Learning Curve in Laparoscopic Living Donor Nephrectomy

To examine the learning curve of laparoscopic living donor nephrectomy (LLDN) in our institution. A retrospective review was performed for the initial 300 cases of laparoscopic living donor nephrectomy in Cipto Mangunkusumo Hospital from November 2011 to December 2015. The data was classified into three groups of 100 procedures. In the initial cases, the procedure was performed by one laparoscopic surgeon. After a series of cases, another laparoscopic surgeon began performing donor nephrectomy, followed by a third laparoscopic surgeon. Each procedure was performed by two laparoscopic surgeon. We evaluated 300 patients of laparoscopic living donor nephrectomy in our center and compared each group. The mean total operating time showed a significant decline in group 3 compared to group 1 (261.6±49 minutes vs. 239.7±36.4 minutes) (p = 0.001). The mean time to clip presented a decline in group 2 and 3 (172.5±44.1 minutes vs. 160.3±31.8 minutes vs. 146.4±34.7 minutes) (p < 0.05). The mean first warm ischemia times dropped from 6.3±3.6 minutes to 2.9±1.9 minutes to 2.0±0.6 minutes (p < 0.05). The median estimated intraoperative blood loss fell from 200 cc in group 1 to 100 cc in group 2 and 3 (p < 0.001). High volume of cases and direct mentoring system enhance the learning curve in LLDN procedure which was categorized as a very difficult procedure. The development of a successful laparoscopic live donor nephrectomy training programme can be achieved without significant detrimental effect to the patient provided the necessary steps are observed.

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Living-donor nephrectomy at Singapore General Hospital: Evolution of surgical techniques over the last two decades

Proceedings of Singapore Healthcare ◽

10.1177/2010105820974386 ◽

2020 ◽

Vol 29 (4) ◽

pp. 239-244

Author(s):

Edwin Jonathan Aslim ◽

Yun Le Linn ◽

Xinyan Yang ◽

Glenn Yang Han Ng ◽

Chui Wan Lee ◽

...

Keyword(s):

Living Donor ◽

Operating Time ◽

Surgical Techniques ◽

Donor Nephrectomy ◽

Surgical Morbidity ◽

Living Donor Nephrectomy ◽

Warm Ischaemia ◽

Singapore General Hospital ◽

The Mean ◽

Time Periods

Background: Laparoscopic living-donor nephrectomy is the current epitome of living kidney donation surgery. We review our experience in living-donor nephrectomies over the last 19 years, transitioning from open surgery to hand-assisted laparoscopy to full laparoscopic techniques. Methods: We retrospectively identified all living-donor nephrectomies performed at our institution from 1976 to 2018. The donors were categorised according to surgical techniques: open (ODN), hand-assisted laparoscopy (HALDN) and full laparoscopy (LDN). We reviewed changes in donor demographics over the years. Surgical outcomes between groups were compared from 2000 to 2018. We also compared the outcomes of LDN between different time periods to evaluate our learning curve. Results: A total of 214 living-donor nephrectomies were performed between 2000 and 2018. The majority were left sided (93%) and had single renal artery anatomy (90%). There were 22 ODN, 20 HALDN and 163 LDN cases. The mean operating time was 84±43, 151±32 and 179±37 minutes for ODN, HALDN and LDN, respectively ( p<0.001). There were no statistically significant differences in mean warm ischaemia times ( p=0.921) and length of hospital stay ( p=0.114) between groups. The overall 30-day surgical morbidity rate was 9.3%, with a major complications rate of 0.9%. The mean warm ischaemia time for LDN was significantly different ( p<0.001) between time periods: 281±260, 184±94 and 140±42 seconds for the periods between 2005–2009, 2010–2014 and 2015–2018, respectively. Conclusion: This study confirms the safety of living-donor nephrectomies performed at our institution, a centre with a modest volume of kidney transplants.

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Comparison of intraoperative hemodynamic parameters of recipients in adult living donor and deceased donor kidney transplantations

Yeni Üroloji Dergisi ◽

10.33719/yud.2021;16-2-850725 ◽

2021 ◽

pp. 178-183

Author(s):

Tümay Uludag Yanaral ◽

Pelin Karaaslan

Keyword(s):

Living Donor ◽

Deceased Donor ◽

Hemodynamic Parameters ◽

Cold Ischemia Time ◽

Cold Ischemia ◽

Donor Kidney ◽

Deceased Donor Kidney ◽

The Mean ◽

Group 2 ◽

Group 1

Objective: There are many studies on kidney transplant anesthesia, there is not enough data in the literature in terms of intraoperative parameters according to the donor type. In this study, we aimed to compare the intraoperative hemodynamic parameters in adult patients who underwent living-donor and deceased-donor kidney transplantation (KT). Material and Methods: The patients who underwent KT were divided into 2 groups according to the donor kidney type. Recipients who underwent deceased donor transplantation were included in the study as Group 1. Among the living donor kidney transplant recipients, the same number of patients with similar demographic data as Group 1 were designated as Group 2. Both groups were compared in terms of recorded data and intraoperative hemodynamic parameters. Results: Twenty-four patients were included in the study. The mean durations of dialysis were 81.6 ± 64.8 and 16.8 ± 17.4 months for Group 1 and Group 2, respectively (p = 0.001). The mean cold ischemia time was significantly longer in Group 1 than Group 2 (p = 0.001). The mean operative urine output for Group 1 and Group 2 were 87.3 ± 149.6 and 634.2 ± 534.5, respectively (p = 0.002). Mean arterial pressure, heart rate, peripheral oxygen saturation and CVP values were all comparable between the two groups. Conclusion: Cold ischemia time is longer and operative urine volume is lower in deceased donor transplants compared to living donor transplants. With good preoperative preparation, close intraoperative follow-up, and proper fluid management, similar intraoperative hemodynamic parameters are achieved in both types of donor recipients. Keywords: Anesthesia, cadaver, hemodynamic monitoring, kidney transplantation, living donors

