Comparative Outcomes of Open Nephrectomy, Hand-Assisted Laparoscopic Nephrectomy, and Full Laparoscopic Nephrectomy for Living Donors

Ungbhakorn, Pokket; Kongchareonsombat, Wisoot; Leenanupan, Chareon; Kijvikai, Kittinut; Wisetsingh, W.; Patcharatrakul, Suthep; Jirasiritam, S.

doi:10.1016/j.transproceed.2011.12.026

Cited by 18 publications

(7 citation statements)

References 15 publications

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“…Comparing the three approaches, others have reported shorter OT and WIT for open followed by HAL and laparoscopic procurement techniques, and longer LOS for ODN. 12,13 Our findings are similar in that OT and WIT were shortest (although the latter was not statistically significant due to missing data from the earlier time periods) in the ODN group, followed by HALDN and LDN. Unlike those studies, the LOS was not significantly different between our study groups; our mean LOS of 3.9 days was shorter than those (6-9.6 days) reported in other studies.…”

Section: Discussionsupporting

confidence: 64%

Living-donor nephrectomy at Singapore General Hospital: Evolution of surgical techniques over the last two decades

Aslim

Linn

Yang

et al. 2020

Proceedings of Singapore Healthcare

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Background: Laparoscopic living-donor nephrectomy is the current epitome of living kidney donation surgery. We review our experience in living-donor nephrectomies over the last 19 years, transitioning from open surgery to hand-assisted laparoscopy to full laparoscopic techniques. Methods: We retrospectively identified all living-donor nephrectomies performed at our institution from 1976 to 2018. The donors were categorised according to surgical techniques: open (ODN), hand-assisted laparoscopy (HALDN) and full laparoscopy (LDN). We reviewed changes in donor demographics over the years. Surgical outcomes between groups were compared from 2000 to 2018. We also compared the outcomes of LDN between different time periods to evaluate our learning curve. Results: A total of 214 living-donor nephrectomies were performed between 2000 and 2018. The majority were left sided (93%) and had single renal artery anatomy (90%). There were 22 ODN, 20 HALDN and 163 LDN cases. The mean operating time was 84±43, 151±32 and 179±37 minutes for ODN, HALDN and LDN, respectively ( p<0.001). There were no statistically significant differences in mean warm ischaemia times ( p=0.921) and length of hospital stay ( p=0.114) between groups. The overall 30-day surgical morbidity rate was 9.3%, with a major complications rate of 0.9%. The mean warm ischaemia time for LDN was significantly different ( p<0.001) between time periods: 281±260, 184±94 and 140±42 seconds for the periods between 2005–2009, 2010–2014 and 2015–2018, respectively. Conclusion: This study confirms the safety of living-donor nephrectomies performed at our institution, a centre with a modest volume of kidney transplants.

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Section: Discussionsupporting

confidence: 64%

Living-donor nephrectomy at Singapore General Hospital: Evolution of surgical techniques over the last two decades

Aslim

Linn

Yang

et al. 2020

Proceedings of Singapore Healthcare

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“…Therefore, it is likely to assume that the single port procedures were performed by skilled surgeons, this may explain why LESS was associated with significantly less blood loss. When trials were divided in two equal groups based on year of publication, the earliest studies (2001–2006) comparing HALDN and LDN showed less complications in favor of HALDN [ 24 , 25 , 27 , 28 , 31 , 32 , 36 ]. This suggests that HALDN is a safer technique for surgeons of centers in their learning curve.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Technique Modifications in Laparoscopic Donor Nephrectomy: A Systematic Review and Meta-Analysis

