Retroperitoneal Laparoscopic Live Donor Nephrectomy:Report of 105 Cases

Retroperitoneal laparoscopic live donor nephrectomy offers an intrinsic advantage over conventional transperitoneal laparoscopic nephrectomy because of the potentially lower risk for early and late donor intraperitoneal complications.Herein we presented our experience performing retroperitoneal laparoscopic live donor nephrectomy in 105 donors.All donor nephrectomy was successful.There were no donor deaths and no conversion to open surgery.Mean operation time was 112 min（range,70-200 min）.Intraoperative blood loss was 10-150 mL with an average of 30 mL.Warm ischemia time was 1.3 to 6 min with an average of 3.1 min.Postoperative retroperitoneal hematoma occurred in only one case and there were no other surgical complications.Donors were discharged from the hospital 5 to 10 days postoperation.Average postoperative hospital stay was 6.4 days.One graft was removed due to acute rejection.Delayed graft function occurred in two recipients but renal function returned to normal within four weeks.The other recipients had normal renal function in two weeks except three recipients in four weeks.We believe that retroperitoneal laparoscopic live donor nephrectomy is safe,reliable,and less invasive.

Robot-assisted kidney transplantation:Is it getting ready for prime time?

Kidney transplantation(KT)is the treatment of choice for patients with end-stage renal disease,providing a better survival rate and quality of life compared to dialysis.Despite the progress in the medical management of KT patients,from a purely surgical standpoint,KT has resisted innovations during the last 50 years.Recently,robot-assisted KT(RAKT)has been proposed as an alternative approach to open surgery,especially due to its potential benefits for fragile and immunocompromised recipients.It was not until 2014 that the role of RAKT has found value thanks to the pioneering Vattikuti Urology Institute-Medanta collaboration that conceptualized and developed a new surgical technique for RAKT following the Idea,Development,Exploration,Assessment,Long-term follow-up recommendations for introducing surgical innovations into real-life practice.During the last years,mirroring the Vattikuti-Medanta technique,several centers developed RAKT program worldwide,providing strong evidence about the safety and the feasibility of this procedure.However,the majority of RAKT are still performed in the living donor setting,as an“eligible”procedure,while only a few centers have realized KT through a robotic approach in the challenging scenario of cadaver donation.In addition,despite the spread of minimally-invasive(predominantly robotic)surgery worldwide,many KTs are still performed in an open fashion.Regardless of the type of incision employed by surgeons,open KT may lead to nonnegligible risks of wound complications,especially among obese patients.Particularly,the assessment for KT should consider not only the added surgical technical challenges but also the higher risk of postoperative complications.In this context,robotic surgery could offer several benefits,including providing a better exposure of the surgical field and better instrument maneuverability,as well as the possibility to integrate other technological nuances,such as the use of intraoperative fluorescence vascular imaging with indocyanine green to assess the ureteral vascularization before the uretero-vesical anastomosis.Therefore,our review aims to report the more significant experiences regarding RAKT,focusing on the results and future perspectives.

Laparoscopic liver resection:Experience based guidelines

Laparoscopic liver resection(LLR) has been progressively developed along the past two decades. Despite initial skepticism, improved operative results made laparoscopic approach incorporated to surgical practice and operations increased in frequency and complexity. Evidence supporting LLR comes from case-series, comparative studies and meta-analysis. Despite lack of level 1 evidence, the body of literature is stronger and existing data confirms the safety, feasibility and benefits of laparoscopic approach when compared to open resection. Indications for LLR do not differ from those for open surgery. They include benign and malignant(both primary and metastatic) tumors and living donor liver harvesting. Currently, resection of lesions located on anterolateral segments and left lateral sectionectomy are performed systematically by laparoscopy in hepatobiliary specialized centers. Resection of lesions located on posterosuperior segments(1, 4a, 7, 8) and major liver resections were shown to be feasible but remain technically demanding procedures, which should be reserved to experienced surgeons. Hand-assisted and laparoscopy-assisted procedures appeared to increase the indications of minimally invasive liver surgery and are useful strategies applied to difficult and major resections. LLR proved to be safe for malignant lesions and offers some short-term advantages over open resection. Oncological results including resection margin status and long-term survival were not inferior to open resection. At present, surgical community expects high quality studies to base the already perceived better outcomes achieved by laparoscopy in major centers' practice. Continuous surgical training, as well as new technologies should augment the application of lap-aroscopic liver surgery. Future applicability of new technologies such as robot assistance and image-guided surgery is still under investigation.

Comparison of transperitoneal and retroperitoneal laparoscopic living donor nephrectomy

Since its introduction in 1995, laparoscopic living donor nephrectomy （LDN） has been shown to alleviate postoperative pain, shorten hospital stay, reduce loss and improve cosmesis while hastening the recovery of normal activities of donors. However, there has been much controversy over minimally invasive surgery with transperitoneal or retroperitoneal approach for nephrectomy. In this non-randomized retrospective study, we analyzed some parameters of the donors who had undergone transperitoneal LDN compared with those who had had retroperitoneoscopic nephrectomy.

活体肝移植的进展与展望

在全世界肝移植等待者数量不断增加情况下,开展活体肝移植能相对缓解供肝数量不足,扩大肝移植供肝池。与经典肝移植比较,活体肝移植手术操作更加复杂和要求更加精细,许多问题亟需进一步探讨和解决。笔者回顾性分析相关研究成果,结合自身临床实践,针对活体肝移植供者筛选与评估、供肝选择、手术革新和肝癌治疗进行讨论,从而为缓解供肝短缺、改善受者预后提供借鉴。