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Laparoscopic Donor Nephrectomy (laparoscopic + donor_nephrectomy)
Selected AbstractsResponse to: ,Injuries Incurred During Laparoscopic Donor Nephrectomy with the Endocatch Retrieval System'AMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2006K. Chavin No abstract is available for this article. [source] 47 Comparison between open and laparoscopic live donor nephrectomyBJU INTERNATIONAL, Issue 2006S. KALOUCAVA Introduction:, Renal replacement therapy is the best management for end stage renal failure. Laparoscopic Donor Nephrectomy (LDN), which is considered safe and effective, began in our unit in July 2003 with an average transplant rate of 12 per year. The aim of this study is to compare the donor morbidity, recovery and costs between Open Donor Nephrectomy (ODN) and LDN. Method:, A retrospective consecutive series of all Donor Nephrectomies since June 2002 were included in this study. Operative details, postoperative donor recovery, donor and recipients renal functions were reviewed. The total costs will also be calculated and compared. Results:, There were 18 LDN and 18 ODN (Total 36 cases) included in this series and equal number of male to female cases. Average operative time for ODN was 2.07 h and LDN was 3.36 h. There was no intra-operative conversion from LDN to ODN and no peri-operative morbidities in either group. The transplanted renal vessel lengths were also compared which showed an average artery length of 40 mm and vein length of 50 mm in the LDN group versus an average of 35 mm artery length and 30 mm vein length in the ODN group. The outcome of the recipient's renal function was not affected whether the donor had OPD or LDN. Average length of hospital stay was 6 days in ODN and 4.5 days in LDN. Costs data to follow. Conclusion:, Laparoscopic Donor Nephrectomy (LDN) is safe and effective in a smaller renal transplant unit. [source] Effect of donor pneumoperitoneum on early allograft perfusion following renal transplantation in pediatric patients: An intraoperative Doppler ultrasound studyPEDIATRIC TRANSPLANTATION, Issue 5 2008S. Dave Abstract:, Decreased perfusion and trauma during laparoscopic harvesting are proposed causative factors for DGF and rejection in children following renal transplantation with laparoscopic donor nephrectomy (LDN) allograft. We performed a retrospective review of 11 children who underwent LDN transplant and 11 preceding patients who underwent ODN transplant. Intraoperative DUS findings, creatinine values and clearance, time to nadir creatinine and AR episodes were compared. There were no significant differences in the BMI, vascular anatomy, side of nephrectomy, or warm ischemia time in the two groups. Mean follow-up duration was 11.4 and 30.4 months in LDN and ODN groups. DUS showed initial turbulent flow in five of the LDN and four of the ODN group with an average RI of 0.59 and 0.66 in the ODN and LDN groups, respectively (NS). Three patients in the ODN group had an abnormal RI compared to none in the LDN group (p = 0.034). The creatinine values, creatinine clearances (at 24 h, one, four wk and last follow-up) and AR episodes were similar in both groups. Pneumoperitoneum during LDN does not appear to have an adverse impact on early graft reperfusion. [source] Kidney and Pancreas Transplantation in the United States, 1999,2008: The Changing Face of Living DonationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4p2 2010D. A. Axelrod The waiting list for kidney transplantation continued to grow between 1999 and 2008, from 41 177 to 76 089 candidates. However, active candidates represented the minority of this increase (36 951,50 624, a 37% change), while inactive candidates increased over 500% (4226,25 465). There were 5966 living donor (LD) and 10 551 deceased donor (DD) kidney transplants performed in 2008. The total number of pancreas transplants peaked at 1484 in 2004 and has declined to 1273. Although the number of LD transplants increased by 26% from 1999 to 2008, the total number peaked in 2004 at 6647 before declining 