et al. 2015

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ObjectiveTo compare the effectiveness of different technique modifications in laparoscopic donor nephrectomy.DesignSystematic review and meta-analyses.Data SourcesSearches of PubMed, EMBASE, Web of Science and Central from January 1st 1997 until April 1st 2014.Study DesignAll cohort studies and randomized clinical trials comparing fully laparoscopic donor nephrectomy with modifications of the standard technique including hand-assisted, retroperitoneoscopic and single port techniques, were included.Data-Extraction and AnalysisThe primary outcome measure was the number of complications. Secondary outcome measures included: conversion to open surgery, first warm ischemia time, estimated blood loss, graft function, operation time and length of hospital stay. Each technique modification was compared with standard laparoscopic donor nephrectomy. Data was pooled with a random effects meta-analysis using odds ratios, weighted mean differences and their corresponding 95% confidence intervals. To assess heterogeneity, the I2 statistic was used. First, randomized clinical trials and cohort studies were analyzed separately, when data was comparable, pooled analysis were performed.Results31 studies comparing laparoscopic donor nephrectomy with other technique modifications were identified, including 5 randomized clinical trials and 26 cohort studies. Since data of randomized clinical trials and cohort studies were comparable, these data were pooled. There were significantly less complications in the retroperitoneoscopic group as compared to transperitoneal group (OR 0.52, 95%CI 0.33–0.83, I2 = 0%). Hand-assisted techniques showed shorter first warm ischemia and operation times.ConclusionsHand-assistance reduces the operation and first warm ischemia times and may improve safety for surgeons with less experience in laparoscopic donor nephrectomy. The retroperitoneoscopic approach was significantly associated with less complications. However, given the, in general, poor to intermediate quality and considerable heterogeneity in the included studies, further high-quality studies are required.Trial RegistrationThe review protocol was registered in the PROSPERO database before the start of the review process (CRD number 42013006565).

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“…[ 10 ] Laparoscopicnephrectomy (LN) now is a mature and applicable surgical approach for some renal conditions, resulting in better short-term outcomes. [ 11 , 12 ]. Compared withthe normal-size kidney, LN for ADPKD is challenging due to the massive size of these kidneys[ 13 ] and there is a difficulty in negotiating this large mass with the laparoscopic approach[ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Nephrectomy versus Open Nephrectomy for Patients with Autosomal Dominant Polycystic Kidney Disease: A Systematic Review and Meta-Analysis

Guo

et al. 2015

PLoS ONE

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ObjectiveTo compare efficacy and safety of laparoscopicnephrectomy (LN) versusopen nephrectomy (ON) in the management of autosomal dominant polycystic kidney disease (ADPKD), we conducted a systematic review and meta-analysis.MethodsA systematic search of the electronic databases PubMed, Scopus, and the Cochrane Library was performed up to October 2014.This systematic review was performed based on observational comparative studies that assessed the two techniques. The weighted mean difference (WMD) and risk ratio (RR), with their corresponding 95% confidence interval (CI), were calculated to compare continuous and dichotomous variables, respectively.ResultsSeven studies were identified, including 195 cases (118 LN / 77 ON). Although LN was associated with longer operative time (WMD 30.236, 95%CI 14.541 −45.932, P<0.001) and the specimen might not have been resected as heavy as the ON group (WMD -986.516, 95%CI -1883.24–-89.795, P = 0.031), patients in this group might benefit from a shorter length of hospital stay (WMD -3.576, 95%CI 4.976–-2.176, P <0.001), less estimated blood loss (WMD -180.245, 95%CI -317.939–-42.556, P = 0.010), and lower need of transfusion (RR 0.345, 95%CI 0.183–0.650, P = 0.001). The LN group also had less overall complications (RR 0.545, 95%CI 0.329–0.903, P = 0.018). The need of narcotic analgesics between the two groups might have no significant difference (WMD -54.66, 95%CI -129.76–20.44, P = 0.154).ConclusionLN for giant symptomatic ADPKD was feasible, safe and efficacious. Morbidity was significantly reduced compared with the open approach. For an experienced laparoscopist, LN might be a better alternative.

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Comparative Outcomes of Open Nephrectomy, Hand-Assisted Laparoscopic Nephrectomy, and Full Laparoscopic Nephrectomy for Living Donors

Cited by 18 publications

References 15 publications

Living-donor nephrectomy at Singapore General Hospital: Evolution of surgical techniques over the last two decades

Living-donor nephrectomy at Singapore General Hospital: Evolution of surgical techniques over the last two decades

A Comparison of Technique Modifications in Laparoscopic Donor Nephrectomy: A Systematic Review and Meta-Analysis

Laparoscopic Nephrectomy versus Open Nephrectomy for Patients with Autosomal Dominant Polycystic Kidney Disease: A Systematic Review and Meta-Analysis

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