Objective Robotic-assisted live donor nephrectomy(LDN)is being gradually adopted across transplant centers.The left donor kidney is preferred over right due to anatomical factors and ease of procurement.We aimed to st...Objective Robotic-assisted live donor nephrectomy(LDN)is being gradually adopted across transplant centers.The left donor kidney is preferred over right due to anatomical factors and ease of procurement.We aimed to study donor and recipient outcomes after robotic procurement and subsequent open implantation of right and left kidneys.Methods All fully robotic LDNs and their corresponding open kidney transplants performed at our center between February 2016 and December 2021 were retrospectively analyzed.Results Out of 196 robotic LDN(49[right]vs.147[left]),10(5.1%)donors had intra-operative events(6.1%[right]vs.4.8%[left],p=0.71).None of the LDN required conversion to open surgery.The operative times were comparable for the two groups.Nausea(13.3%)was the most common post-operative complication.There was no mortality in either LDN group.Herein,we report our outcomes on 156 recipients(39 right and 117 left allografts)excluding robotic implants,exports,and pediatric recipients.There were no significant differences between right and left kidney recipients with respect to 1-year post-transplant patient survival(100.0%vs.98.1%,p=0.45)or graft survival(93.9%vs.97.1%,p=0.11),or delayed graft function(7.7%vs.5.1%,p=0.55).Conclusion Non-hand-assisted robotic live donor nephrectomies can be safely performed with excellent outcomes.Right LDN was not associated with higher incidence of complications compared to left LDN.Open implantation of robotically procured right renal allografts was not associated with higher risk of recipient complications.展开更多
AIM To compare laparoscopic and open living donor neph-rectomy, based on the results from a single center during a decade.METHODS This is a retrospective review of all living donor neph-rectomies performed at the Mass...AIM To compare laparoscopic and open living donor neph-rectomy, based on the results from a single center during a decade.METHODS This is a retrospective review of all living donor neph-rectomies performed at the Massachusetts General Hospital, Harvard Medical School, Boston, between 1/1998 - 12/2009. Overall there were 490 living donors, with 279 undergoing laparoscopic living donor nephrectomy （LLDN） and 211 undergoing open donor nephrectomy （OLDN）. Demographic data, operating room time, the effect of the learning curve, the number of conversions from laparoscopic to open surgery, donor preoperative glomerular fltration rate and creatinine （Cr）, donor and recipient postoperative Cr, delayed graft function and donor complications were analyzed. Statistical analysis was performed.RESULTSOverall there was no statistically significant differencebetween the LLDN and the OLDN groups regardingoperating time, donor preoperative renal function, donorand recipient postoperative kidney function, delayed graftfunction or the incidence of major complications. Whenthe last 100 laparoscopic cases were analyzed, there wasa statistically significant difference regarding operatingtime in favor of the LLDN, pointing out the importanceof the learning curve. Furthermore, another significantdifference between the two groups was the decreasedlength of stay for the LLDN （2.87 d for LLDN vs 3.6 d for OLDN）.CONCLUSION Recognizing the importance of the learning curve, this paper provides evidence that LLDN has a safety profle comparable to OLDN and decreased length of stay for the donor.展开更多
BACKGROUND Over the last few years,the deceased donor organ donation rate was declined or remained stable,whereas the live donor organ donation rate has increased to compensate for the demand.Minimally invasive techni...BACKGROUND Over the last few years,the deceased donor organ donation rate was declined or remained stable,whereas the live donor organ donation rate has increased to compensate for the demand.Minimally invasive techniques for live donor nephrectomy(LDN)have also improved the live donor kidney donation rates.This increase has led to an interest in the surgical procedures used for LDN.AIM To evaluate the LDN techniques performed in Turkey,the structure of surgical teams,and the training received.Additionally,the number of kidney transplantations at different centers,the surgeon experience level,differences in surgical approach during donor surgeries,and outcomes were assessed.METHODS A questionnaire was sent to the Turkish Ministry of Health-accredited transplant centers.It inquired of the number of LDN surgeries,surgical techniques,complications,optimization protocols,the experience of surgeons,and the training.Descriptive statistics were outlined as follows:Discrete numeric variables were expressed as medians(minimum-maximum),while categorical variables were shown as numbers and percentages.As a result of the goodness-of-fit tests,if the significance of the differences between the groups in discrete numerical variables for which the parametric test statistical assumptions were not met,data were analyzed with the Mann Whitney U test and theχ^(2)test.RESULTS The questionnaire was sent to 72 transplant centers,all of which replied.Five centers that reported not performing LDN procedures were excluded.Responses from the remaining 67 centers were analyzed.In 2019,the median number of kidney transplants performed was 45,and the median number of kidney transplants from living donors was 28(1-238).Eleven(16.5%)centers performed 5-10,while 34(50.7%)centers performed more than 100 live donor kidney transplants in 2019.While 19(28.4%)centers performed the LDN procedures using the open technique,48(71.6%)centers implemented minimally invasive techniques.Among the centers preferring minimally invasive techniques for LDN,eight(16.6%)used more than one surgical technique.The most and the least common surgical techniques were transperitoneal laparoscopic(43 centers,89.6%)and single port laparoscopic LDN(1 center,2.1%)techniques,respectively.A positive association was found between the performance of minimally invasive techniques and the case volume of a transplant center,both in the total number and live donor kidney transplants(15 vs 55,P=0.001 and 9 vs 42,P≤0001 respectively).The most frequently reported complication was postoperative atelectasis(n=33,49.2%).There was no difference between the techniques concerning complications except for the chyle leak.CONCLUSION Turkish transplant centers performed LDN surgeries successfully through various techniques.Centers implementing minimally invasive techniques had a relatively higher number of live donor kidney transplants in 2019.展开更多
