Hand-assisted Laparoscopic Nephrectomy: Evaluation of the Learning Curve

Baez-Suarez, Yenny; Amaya-Nieto, Javier; Girón-Luque, Fernando

doi:10.1016/j.transproceed.2019.10.010

Cited by 6 publications

(7 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Especially in medium‐sized centers like ours, it is easy suffering the perception of increased complications anytime we observed one. It certainly reflects the experience of a unit that can cope and adapt to rapidly increased case volumes with the inevitable, resultant numbers of complications 30,38 . Nevertheless, we found that urological complications rate remained low throughout the study period and comparable to other published series 39,40 .…”

Section: Discussionsupporting

confidence: 77%

“…Consistently maintaining cold ischemia time (CIT) below three hours has also undoubtedly played a role [35][36][37] This practice is shared by many transplant centers and reduces the inevitable stress on the mentored surgeon while maintaining the highest quality of the service without the effects of multiple learning curves. 30,38 Reported incidence of DGF after LDRT varies from 4% to 10%, depending on the series. 35 We noticed that DGF rate was higher after RP-HALDN than TP-HALDN (4.9% vs 1.3% Nevertheless, we found that urological complications rate remained low throughout the study period and comparable to other published series.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, we have consistently ensured the attendance of two senior consultants during the most crucial parts of the procedure thus allowing the surgeon to remain focused on the critical steps of the operation. This practice is shared by many transplant centers and reduces the inevitable stress on the mentored surgeon while maintaining the highest quality of the service without the effects of multiple learning curves 30,38 . Reported incidence of DGF after LDRT varies from 4% to 10%, depending on the series 35 .…”

Section: Discussionmentioning

confidence: 99%

“…More difficult dissection of the kidney and shorter renal vein have been the main factors behind this policy but longer donor operating time, more challenging vascular anastomosis in the recipient, and increased risk of DGF after transplantation have been also considered valid reasons for avoiding the right side. 4,35 Even though several reports have suggested that in medium-to high-volume centers with properly trained surgeons, both right-sided and multiple-vessel donor nephrectomies can be safely performed with a MIDN technique, 5,7,8,10,30,38 many transplant units remain concerned regarding right-sided MIDN. Our data support the use of TP-HALDN and RP-HALDN for right-sided and multiple-vessel kidneys because no differences in donor-or recipient-related outcomes could be detected.…”

Section: Discussionmentioning

confidence: 99%

“…Especially in medium-sized centers like ours, it is easy suffering the perception of increased complications anytime we observed one. It certainly reflects the experience of a unit that can cope and adapt to rapidly increased case volumes with the inevitable, resultant numbers of complications 30,38.…”

mentioning

confidence: 97%

See 4 more Smart Citations

Outcomes and surgical complications following living‐donor renal transplantation using kidneys retrieved with trans‐peritoneal or retro‐peritoneal hand‐assisted laparoscopic nephrectomy

Favi

Iesari

Catarsini

et al. 2020

Clinical Transplantation

View full text Add to dashboard Cite

The best minimally invasive procedure for living-donor kidney retrieval remains debated. Our objective was to assess trans-peritoneal (TP) and retro-peritoneal (RP) hand-assisted laparoscopic donor nephrectomy (HALDN). In this single-center retrospective study, we analyzed results from 317 living-donor renal transplants (RT) performed between 2008 and 2016. Donor and recipient outcomes were compared between TP-HALDN (n = 235) and RP-HALDN (n = 82). Conversion to open nephrectomy (0.4% vs 0%; P = 1.000), intra-operative complications (1.7% vs 1.2%; P = 1.000), and 1-year overall post-operative complications (11.9% vs 17.1%; P = .258) rates were similar in TP-HALDN and RP-HALDN. Overall surgical site infections were higher in RP-HALDN (6.1% vs 1.7%; P = .053), whereas incisional hernias were only recorded following TP-HALDN (3.4% vs 0%; P = .118). The duration of the procedure was 11-minute shorter for TP-HALDN than RP-HALDN (P < .001) but extraction time was equivalent (2, IQR 1.5-2.5 minutes; P = 1.000). RT following TP-HALDN and RP-HALDN showed comparable one-year death-censored allograft survival (97% vs 98.8%; P = .685), primary non-function (0.4% vs 0%; P = .290), delayed graft function (1.3% vs 4.9%; P = .077), and urological complications (2.6% vs 4.9%; P = .290) rates. In our series, donor and recipient outcomes were not substantially affected by the approach used for donor nephrectomy. TP-HALDN and RP-HALDN were both safe and effective. K E Y W O R D S complications, hand-assisted laparoscopic nephrectomy, kidney transplantation, minimally invasive surgery, organ donation, outcomes, surgical training, ureteric leakage, ureteric stenosis, warm ischemia time How to cite this article: Favi E, Iesari S, Catarsini N, et al. Outcomes and surgical complications following living-donor renal transplantation using kidneys retrieved with transperitoneal or retro-peritoneal hand-assisted laparoscopic nephrectomy.

