Comparison of three different techniques of extraction in laparoscopic donor nephrectomy

Abstract

Aim:We compare the outcome of three different methods of graft extraction after a laparoscopic donor nephrectomy.Materials and Methods:After a conventional five port laparoscopic donor nephrectomy, specimen was extracted through one of three approaches: 1. Iliac fossa (IF) incision and hand extraction, 2. Midline (MD) periumbilical with a lower polar fat stitch incorporating gonadal vein for traction while retrieval, and 3. Pfannensteil (PF) with Gel port extraction. Estimated blood loss, operating time, warm ischemia time, incision length, pain score, analgesic consumption, hospital stay, wound complications, graft complications and recipient creatinine at 6 weeks were analyzed.Results:Warm ischemia time was significantly reduced in PF group when compared to other groups. Length of the incision was less in the MD group compared to other groups. Wound complications were significantly less in PF group when compared to other groups. Graft extraction complications were significantly high in MD group compared to other two groups.Conclusion:Based on the results obtained, our current method of preference is by Pfannensteil incision. A controlled extraction with the use of a hand assist device would be best for donor safety and to avoid graft related complications.

Laparoscopic nephrectomy – Pfannenstiel or expanded port site specimen extraction: a systematic review and meta-analysis

“…The quality of included studies was generally low with randomisation occurring in only one study [ 8 ]. In the retrospective studies, there was no clear protocol for treatment allocation; this tended to be performed at the discretion of the surgeon.…”

“…Two studies, performing donor nephrecromy (DN) [ 8 , 9 ], found the procedure to be statistically longer in the PFN group ((two studies, 396 participants): 95% MD -10.21, 95% CI from -19.46 to -0.96, p = 0.03, I 2 = 0%). A limitation to this dataset is that Gupta [ 9 ] did not provide variance data and as such, the standard error was extrapolated from the provided p-value (0.15) to generate a t-value (SD = t/SE).…”

Iliac fossa vs Pfannenstiel retrieval incision in laparoscopic donor nephrectomy: A critical analysis

“…Whereas with a Pfannenstiel incision, the rectus abdominis muscles are retracted once the anterior rectus sheath is incised, thus requiring less time to approximate the muscles and the sheath. Gupta et al [10] and Adiyat et al [3] in their respective studies did not find a significant difference in mean operating time. Binsaleh et al [11] compared the Pfannenstiel incision with an extended port-site incision in laparoscopic radical nephrectomy and found no statistically significant difference in operative time.…”

“…This finding concurs with the finding in the Gupta et al [10] study (3 vs 3.5 min, P = 0.18). However, in the Adiyat et al [3] study, the WIT was significantly less in the Pfannenstiel-incision arm as compared to the iliac fossa-incision and midline-incision arms [mean (SD) 175 (59) vs 241 (62) vs 206 (49) s; P < 0.001]. In our present study, we additionally recorded the retrieval time, which was defined as the time from placement of first Hem-o-lok® clips (Weck Closure Systems, Research Triangle Park, NC, USA) on the renal artery until the time the kidney was extracted and placed on the ice slush.…”

“…Amongst the operative steps involved in LDN, graft retrieval is one of the most critical steps. The kidney can be retrieved through a Pfannenstiel, iliac fossa, midline periumbilical, or subcostal flank incision [3].…”