Abbey B Gershbein1, Gerhard J Fuchs. 1. Endourology Institute, Cedars Sinai Medical Center, 8635 W. 3rd Street, Suite 1070, Los Angeles, CA 90048, USA. shsannon.piazza@cshs.org
Abstract
BACKGROUND AND PURPOSE: Laparoscopic nephrectomy may make kidney donation more attractive. Modifications such as hand assistance may improve surgical outcomes. We compared our initial experience with hand-assisted laparoscopic nephrectomy with that of the conventional laparoscopic technique. PATIENTS AND METHODS: Two series of similar patients underwent conventional laparoscopic donor nephrectomy (LDN; N = 15) or hand-assisted laparoscopic donor nephrectomy (HLDN; N = 29). Operative time, warm ischemia time, estimated blood loss, complications, analgesic use, postoperative recovery, and serum creatinine concentration were compared. RESULTS: Open conversion was required in one HLDN patient because of intra-abdominal adhesions, and this patient was excluded from further analysis. The operative time, time to kidney extraction, and warm ischemia time were significantly shorter in the HLDN group, averaging 204.8 v 275.7 minutes, 173.4 v 239.3 minutes, and 2 minutes 21 seconds v 3 minutes 45 seconds, respectively. The intraoperative complication rates were 3.6% and 13.3%, respectively (P = 0.07). The postoperative complication rates were 6.8% and 6.7%. All grafts were functioning at the end of the study period, and there were no differences in rejection episodes, need for dialysis, complications, or nadir creatinine concentration according to the method of harvest. CONCLUSIONS: Hand-assisted laparoscopic donor nephrectomy provides shorter operative and warm ischemia times without a significant increase in donor morbidity.
BACKGROUND AND PURPOSE: Laparoscopic nephrectomy may make kidney donation more attractive. Modifications such as hand assistance may improve surgical outcomes. We compared our initial experience with hand-assisted laparoscopic nephrectomy with that of the conventional laparoscopic technique. PATIENTS AND METHODS: Two series of similar patients underwent conventional laparoscopic donor nephrectomy (LDN; N = 15) or hand-assisted laparoscopic donor nephrectomy (HLDN; N = 29). Operative time, warm ischemia time, estimated blood loss, complications, analgesic use, postoperative recovery, and serum creatinine concentration were compared. RESULTS: Open conversion was required in one HLDN patient because of intra-abdominal adhesions, and this patient was excluded from further analysis. The operative time, time to kidney extraction, and warm ischemia time were significantly shorter in the HLDN group, averaging 204.8 v 275.7 minutes, 173.4 v 239.3 minutes, and 2 minutes 21 seconds v 3 minutes 45 seconds, respectively. The intraoperative complication rates were 3.6% and 13.3%, respectively (P = 0.07). The postoperative complication rates were 6.8% and 6.7%. All grafts were functioning at the end of the study period, and there were no differences in rejection episodes, need for dialysis, complications, or nadir creatinine concentration according to the method of harvest. CONCLUSIONS: Hand-assisted laparoscopic donor nephrectomy provides shorter operative and warm ischemia times without a significant increase in donor morbidity.
Authors: Denise M D Özdemir-van Brunschot; Michiel C Warlé; Michel F van der Jagt; Janneke P C Grutters; Sharon B C E van Horne; Heinrich J Kloke; Johannes A van der Vliet; Johan F Langenhuijsen; Frank C d'Ancona Journal: World J Urol Date: 2014-11-02 Impact factor: 4.226
Authors: Denise M D Özdemir-van Brunschot; Giel G Koning; Kees C J H M van Laarhoven; Mehmet Ergün; Sharon B C E van Horne; Maroeska M Rovers; Michiel C Warlé Journal: PLoS One Date: 2015-03-27 Impact factor: 3.240
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