Altering the Approach: Open Minimally Invasive Renal Transplant in Obese Patients Through the Anterior Rectus Sheath

Phillips, Stephen; Hill, Sharon; Lipscomb, Lorie; Africa, Joseph

doi:10.1016/j.urology.2017.03.011

Cited by 7 publications

(4 citation statements)

References 15 publications

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“…MIKT, using a 7–9 cm transverse incision, 3–5 cm above the inguinal ligament, was first described in 21 kidney transplants by Oyen in 2006 ( 6 ). Kim ( 5 ), Kacar ( 9 ), and other similar series published later confirmed that MIKT is feasible and safe ( 10 ). Although there are few publications about MIKT in adults, we believe that SMIPKT is feasible and a more obvious choice for several reasons.…”

Section: Discussionmentioning

confidence: 76%

Super-Minimal Incision Technique in Pediatric Kidney Transplantation: A Paired Kidney Analysis

et al. 2022

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BackgroundRecently, the demand for minimally invasive techniques in kidney transplantation (MIKT) has increased. However, there is only a limited number of studies on MIKT, especially in pediatric kidney transplants. Hence, we evaluated whether there is a difference between the super-minimal incision technique in pediatric kidney transplantation (SMIPKT) and conventional kidney transplantation (CKT).MethodsBetween December 2018 and November 2021, 34 patients who underwent pediatric kidney transplantation with a follow-up of 1 month were enrolled. A paired kidney analysis was performed to minimize donor variability and bias. The SMIPKT and CKT groups included 17 patients.ResultsThere was no difference in baseline clinical characteristics, including age, sex, the donor/ recipient weight ratio (DRWR), choice of dialysis modality, pretransplant dialysis time, BMI, renal artery number, cause of ESRD, DGF, length of the kidney and cold ischemic time, tacrolimus concentration at 3 and 7 days, serum creatinine at 1 month and postoperative complication rate between the SMIPKT and CKT groups (all P > 0.05). However, the length of the incision, operation time, intraoperative bleeding, postoperative drainage volume within 24 h and Vancouver scar scale at 1 month were statistically significant (all P < 0.05).ConclusionCompared with CKT, our results indicated that SMIPKT showed more satisfactory cosmetic results, shorter SMIPKT operating time, and reduced intraoperative bleeding and postoperative drainage volume within 24 h. There were also no statistical differences in postoperative complications. Hence, we suggest that SMIPKT is an appropriate method for pediatric kidney transplantation.

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Section: Discussionmentioning

confidence: 76%

Super-Minimal Incision Technique in Pediatric Kidney Transplantation: A Paired Kidney Analysis

et al. 2022

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“…The ARS has been previously described by Phillips et al 8 . A supplementary video demonstrating the technique is included.…”

Section: Methodsmentioning

confidence: 99%

“…The ARS has been previously described by Phillips et al 8 A supplementary video demonstrating the technique is included. A 7−12 cm oblique skin incision 2−5 cm above and parallel to the inguinal ligament is made (Figure 1A).…”

Section: Interventionmentioning

confidence: 99%

“…One method to decrease WRC is via modifications in surgical technique. The anterior rectus sheath approach (ARS) to kidney transplantation, an open minimally‐invasive technique, has been previously shown to significantly decrease WRC in obese patients when compared to the conventional Gibson approach (GA) without compromising graft outcomes 8 . Moreover, as opposed to other minimally‐invasive techniques, the ARS does not require novel equipment or expertise in laparoscopy or robotic surgery to perform.…”

Section: Introductionmentioning

confidence: 99%

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Wound related complications and the anterior rectus sheath versus Gibson approach to kidney transplantation: A single center randomized controlled trial

Murthy

Fascelli

Lyon

et al. 2023

Clinical Transplantation

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IntroductionWound related complications (WRC) are a significant source of morbidity in kidney transplant recipients, and may be mitigated by surgical approach. We hypothesize that the anterior rectus sheath approach (ARS) may decrease WRC and inpatient opiate use compared to the Gibson Approach (GA).MethodsThis double‐blinded randomized controlled trial allocated kidney transplant recipients aged 18 or older, exclusive of other procedures, 1:1 to ARS or GA at a single hospital. The ARS involves a muscle‐splitting paramedian approach to the iliopsoas fossa, compared to the muscle‐cutting GA. Patients and data analysts were blinded to randomization.ResultsSeventy five patients were randomized to each group between August 27, 2019 and September 18, 2020 with a minimum 12 month follow‐up. There was no difference in WRC between groups (p = .23). Nine (12%) and three patients (4%) experienced any WRC in the ARS and GA groups, respectively. Three and one Clavien IIIb complications occurred in the ARS and GA groups, respectively. In a multiple linear regression model, ARS was associated with decreased inpatient opioid use (β = –58, 95% CI: –105 to –12, p = .016).ConclusionsThe ARS did not provide a WRC benefit in kidney transplant recipients, but may be associated with decreased inpatient opioid use.

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Incisional hernias post renal transplant: a systematic review and meta-analysis

Mac Curtain,

Qian,

Temperley

et al. 2023

Hernia

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Altering the Approach: Open Minimally Invasive Renal Transplant in Obese Patients Through the Anterior Rectus Sheath

Cited by 7 publications

References 15 publications

Super-Minimal Incision Technique in Pediatric Kidney Transplantation: A Paired Kidney Analysis

Super-Minimal Incision Technique in Pediatric Kidney Transplantation: A Paired Kidney Analysis

Wound related complications and the anterior rectus sheath versus Gibson approach to kidney transplantation: A single center randomized controlled trial

Incisional hernias post renal transplant: a systematic review and meta-analysis

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