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Laparoscopic Live Donor Nephrectomy (laparoscopic + live_donor_nephrectomy)

Distribution by Scientific Domains

Medical Sciences	100%

Distribution within Medical Sciences

Transplantation	58%
Urology	11%

Selected Abstracts

Giving Birth to an Operation: Laparoscopic Live Donor Nephrectomy with Vaginal Extraction.

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2010
Is This Misconceived?
Vaginal extraction of the kidney: the start of something new or only a case report? See article by Allaf et al on page 1473. [source]

Laparoscopic Live Donor Nephrectomy with Vaginal Extraction: Initial Report

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2010
M. E. Allaf
The recent decrease in the total number of living kidney transplants coupled with the increase in the number of candidates on the waiting list underscores the importance of eliminating barriers to living kidney donation. We report what we believe to be the first pure right-sided laparoscopic live donor nephrectomy with extraction of the kidney through the vagina. The warm ischemia time was 3 min and the renal vessels and ureter of the procured kidney were of adequate length for routine transplantation. The donor did not receive any postoperative parenteral narcotic analgesia, was discharged home within 24 h and was back to normal activity in 14 days. The kidney functioned well with no complications or infections. Laparoscopic live donor nephrectomy with vaginal extraction may be a viable alternative to open and standard laparoscopic approaches. Potential advantages include reduced postoperative pain, shorter hospital stay and convalescence and a more desirable cosmetic result. These possible, but yet unproven, advantages may encourage more individuals to consider live donation. [source]

The Detrimental Effect of Poor Early Graft Function After Laparoscopic Live Donor Nephrectomy on Graft Outcomes

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2009
J. M. Nogueira
We undertook this study to assess the rate of poor early graft function (EGF) after laparoscopic live donor nephrectomy (lapNx) and to determine whether poor EGF is associated with diminished long-term graft survival. The study population consisted of 946 consecutive lapNx donors/recipient pairs at our center. Poor EGF was defined as receiving hemodialysis on postoperative day (POD) 1 through POD 7 (delayed graft function [DGF]) or serum creatinine , 3.0 mg/dL at POD 5 without need for hemodialysis (slow graft function [SGF]). The incidence of poor EGF was 16.3% (DGF 5.8%, SGF 10.5%), and it was stable in chronologic tertiles. Poor EGF was independently associated with worse death-censored graft survival (adjusted hazard ratio (HR) 2.15, 95% confidence interval (CI) 1.34,3.47, p = 0.001), worse overall graft survival (HR 1.62, 95% CI 1.10,2.37, p = 0.014), worse acute rejection-free survival (HR 2.75, 95% CI 1.92,3.94, p < 0.001) and worse 1-year renal function (p = 0.002). Even SGF independently predicted worse renal allograft survival (HR 2.54, 95% CI 1.44,4.44, p = 0.001). Risk factors for poor DGF included advanced donor age, high recipient BMI, sirolimus use and prolonged warm ischemia time. In conclusion, poor EGF following lapNx has a deleterious effect on long-term graft function and survival. [source]

Laparoscopic Live Donor Nephrectomy: A Risk Factor for Delayed Function and Rejection in Pediatric Kidney Recipients?

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 1 2005
A UNOS Analysis
The impact of laparoscopic (vs. open) donor nephrectomy on early graft function and survival in pediatric kidney recipients (,18 years) is unknown. We studied 995 pediatric live donor txs reported to UNOS from January 2000 to June 2002, in two recipient age groups: 0,5 years (n = 212, 44% laparoscopic donors [LapD]) and 6,18 years (n = 783, 50% LapD). Delayed graft function (DGF) rates were higher for LapD versus open donor (OpD) txs (0,5 years, 12.8% vs. 2.5%[p = 0.004]; 6,18 years, 5.9% vs. 2.8%[p = 0.03]). Acute rejection incidence for LapD versus OpD txs was higher at 6 months for recipients 0,5 years (18.6% vs. 5.9%, p = 0.01) and 6,18 years (22.5% vs. 15.6%, p = 0.03), and 1 year for recipients 0,5 years (24.3% vs. 7.9%, p = 0.004). In multivariate analyses, significant independent risk factors for rejection at 6 months and 1 year were recipient age 6,18 years, pretx dialysis, LapD nephrectomy and DGF. Graft survival was similar for LapD versus OpD txs. In this retrospective UNOS database analysis, LapD procurement was associated with increased DGF and an independent risk factor for rejection during the first year, particularly for recipients 0,5-years old. Future investigations must confirm these findings and identify strategies to optimize procurement and pediatric recipient outcome. [source]

