results. One RCT and 7 retrospective studies were identified, which included a total of 461 cases. Compared with the non-SRBS, use of the SRBS for parenchymal repair during LPN was associated with shorter WIT ( P < .00001), shorter overall operative time ( P < .00001), lower estimated blood loss ( P = .02), and better renal function preservation ( P = .001). There was no significant difference between the SRBS and non-SRBS with regard to complications ( P = .08) and length of hospital stay ( P = .25). Conclusions. The SRBS for parenchymal repair during LPN can significantly shorten the WIT and overall operative time, decrease blood loss, and preserve renal function.

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Characterization of complications associated with open and endoscopic craniosynostosis surgery at a single institution

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.7.peds15187 ◽

2016 ◽

Vol 17 (3) ◽

pp. 361-370 ◽

Cited By ~ 38

Author(s):

Rowland H. Han ◽

Dennis C. Nguyen ◽

Brent S. Bruck ◽

Gary B. Skolnick ◽

Chester K. Yarbrough ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Csf Shunt ◽

Medical Complications ◽

Complication Rates ◽

Endoscopic Procedures ◽

Packed Red Blood Cells ◽

Estimated Blood Loss ◽

Csf Leakage

OBJECT The authors present a retrospective cohort study examining complications in patients undergoing surgery for craniosynostosis using both minimally invasive endoscopic and open approaches. METHODS Over the past 10 years, 295 nonsyndromic patients (140 undergoing endoscopic procedures and 155 undergoing open procedures) and 33 syndromic patients (endoscopic procedures in 10 and open procedures in 23) met the authors’ criteria. Variables analyzed included age at surgery, presence of a preexisting CSF shunt, skin incision method, estimated blood loss, transfusions of packed red blood cells, use of intravenous steroids or tranexamic acid, intraoperative durotomies, procedure length, and length of hospital stay. Complications were classified as either surgically or medically related. RESULTS In the nonsyndromic endoscopic group, the authors experienced 3 (2.1%) surgical and 5 (3.6%) medical complications. In the nonsyndromic open group, there were 2 (1.3%) surgical and 7 (4.5%) medical complications. Intraoperative durotomies occurred in 5 (3.6%) endoscopic and 12 (7.8%) open cases, were repaired primarily, and did not result in reoperations for CSF leakage. Similar complication rates were seen in syndromic cases. There was no death or permanent morbidity. Additionally, endoscopic procedures were associated with significantly decreased estimated blood loss, transfusions, procedure length, and length of hospital stay compared with open procedures. CONCLUSIONS Rates of intraoperative durotomies and surgical and medical complications were comparable between endoscopic and open techniques. This is the largest direct comparison to date between endoscopic and open interventions for synostosis, and the results are in agreement with previous series that endoscopic surgery confers distinct advantages over open surgery in appropriate patient populations.

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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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POST OPERATIVE LESS COMPLICATIONS IN ROBOTIC DONOR NEPHRECTOMY WITH MINIMAL HOSPITAL STAY

10.36106/ijsr/4626656 ◽

2021 ◽

pp. 74-76

Author(s):

Vinay Mahendra ◽

Palash Saha ◽

J.B. Roy ◽

Tridibesh Mandal ◽

Debarshi Jana

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Donor Nephrectomy ◽

Postoperative Blood Loss ◽

Minimally Invasive Surgical ◽

Number Of Patients ◽

Widespread Acceptance ◽

Pain Duration ◽

Group 2

Introduction: Minimally invasive surgical procedures have gained widespread acceptance in the eld of living kidney donation over the last decade. Ratner et al. were the rst to describe laparoscopic donor nephrectomy (LDN). Since then, compared to open donor nephrectomy, LDN has demonstrated several improvements in terms of decreased postoperative pain, decreased length of hospital stay (LOS), rapid patient rehabilitation, reduced postoperative blood loss, and superior cosmetic results. Aims And Objective: The aim of this study is to study less complication in robotic Donor nephrectomy with Respect to clinical outcome which include pordoprade pain, time and minimal stay in hospital. Materials And Methods: This study had been conducted on patients admitted for Robotic Donor Nephrectomy. This study done at Apollo Gleneagles Hospital, Kolkata. Prospective study was carried out in cases performed between which includes number of patients. All patients were older then 20years for this study. Result And Analysis: It was found that 49 (96.1%) patients had under vein group1, and 2(3.9%) patient had under vein group 2. 43 (84.3%) patients had under artery group1, and 8(15.7%) patient had under artery group 2. 1(2.0%) patient had acute graft rejection. 41 (80.4%) patients had Left site, and 10(19.6%) patient had Right site. Conclusion:Robotic donor Nephrotomy performed by the vinei Robot the use 7 Robot allows Minimum blood loss, Minimum OT time in their better result our study proven the ruperiority 7 then method and add then there were less complication. Pastopade pain Duration of hospital stay was less and return to regular life earlier so therefore Robot arrited Donor Nephrotomy is the method I choice for Renal tramplant Surgery.