10% by 2008. The rate of LD transplantation continues to vary significantly as a function of demographic and geographic factors, including waiting time for DD transplant. Posttransplant survival remains excellent, and there appears to be greater use of induction agents and reduced use of corticosteroids in LD recipients. Significant changes occurred in the pediatric population, with a dramatic reduction in the use of LD organs after passage of the Share 35 rule. Many strategies have been adopted to reverse the decline in LD transplant rates for all age groups, including expansion of kidney paired donation, adoption of laparoscopic donor nephrectomy and use of incompatible LD. [source] Chylous Ascites Requiring Surgical Intervention after Donor Nephrectomy: Case Series and Single Center ExperienceAMERICAN JOURNAL OF TRANSPLANTATION, Issue 1 2010J. Aerts Chylous ascites as a result of laparoscopic donor nephrectomy (LDN) is a rare complication that carries significant morbidity, including severe protein-calorie malnutrition and an associated immunocompromised state. We report a patient who underwent hand-assisted left LDN and subsequently developed chylous ascites. He failed conservative therapy including low-fat diet with medium-chain triglycerides (LFD/MCT) and oral protein supplementation as well as strict NPO status with intravenous (IV) total parenteral nutrition (TPN) and subcutaneous (SQ) somatostatin analogue administration. Laparoscopic re-exploration and intracorporeal suture ligation and clipping of leaking lymph channels successfully sealed the chyle leak. We review the literature to date including diagnosis, incidence, management options, psychosocial aspects and clinical outcomes of chylous ascites after LDN. [source] Laparoscopic Procurement of Kidneys with Multiple Renal Arteries is Associated with Increased Ureteral Complications in the RecipientAMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2005Jonathan T. Carter This study investigates the effect of renal artery multiplicity on donor and recipient outcomes after laparoscopic donor nephrectomy. Three-hundred and sixty-one sequential procedures were performed over a 4-year period. Forty-nine involved accessory renal arteries; of these, 36 required revascularization and 13 were small polar vessels and ligated. The 312 remaining kidneys with single arteries served as controls. Study variables included operative times, blood loss, hospital stay, graft function and donor and recipient complications. Kidneys with multiple revascularized arteries had a longer mean warm ischemia time (35.3 vs. 29.2 min, p = 0.0003), and more ureteral complications (6/36 vs. 10/312, p = 0.0013) than single-artery controls. In contrast, ligation of a small superior accessory artery had no significant effect on donor operative time, blood loss, or complication rate while providing similar recipient graft function compared to single-artery controls. Renal artery number is important in selecting the appropriate kidney for laparoscopic procurement. Given the current excellent results with right-sided donor nephrectomy, kidneys with single arteries should be preferentially procured, irrespective of side. [source] Concomitant Surgery With Laparoscopic Live Donor NephrectomyAMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2003Ernesto P. Molmenti Routine live donor evaluations reveal unexpected silent pathologies. Herein, we describe our experience treating such pathologies at the time of laparoscopic donor nephrectomy. We have not encountered any previous reports of such an approach. We prospectively collected data on 321 donors. Concomitant surgeries at the time of procurement included two laparoscopic adrenalectomies, one colposuspension, one laparoscopic cholecystectomy, and one liver biopsy. Mean operative time was 321 min (range 230,380), with a mean blood loss of 280 mL (range 150,500). No blood transfusions were required. The left kidney was procured in four cases. The right kidney was obtained on one occasion. Mean hospital stay was 3 days (median 3, range 2,4). No