文摘Objective Robotic-assisted live donor nephrectomy(LDN)is being gradually adopted across transplant centers.The left donor kidney is preferred over right due to anatomical factors and ease of procurement.We aimed to study donor and recipient outcomes after robotic procurement and subsequent open implantation of right and left kidneys.Methods All fully robotic LDNs and their corresponding open kidney transplants performed at our center between February 2016 and December 2021 were retrospectively analyzed.Results Out of 196 robotic LDN(49[right]vs.147[left]),10(5.1%)donors had intra-operative events(6.1%[right]vs.4.8%[left],p=0.71).None of the LDN required conversion to open surgery.The operative times were comparable for the two groups.Nausea(13.3%)was the most common post-operative complication.There was no mortality in either LDN group.Herein,we report our outcomes on 156 recipients(39 right and 117 left allografts)excluding robotic implants,exports,and pediatric recipients.There were no significant differences between right and left kidney recipients with respect to 1-year post-transplant patient survival(100.0%vs.98.1%,p=0.45)or graft survival(93.9%vs.97.1%,p=0.11),or delayed graft function(7.7%vs.5.1%,p=0.55).Conclusion Non-hand-assisted robotic live donor nephrectomies can be safely performed with excellent outcomes.Right LDN was not associated with higher incidence of complications compared to left LDN.Open implantation of robotically procured right renal allografts was not associated with higher risk of recipient complications.
文摘AIM To compare laparoscopic and open living donor neph-rectomy, based on the results from a single center during a decade.METHODS This is a retrospective review of all living donor neph-rectomies performed at the Massachusetts General Hospital, Harvard Medical School, Boston, between 1/1998 - 12/2009. Overall there were 490 living donors, with 279 undergoing laparoscopic living donor nephrectomy （LLDN） and 211 undergoing open donor nephrectomy （OLDN）. Demographic data, operating room time, the effect of the learning curve, the number of conversions from laparoscopic to open surgery, donor preoperative glomerular fltration rate and creatinine （Cr）, donor and recipient postoperative Cr, delayed graft function and donor complications were analyzed. Statistical analysis was performed.RESULTSOverall there was no statistically significant differencebetween the LLDN and the OLDN groups regardingoperating time, donor preoperative renal function, donorand recipient postoperative kidney function, delayed graftfunction or the incidence of major complications. Whenthe last 100 laparoscopic cases were analyzed, there wasa statistically significant difference regarding operatingtime in favor of the LLDN, pointing out the importanceof the learning curve. Furthermore, another significantdifference between the two groups was the decreasedlength of stay for the LLDN （2.87 d for LLDN vs 3.6 d for OLDN）.CONCLUSION Recognizing the importance of the learning curve, this paper provides evidence that LLDN has a safety profle comparable to OLDN and decreased length of stay for the donor.
文摘BACKGROUND Over the last few years,the deceased donor organ donation rate was declined or remained stable,whereas the live donor organ donation rate has increased to compensate for the demand.Minimally invasive techniques for live donor nephrectomy(LDN)have also improved the live donor kidney donation rates.This increase has led to an interest in the surgical procedures used for LDN.AIM To evaluate the LDN techniques performed in Turkey,the structure of surgical teams,and the training received.Additionally,the number of kidney transplantations at different centers,the surgeon experience level,differences in surgical approach during donor surgeries,and outcomes were assessed.METHODS A questionnaire was sent to the Turkish Ministry of Health-accredited transplant centers.It inquired of the number of LDN surgeries,surgical techniques,complications,optimization protocols,the experience of surgeons,and the training.Descriptive statistics were outlined as follows:Discrete numeric variables were expressed as medians(minimum-maximum),while categorical variables were shown as numbers and percentages.As a result of the goodness-of-fit tests,if the significance of the differences between the groups in discrete numerical variables for which the parametric test statistical assumptions were not met,data were analyzed with the Mann Whitney U test and theχ^(2)test.RESULTS The questionnaire was sent to 72 transplant centers,all of which replied.Five centers that reported not performing LDN procedures were excluded.Responses from the remaining 67 centers were analyzed.In 2019,the median number of kidney transplants performed was 45,and the median number of kidney transplants from living donors was 28(1-238).Eleven(16.5%)centers performed 5-10,while 34(50.7%)centers performed more than 100 live donor kidney transplants in 2019.While 19(28.4%)centers performed the LDN procedures using the open technique,48(71.6%)centers implemented minimally invasive techniques.Among the centers preferring minimally invasive techniques for LDN,eight(16.6%)used more than one surgical technique.The most and the least common surgical techniques were transperitoneal laparoscopic(43 centers,89.6%)and single port laparoscopic LDN(1 center,2.1%)techniques,respectively.A positive association was found between the performance of minimally invasive techniques and the case volume of a transplant center,both in the total number and live donor kidney transplants(15 vs 55,P=0.001 and 9 vs 42,P≤0001 respectively).The most frequently reported complication was postoperative atelectasis(n=33,49.2%).There was no difference between the techniques concerning complications except for the chyle leak.CONCLUSION Turkish transplant centers performed LDN surgeries successfully through various techniques.Centers implementing minimally invasive techniques had a relatively higher number of live donor kidney transplants in 2019.