show abstract

Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 97%

See 3 more Smart Citations

Outcomes and surgical complications following living‐donor renal transplantation using kidneys retrieved with trans‐peritoneal or retro‐peritoneal hand‐assisted laparoscopic nephrectomy

Favi

Iesari

Catarsini

et al. 2020

Clinical Transplantation

View full text Add to dashboard Cite

show abstract

Robotic donor nephrectomy: optimizing outcomes beyond the limitations of laparoscopy

Olumba

Vachharajani

et al. 2023

Surg Endosc

View full text Add to dashboard Cite

Utilizing the same incision for staged renal transplant in patients with polycystic kidney disease requiring hand‐assisted laparoscopic nephrectomy

Huynh

Yoon

Hort

et al. 2022

ANZ Journal of Surgery

View full text Add to dashboard Cite

Backgrounds: Many autosomal dominant polycystic kidney disease (ADPKD) patients undergo nephrectomy and subsequent renal transplantation. We report our outcomes after hand-assisted laparoscopic nephrectomy (HALN) where a Rutherford-Morrison incision is used as a hand-port site and kidney extraction site, as well the future incision site for staged transplantation. Methods: A retrospective review was performed on all adult nephrectomies for ADPKD by the Transplant Surgery department at Westmead Hospital between June 2011 and June 2021. Outcomes were compared between HALN, laparoscopic nephrectomy (LN) and open nephrectomy (ON) including operation time, hospital length of stay (LOS), post-operative complications, subsequent transplantation and post-transplantation wound complications. Results: Twenty-two HALN, 8 LN and 5 ON were performed during the study period. Median kidney weights for HALN, LN and ON were significantly different (1575, 403, 3420 g respectively, P = 0.001). There was a significant difference in LOS between the HALN and ON (5.8 versus 9.8 days, P = 0.04), but not between HALN and LN (5.8 versus 5.1, P = 0.06). There was no significant difference for operation time (P = 0.34) and major complication rates (P = 0.58). There were 8 HALN, 5 LN and 2 ON who have had subsequent renal transplantation with one wound complication, an incisional hernia in the HALN group. Conclusion: Our HALN is associated with a shorter LOS and similar complication rate to ON and can be efficiently performed for significantly larger kidneys than LN without a significant difference in operation time or LOS. The same Rutherford-Morrison incision site can be used for transplantation.Previous transplant 3 (13.6%) 1 (20%) †Includes patients with multiple indications for nephrectomy.

show abstract

Hand-assisted Laparoscopic Nephrectomy: Evaluation of the Learning Curve

Cited by 6 publications

References 21 publications

Outcomes and surgical complications following living‐donor renal transplantation using kidneys retrieved with trans‐peritoneal or retro‐peritoneal hand‐assisted laparoscopic nephrectomy

Outcomes and surgical complications following living‐donor renal transplantation using kidneys retrieved with trans‐peritoneal or retro‐peritoneal hand‐assisted laparoscopic nephrectomy

Robotic donor nephrectomy: optimizing outcomes beyond the limitations of laparoscopy

Utilizing the same incision for staged renal transplant in patients with polycystic kidney disease requiring hand‐assisted laparoscopic nephrectomy

Contact Info

Product

Resources

About