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Single-Institution Early Experience and Learning Curve with Robotic Liver Resections

The American Surgeon ◽

10.1177/000313481908500143 ◽

2019 ◽

Vol 85 (1) ◽

pp. 115-119 ◽

Cited By ~ 2

Author(s):

Aviad Gravetz ◽

Iswanto Sucandy ◽

Chandler Wilfong ◽

Nirrita Patel ◽

Janelle Spence ◽

...

Keyword(s):

Liver Resection ◽

Blood Loss ◽

Learning Curve ◽

Intraoperative Complications ◽

Length Of Hospital Stay ◽

Early Experience ◽

Robotic Liver Resection ◽

Open Operation ◽

Estimated Blood Loss ◽

Posterosuperior Segment

Robotic liver resection is being introduced with its potential to overcome limitations of conventional laparoscopy. This study was undertaken to document early experience and learning curve of robotic liver resection in our institution. All patients undergoing liver resection between 2013 and 2017 were prospectively followed. Patients were divided into three consecutive tertiles (cohort I–III). Thirty-three patients underwent robotic liver resection within the study period. Twenty-four per cent of patients underwent formal right or left hemihepatectomy, 21 per cent underwent sectionectomy, 6 per cent underwent central hepatectomy, and the remainder underwent non-anatomical liver resection. Formal hemihepatectomy and right posterosuperior segment resection were undertaken in two patients in cohort I, four patients in cohort II, and four patients in cohort III. Two cases were converted to “open” operation. Operative time was 172 (194.5 ± 65.1) minutes in cohort I, 222 (247.8 ± 109.8) minutes in cohort II, and 280 (302.5 ± 84.9) minutes in cohort III, reflecting increasing degree of technical complexity. Estimated blood loss decreased significantly throughout the cohorts, being 400 mL, 200 mL, and 100 mL in cohorts I to III, respectively. Major intraoperative complications were not seen. Three patients experienced postoperative complications, resulting in a single mortality. Length of hospital stay was three days, with two patients being readmitted within 30 days. Robotic technique for liver resection is feasible and safe. It offers good short-term clinical outcomes, including for patients who require major liver resection. As the proficiency developed, a notable improvement in technically ability to undertake more complex resections with decreasing blood loss and minimal morbidity was seen.

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Posterior thoracic corpectomy with cage reconstruction for metastatic spinal tumors: comparing the mini-open approach to the open approach

Journal of Neurosurgery Spine ◽

10.3171/2014.12.spine14543 ◽

2015 ◽

Vol 23 (2) ◽

pp. 217-227 ◽

Cited By ~ 46

Author(s):

