Retroperitoneoscopic Nephrectomy With a Modified Hand-assisted Approach

Capolicchio, John-Paul; Saemi, Arash M; Trotter, Samuel J.; Plante, Mark

doi:10.1016/j.urology.2010.05.046

Cited by 8 publications

(8 citation statements)

References 28 publications

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“…Because the retroperitoneal approach has a lower rate of complications, it is a feasible alternative to LDN [9,21,22]. To obtain maximum benefits, many investigators prefer HARPLDN, which combines these 2 techniques [1,9,18,23]. A large study of 413 cases in 4 centers concluded that the hand-assisted technique reduced the risk of intraabdominal complications even with significant differences in donor characteristics [23].…”

Section: Discussionmentioning

confidence: 99%

“…To obtain maximum benefits, many investigators prefer HARPLDN, which combines these 2 techniques [1,9,18,23]. A large study of 413 cases in 4 centers concluded that the hand-assisted technique reduced the risk of intraabdominal complications even with significant differences in donor characteristics [23]. In another study by Klop et al [10], all intraoperative complications were grade 1 or 2, non-life-threatening and without residual disability, which is similar to our findings for the modified HARPLDN.…”

Section: Discussionmentioning

confidence: 99%

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Modified Hand-Assisted Retroperitoneoscopic Living Donor Nephrectomy with a Mini-Open Muscle Splitting Gibson Incision

Zhu¹,

Lin²,

Guo³

et al. 2016

Urol Int

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Background: We aimed to confirm the advantages of a modified hand-assisted retroperitoneoscopic living donor nephrectomy (HARPLDN) compared to the performance of standard retroperitoneoscopic living donor nephrectomy (RPLDN). Methods: One hundred twenty-eight consecutive surgical cases were categorized into 2 groups, one receiving standard RPLDN (group 1) and one receiving modified HARPLDN (group 2). Perioperative factors of both groups were evaluated retrospectively, including donors' demographics, overall operating time, warm ischemia time (WIT), graft vessel length, blood loss, complications, pain visual analogue scale (VAS) scores, hospital stay, and matched recipients' perioperative outcomes. One-year follow-up data were also examined. Results: The standard RPLDN group (n = 44) and modified HARPLDN group (n = 84) had comparable age, gender, and body mass index. The RPLDN group donors had longer operative time, shorter vein length and longer WIT than the modified HARPLDN (all p < 0.001). RPLDN had higher VAS scores (p < 0.001), longer carminative time (p = 0.002) and higher morphine requirement (p = 0.039) than the modified HARPLDN. No complications occurred in either group. All recipients and grafts had survived at 1-year follow-up. Conclusion: The modified HARPLDN technique is safe and effective for living donor nephrectomy and has shorter operating time, shorter WIT and better pain control. Further study is required to evaluate donors' long-term quality of life and recipients' long-term outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Modified Hand-Assisted Retroperitoneoscopic Living Donor Nephrectomy with a Mini-Open Muscle Splitting Gibson Incision

Zhu¹,

Lin²,

Guo³

et al. 2016

Urol Int

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“…However, the procedure of retroperitoneoscopic surgery, where the main step is the management of the renal pedicle and the adrenal gland, is controversial and needs to improve [24,25]. During the surgery, adrenal gland-sparing is necessary in many cases, such as when tumors are located in the lower-middle part of the kidney, and for small RCC and renal pelvic tumors [26].…”

Section: Discussionmentioning

confidence: 99%

A modified adrenal gland-sparing surgery based on retroperitoneal laparoscopic radical nephrectomy

Zhang

Gao

et al. 2014

World J Surg Onc

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BackgroundThe objective of this study was to modify the adrenal gland-sparing strategy based on retroperitoneal laparoscopic radical nephrectomy by reviewing the anatomic relationship between the kidney and the adrenal gland.MethodsFrom June 2010 to October 2012, a total of 68 patients (45 males and 23 females) with localized renal cell carcinoma were treated at our hospital. The study included 35 cases that were right side and 33 cases that were left, and average patient age was 54.06 years. The average tumor size was 4.7 cm. Tumors were classified via the TNM staging system. All patients underwent adrenal gland-sparing surgery based on retroperitoneal laparoscopic radical nephrectomy.ResultsFor each patient, surgery was successful without conversion to open surgery. The average operative time was 56.65 ± 26.60 min, and the mean blood loss was 70.61 ± 60.96 ml. All patients were discharged from the hospital 3 to 8 days after surgery. During surgery, the adrenal gland was slightly lacerated in three cases and the peritoneum showed perforation in six cases. Only one case recurred during the study follow-up.ConclusionsBased on retroperitoneal laparoscopy radical nephrectomy, this effective adrenal gland-sparing surgery showed direct exposure of tissue and little interference of the upper pole of the kidney. Elevation of the adrenal gland could help with the complete dissection of the adrenal gland from the kidney. The separation of the kidney was rapid, simple and accurate. The probability of adrenal gland damage was reduced. This strategy is recommended for widespread use in T1-2 renal neoplasms.

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“…Several methods of endoscopic (including robotically assisted) nephrectomy have been introduced and have been shown to be relatively safe 28–38. Single-centre reports mainly concentrate on a single technology rather than providing unbiased comparisons of different methods 30 33–36. To our knowledge, no national prospective cohorts have yet reported on these issues, and those that are planned will compare only two methods 32…”

Section: Discussionmentioning

confidence: 99%

Prospective Swiss cohort study of living-kidney donors: study protocol

2011

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BackgroundOffering living kidney donation raised the concern that donors are exposed to unknown risks. All Swiss transplant centres therefore decided to start a prospective cohort study of living kidney donors in Switzerland. This paper describes the rationale for and implementation of this cohort study.Methods/designAll kidney donors in Switzerland are registered and examined before donation and biennially after donation starting in the first year after nephrectomy. Before each follow-up visit, the study centre sends a package to the kidney donor containing the health questionnaire, blood and urine tubes and a prepaid envelope for sending the samples to the central laboratory. The donor makes an appointment with their family physician, who examines the donor and reports findings such as pain and other complaints, blood pressure, creatinine, albumin, all major health events and the state of mental and social well-being to the study centre. The family doctor draws the blood sample and mails it with the urine sample in the prepaid envelope. All data are centrally managed. All abnormal findings in the follow-up of individual donors are regularly discussed with the principal investigator, and necessary clinical changes made and recorded in the database. The health insurance of the recipient covers all costs of the donor follow-up. The main outcomes are the occurrence of albuminuria, hypertension and renal insufficiency. The secondary outcomes are major somatic and social events such as death, cardiovascular disease, stroke and depression.DiscussionThis prospective cohort offers unique opportunities to assess the risks of living kidney donation and will allow us to examine the risks associated with the methods used for nephrectomy in Switzerland (various forms of open surgery and laparoscopic nephrectomy). The prospective collection of all clinically relevant data and the regular monitoring of donors will allow timely interventions at early stages before serious kidney and general health problems occur.

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Retroperitoneoscopic Nephrectomy With a Modified Hand-assisted Approach

Cited by 8 publications

References 28 publications

Modified Hand-Assisted Retroperitoneoscopic Living Donor Nephrectomy with a Mini-Open Muscle Splitting Gibson Incision

Modified Hand-Assisted Retroperitoneoscopic Living Donor Nephrectomy with a Mini-Open Muscle Splitting Gibson Incision

A modified adrenal gland-sparing surgery based on retroperitoneal laparoscopic radical nephrectomy

Prospective Swiss cohort study of living-kidney donors: study protocol

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