A retrospective analysis of complications of laparoscopic left donor nephrectomy using the Kocak's modification of Clavien-Dindo system

Abstract

Introduction:Kocak described a modification of Clavien-Dindo classification system (CDCS) for reporting procedure-related complications in laparoscopic donor nephrectomy (LDN). We used the Kocak modification in grading and reporting the severity of complications in patients who underwent LDN and in evaluating various parameters that predict them.Methods:In all, 1430 patients who underwent left LDN from 2000 to 2016 were included in this study. All data was retrospectively collected and analyzed for complications occurring in the postoperative period. All complications were classified according to the four grades of Kocak-modified CDCS.Results:124 patients (8.6%) suffered a total of 235 postoperative complications. Most of the complications were Grade I and Grade II (Grade I: 79.5% [n = 187] and Grade II 16.2% [n = 38]), 2.5% of the complications were Grade III (n = 6) and Kocak Grade IVa complications occurred in three patients. There was one death (Grade IVb: 0.4%, overall mortality rate: 0.06%). The incidence of complications was significantly greater for male patients, those with body mass index ≥25 kg/m2, and if the operating surgeon had ≤ 1 year of experience in performing LDN surgery.Conclusion:LDN is a safe procedure with low morbidity. The rate of complications is 8.6% and most of these complications are of low grade. The use of a standardized system for reporting the complications of LDN allows appropriate comparison between reported data.

Safety and Intraoperative Results in Live Kidney Donors with Vascular Multiplicity After Hand-Assisted Laparoscopy Living Donor Nephrectomy

“… 18 Our classification of the perioperative complications by the modified Clavien system is similar to the results reported in the literature with HALDN and different donor nephrectomy techniques. 22 , 39 , 40 Compared to our results, a retrospective study with 700 kidney live donors with HALDN calculated the modified Clavien gradient system with a higher incidence of grade 1 complications than our study, but the lower incidence in the other categories. 19 …”

Comparing the complications of laparoscopically performed simple, radical and donor nephrectomy

“…Considering that the frequency of complications and the length of hospital stay may be correlated, it is rather evident that the shorter duration of hospital stay in our study is associated with the presence of fewer complications. Among the studies evaluating only LDN results, Treat et al reported 7.9% (6.1% grade 1) complication frequency, and 1.37 (1-10) days of hospital stay [20], Schold et al reported 7.9% complication frequency [21], Srivastava et al reported 8.6% postoperative complication rate (the majority being grade 1), and 3.8 ± 10.5 days of hospital stay [22]. In studies evaluating the frequency of complications with different methods, an overall higher frequency of complications has been reported [23][24][25].…”

Arterias y venas múltiples en injertos renales. Revisión de literatura sobre la anatomía y embriología en variantes vasculares renales y sobre los resultados en donación y trasplante de riñones con vascularidad múltiple

“…30 Para estadificar las complicaciones de manera cualitativa, se usa la clasificación de Clavien-Dindo. 24,28,31 Con esta clasificación, el porcentaje de complicaciones postquirúrgicas en los donantes de un injerto con vasculatura convencional se divide en: grado I en un 10%; grado II en 8%; grado III en 7%, y grado IV en 0.3%. Cuando se realiza la comparación con las complicaciones postquirúrgicas en los donantes vivos de un injerto con vasculatura múltiple, éstas se dividen en: grado I en 6%; grado II en 11%; grado III en 9%, y grado IV en 0.8%.…”

“…Receptor de injerto con vasculatura convencional (%) 5 Injerto de vasculatura convencional Receptor de injerto con vasculatura múltiple (%) 5 Injerto de vasculatura múltiple (%) Creatinina (mg/dL) 1,5 (%) Creatinina (mg/dL) renal izquierda respecto a la derecha, la mayoría de los cirujanos de trasplantes prefieren el uso de injertos renales izquierdos. 12,18,24,28,29,31 En la actualidad, como parte del protocolo realizado a todo donador vivo previo a la cirugía, se realiza una angiotomografía renal. Este método de imagen permite visualizar la presencia de patologías intrínsecas de los riñones del donante vivo, y de igual modo sirve para definir la anatomía vascular renal.…”