Concomitant Surgery With Laparoscopic Live Donor Nephrectomy

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2003
Ernesto 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]

Laparoscopic Live Donor Nephrectomy with Vaginal Extraction: Initial Report

Laparoscopic live donor nephrectomy

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 11 2003
N. R. Brook
Removing disincentives to donation [source]

A systematic review of hand-assisted laparoscopic live donor nephrectomy

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2004
P. Dasgupta
Summary We provide a systematic review of hand-assisted laparoscopic live donor nephrectomy (HALDN), a relatively new procedure. Medline search of HALDN between 1995 and 2002 was conducted. Published studies were scored by two independent assessors using a modified form of 11 generic questions. All questions required one of three responses: 0 , criterion not reported, 1 , criterion reported but inadequate, 2 , criterion reported and adequate. The studies were placed according to their scoRes in category A (score 20,22), category B (17,19) and category C (16 or less). Higher scores indicate better quality of studies. Where possible, statistical analysis of comparative data was performed. Most reports of HALDN are expert series, some comparative and a few prospective. There was good correlation between the assessors (r = 0.91), and of the seven published series on HALDN, two fell into category B and five into category C. At present, there is only one published randomised-controlled trial of HALDN vs. open donor nephrectomy; this is the only such trial in laparoscopic urology. HALDN allows kidneys to be harvested with short operating and warm ischaemia times and fewer ureteric complications. HALDN is a relatively new and effective technique, designed to make kidney donation more attractive and minimally invasive without affecting recipient outcomes. More prospective data of this technique is needed, and wide variation in reported outcome parameters need to be standardised to allow meaningful comparison. [source]

Complete robotic-assistance during laparoscopic living donor nephrectomies: An evaluation of 38 procedures at a single site

INTERNATIONAL JOURNAL OF UROLOGY, Issue 11 2007
Jacques Hubert
Objective: To evaluate our initial experience with entirely robot-assisted laparoscopic live donor (RALD) nephrectomies. Methods: From January 2002 to April 2006, we carried out 38 RALD nephrectomies at our institution, using four ports (three for the robotic arms and one for the assistant). The collateral veins were ligated, and the renal arteries and veins clipped, after completion of ureteral and renal dissection. The kidney was removed via a suprapubic Pfannenstiel incision. A complementary running suture was carried out on the arterial stump to secure the hemostasis. Results: Mean donor age was 43 years. All nephrectomies were carried out entirely laparoscopically, without complications and with minimal blood loss. Mean surgery time was 181 min. Average warm ischemia and cold ischemia times were 5.84 min and 180 min, respectively. Average donor hospital stay was 5.5 days. None of the transplant recipients had delayed graft function. Conclusions: Robot-assisted laparoscopic live donor nephrectomy can be safely carried out. Robotics enhances the laparoscopist's skills, enables the surgeon to dissect meticulously and to prevent problematic bleeding more easily. Donor morbidity and hospitalization are reduced by the laparoscopic approach and the use of robotics allows the surgeon to work under better ergonomic conditions. [source]

Laparoscopic Live Donor Nephrectomy with Vaginal Extraction: Initial Report

The Detrimental Effect of Poor Early Graft Function After Laparoscopic Live Donor Nephrectomy on Graft Outcomes

47 Comparison between open and laparoscopic live donor nephrectomy

BJU INTERNATIONAL, Issue 2006
S. 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]

Erratum to a letter by F. Mosimann, V. Bettschart and O.Martinet commenting on "Hand assisted laparoscopic live donor nephrectomy" (Br J Surg 2004; 91: 344-348)

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 8 2004
Article first published online: 27 JUL 200
The original article to which the Erratum refers was published in the June 2004 issue of British Journal of Surgery, and was the letter by F. Mosimann, V. Bettschart and O. Martinet commenting on "Hand assisted laparoscopic live donor nephrectomy" (Br J Surg 2004; 91: 344-348) (p. 779). Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Hand-assisted versus total laparoscopic live donor nephrectomy: comparison and technique evolution at a single center in Taiwan

CLINICAL TRANSPLANTATION, Issue 5 2010
I-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]