short- or long-term complications have been identified. Mean follow-up time was 2.63 years (median 2.76, range 2.23,2.99). Four of the five kidney recipients were first-time transplants who had not yet started dialysis. Simultaneous surgical interventions at the time of laparoscopic live kidney donation are safe and can be undertaken in selected cases. This practice is beneficial to both the donor and the recipient, and is likely to become more commonplace with changing practice patterns involving donor evaluation and management. [source] Hand-Assisted Laparoscopic Living-Donor Nephrectomy as an Alternative to Traditional Laparoscopic Living-Donor NephrectomyAMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2002Joseph F. Buell The benefits of laparoscopic living-donor nephrectomy (LDN) are well described, while similar data on hand-assisted laparoscopic living-donor nephrectomy (HALDN) are lacking. We compare hand-assisted laparoscopic living-donor nephrectomy with open donor nephrectomy. One hundred consecutive hand-assisted laparoscopic living-donor nephrectomy (10/98,8/01) donor/recipient pairs were compared to 50 open donor nephrectomy pairs (8/97, 1/00). Mean donor weights were similar (179.6 ± 40.8 vs. 167.4 ± 30.3 lb; p =,NS), while donor age was greater among hand-assisted laparoscopic living-donor nephrectomy (38.2 ± 9.5 vs. 31.2 ± 7.8 year; p <,0.01). Right nephrectomies was fewer in hand-assisted laparoscopic living-donor nephrectomy [17/100 (17%) vs. 22/50 (44%); p <,0.05]. Operative time for hand-assisted laparoscopic living-donor nephrectomy (3.9 ± 0.7 vs. 2.9 ± 0.5 h; p <,0.01) was longer; however, return to diet (6.9 ± 2.8 vs. 25.6 ± 6.1 h; p <,0.01), narcotics requirement (17.9 ± 6.3 vs. 56.3 ± 6.4 h; p <,0.01) and length of stay (51.7 ± 22.2 vs. 129.6 ± 65.7 h; p <,0.01) were less than open donor nephrectomy. Costs were similar ($11 072 vs. 10 840). Graft function and 1-week Cr of 1.4 ± 0.9 vs. 1.6 ± 1.1 g/dL (p =,NS) were similar. With the introduction of HALDN, our laparoscopic living-donor nephrectomy program has increased by 20%. Thus, similar to traditional laparoscopic donor nephrectomy, hand-assisted laparoscopic living-donor nephrectomy provides advantages over open donor nephrectomy without increasing costs. [source] Hand-assisted versus total laparoscopic live donor nephrectomy: comparison and technique evolution at a single center in TaiwanCLINICAL TRANSPLANTATION, Issue 5 2010I-Rue Lai Lai I-R, Yang C-Y, Yeh C-C, Tsai M-K, Lee P-H. Hand-assisted versus total laparoscopic live donor nephrectomy: comparison and technique evolution at a single center in Taiwan. Clin Transplant 2009 DOI: 10.1111/j.1399-0012.2009.01173.x. © 2009 John Wiley & Sons A/S. Abstract:, Purpose:, To compare the outcome of hand-assisted laparoscopic live donor nephrectomy (HLDN) and total laparoscopic live donor nephrectomy (TLDN) in a single center. Methods:, The demographics, complications, and outcomes were compared between successfully performed 51 HLDN and 42 TLDN. Results:, The patients' demographics including body mass index were all similar. Four conversions were excluded for the outcome analysis. The operation time of HLDN group (188 ± 62 min) was shorter, although not significantly, than that of TLDN group's (207 ± 30 min) (p = 0.065). However, the operation time of the first 24 cases (237 ± 66 min) was significantly longer than that of the later 69 performed (180 ± 35 min). The warm ischemia time was shorter in HLDN (2.5 ± 1.3 min) compared to that of TLDN (4.1 ± 1.7 min) (p < 0.01), but the serum creatinine values (mg/dL) of recipients were equivalent (HLDN/TLDN = 1.18 ± 0.3:1.14 ± 0.3, p = 0.587). There was no difference in the length of hospital stay (6.7 vs. 6.4 d, p = 0.475). There was no graft loss, but one ureter stricture (HLDN group) and one urinary leakage (TLDN group) were recorded. Conclusions:, Both HLDN and TLDN are effective and safe as reflected in graft functions and limited complications. There was a learning curve in establishing the technique of laparoscopic donor nephrectomy. [source] | ||||||||||