Darryl Lau ◽

Dean Chou

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Complication Rate ◽

Open Surgery ◽

Operative Time ◽

Spinal Metastases ◽

Open Group ◽

Open Approach ◽

Mini Open

OBJECT Spinal metastases most commonly affect the vertebral bodies of the spinal column, and spinal cord compression is an indication for surgery. Commonly, an open posterior approach is employed to perform a transpedicular costotransversectomy or lateral extracavitary corpectomy. Because of the short life expectancies in patients with metastatic spinal disease, decreasing the morbidity of surgical treatment and recovery time is critical. One potential approach to decreasing morbidity is utilizing minimally invasive surgery (MIS). Although significant advances have been made in MIS of the spine, data supporting the utility of MIS are still emerging. This study compared outcomes of patients who underwent mini-open versus traditional open transpedicular corpectomy for spinal metastases in the thoracic spine. METHODS A consecutive cohort from 2006 to 2013 of 49 adult patients who underwent thoracic transpedicular corpectomies for spinal metastases was retrospectively identified. Patients were categorized into one of 2 groups: open surgery and mini-open surgery. Mini-open transpedicular corpectomy was performed with a midline facial incision over only the corpectomy level of interest and percutaneous instrumentation above and below that level. The open procedure consisted of a traditional posterior transpedicular corpectomy. Chi-square test, 2-tailed t-test, and ANOVA models were employed to compare perioperative and follow-up outcomes between the 2 groups. RESULTS In the analysis, there were 21 patients who had mini-open surgery and 28 patients who had open surgery. The mean age was 57.9 years, and 59.2% were male. The tumor types encountered were lung (18.3%), renal/bladder (16.3%), breast (14.3%), hematological (14.3%), gastrointestinal tract (10.2%), prostate (8.2%), melanoma (4.1%), and other/unknown (14.3%). There were no significant intergroup differences in demographics, comorbidities, neurological status (American Spinal Injury Association [ASIA] grade), number of corpectomies performed, and number of levels instrumented. The open group had a mean operative time of 413.6 minutes, and the mini-open group had a mean operative time of 452.4 minutes (p = 0.329). Compared with the open group, the mini-open group had significantly less blood loss (917.7 ml vs 1697.3 ml, p = 0.019) and a significantly shorter hospital stay (7.4 days vs 11.4 days, p = 0.001). There was a trend toward a lower perioperative complication rate in the mini-open group (9.5%) compared with the open group (21.4%), but this was not statistically significant (p = 0.265). At follow-up, there were no significant differences in ASIA grade (p = 0.342), complication rate after the 30-day postoperative period (p = 0.999), or need for surgical revision (p = 0.803). The open approach had a higher overall infection rate of 17.9% compared with that in the mini-open approach of 9.5%, but this was not statistically significant (p = 0.409). CONCLUSIONS The mini-open transpedicular corpectomy is associated with less blood loss and shorter hospital stay compared with open transpedicular corpectomy. The mini-open corpectomy also trended toward lower infection and complication rates, but these did not reach statistical significance.

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Simple prostatectomy using the open and robotic approaches for lower urinary tract symptoms: A retrospective, case-control series

Canadian Urological Association Journal ◽

10.5489/cuaj.7351 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Dor Golomb ◽

Fernanda Gabrigna Berto ◽

Jennifer Bjazevic ◽

Jose A. Gomez ◽

Joseph L.K. Chin ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Functional Results ◽

Perioperative Outcomes ◽

Minimal Risk ◽

Complication Rates ◽

Control Series ◽

Estimated Blood Loss ◽

Simple Prostatectomy

Introduction: We aimed to assess the outcome of our series of simple prostatectomy using the open simple prostatectomy (OSP) and robotic-assisted simple prostatectomy (RASP) approaches, at our institution. Methods: A retrospective chart review of men who underwent OSP and RASP at Western University, in London, ON. Preoperative, intraoperative, and postoperative data were collected and analyzed. Results: From 2012–2020, 29 men underwent a simple prostatectomy at our institution. Eight patients underwent an OSP and 21 patients underwent a RASP. The median age was 69 years. Preoperative median prostate volume was 153 cm3 (range 80–432 cm3). The surgical indications were failed medical treatment, urinary retention, hydronephrosis, cystolithiasis, and recurrent hematuria. The median operative time was 137.5 minutes in OSP and 185 minutes in the robotic approach (p=0.04). Median estimated blood loss was 2300 ml (range 600–4000 ml) and 100 ml (range 50–400 ml) in the open and robotic procedures, respectively (p=0.4). The mean length of hospital stay was shorter in the RASP group, one day vs. three days (z=4.152, p<0.005). Perioperative complication rates were significantly lower in the group undergoing RASP, with no complications recorded in this group (p=0.004). Both groups demonstrated excellent functional results, with most patients reporting complete urinary continence (p=0.8). Conclusions: We report very good perioperative outcomes, with a minimal risk profile and excellent functional results, leading to marked improvement in patients' symptoms at followup after both the OSP and RASP approaches. RASP was associated with a shorter length of hospital stay, decreased blood loss, and a lower complication rate.

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