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Full Robot-Assisted Living Donor Nephrectomy and Kidney Transplantation in a Twin Dedicated Operating Room: Initial Experience From a High-Volume Robotic Center

Surgical Innovation ◽

10.1177/1553350619835429 ◽

2019 ◽

Vol 26 (4) ◽

pp. 449-455 ◽

Cited By ~ 1

Author(s):

Giampaolo Siena ◽

Graziano Vignolini ◽

Andrea Mari ◽

Vincenzo Li Marzi ◽

Simone Caroassai ◽

...

Keyword(s):

Kidney Transplantation ◽

Operating Room ◽

Living Donor ◽

High Volume ◽

Late Complications ◽

Donor Nephrectomy ◽

Initial Experience ◽

Robot Assisted ◽

No Conversion ◽

Living Donor Nephrectomy

Purpose. To describe our initial experience with a full robot-assisted approach for living donor nephrectomy (RALDN) and kidney transplantation (RAKT) in a dedicated twin operating room. Methods. From January to December 2017, 5 cases of RALDN and RAKT were performed in a single high-volume robotic center. All patients underwent a standard left RALDN. The renal hilum was controlled with Hem-O-Lok clips (WECK) and the kidney extracted through a Pfannenstiel incision. RAKT was performed according to the Vattikuti Urology Institute–Medanta technique. Results. RALDN: median estimated blood loss was 182 mL (range = 80-450 mL), no postoperative blood transfusion was required. The median (range) warm ischemia time was 175 (90-220 seconds). No conversion was registered. Median console time was 143 minutes (range = 115-220 minutes). No major surgical intraoperative and postoperative early and late complications occurred. RAKT: all 5 patients successfully underwent RAKT. Median (range) console time was 230 (190-200) minutes, vascular suture time was 58.7 (48-73) minutes, cold ischemia time was 46.2 (30-88) minutes, and rewarming time was 61.2 (55-72) minutes. No conversion was required. No major surgical intraoperative and postoperative early and late complications occurred. Mean glomerular filtration rate at days 1, 3, and 7 postoperatively was 26, 42, and 57 (range = 6-90) mL/min/1.73 m2, respectively. No case of delayed graft function was observed. No anastomosis revision, urological complications, lymphocele, and surgical site infection occurred. Conclusions. In our experience, RALDN and RAKT are safe and effective. The intuitiveness of the robotic approach provided substantial benefits both for the living donor and recipient from the very beginning of our series. No intraoperative and postoperative complications occurred.

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Super-mini percutaneous nephrolithotomy (SMP) vs retrograde intrarenal surgery (RIRS) in the management of renal calculi ≤ 2 cm: a propensity matched study

World Journal of Urology ◽

10.1007/s00345-021-03860-w ◽

2021 ◽

Author(s):

Sunil Bhaskara Pillai ◽

Arun Chawla ◽

Jean de la Rosette ◽

Pilar Laguna ◽

Rajsekhar Guddeti ◽

...

Keyword(s):

Hospital Stay ◽

Pain Score ◽

Final Analysis ◽

High Volume ◽

Renal Calculi ◽

Complication Rates ◽

Retrograde Intrarenal Surgery ◽

The Mean ◽

Group 2 ◽

Group 1

Abstract Objective To compare the effectiveness and safety of Super-Mini PCNL (SMP) and Retrograde Intrarenal Surgery (RIRS) in the management of renal calculi ≤ 2 cm. Patients and methods A prospective, inter-institutional, observational study of patients presenting with renal calculi ≤ 2 cm. Patients underwent either SMP (Group 1) or RIRS (Group 2) and were performed by 2 experienced high-volume surgeons. Results Between September 2018 and April 2019, 593 patients underwent PCNL and 239 patients had RIRS in two tertiary centers. Among them, 149 patients were included for the final analysis after propensity-score matching out of which 75 patients underwent SMP in one center and 74 patients underwent RIRS in the other. The stone-free rate (SFR) was statistically significantly higher in Group 1 on POD-1 (98.66% vs. 89.19%; p = 0.015), and was still higher in Group 1 on POD-30 (98.66% vs. 93.24%, p = 0.092) SFR on both POD-1 and POD-30 for lower pole calculi was higher in Group 1 (100 vs. 82.61%, p = 0.047 and 100 vs 92.61% p = 0.171). The mean (SD) operative time was significantly shorter in Group 1 at 36.43 min (14.07) vs 51.15 (17.95) mins (p < 0.0001). The mean hemoglobin drop was significantly less in Group 1 (0.31 vs 0.53 gm%; p = 0.020). There were more Clavien–Dindo complications in Group 2 (p = 0.021). The mean VAS pain score was significantly less in Group 2 at 6 and 12 h postoperatively (2.52 vs 3.67, 1.85 vs 2.40, respectively: p < 0.0001), whereas the mean VAS pain score was significantly less in Group 1 at 24 h postoperatively (0.31 vs 1.01, p < 0.0001). The mean hospital stay was significantly shorter in Group 1 (28.37 vs 45.70 h; p < 0.0001). Conclusion SMP has significantly lower operative times, complication rates, shorter hospital stay, with higher stone-free rates compared to RIRS. SMP is associated with more early post-operative pain though.

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