Comparison of Minimal Skin Incision Technique in Living Kidney Transplantation and Conventional Kidney Transplantation

Abstract

Background:Recently, the most common incision for kidney transplantation (KT) is an inverted J-shaped incision known as the “hockey-stick.” However, demands for minimally invasive surgery in KT are increasing as in other various fields of surgery. Hence, we evaluated whether there is difference between minimal skin incision technique in kidney transplantation (MIKT) and conventional KT (CKT).Methods:Between June 2006 and March 2013, a total of 452 living kidney transplant patients were enrolled. The MIKT group included 17 young unmarried women whose body mass index was <25 kg/m2 and had no anatomic variation. The CKT group included 435 patients. The MIKT operation technique restricted to the 10 cm-sized skin incision in the lower right abdomen from laterally below the anterior superior iliac spine to the midline just above the pubis was performed. We compared the baseline clinical characteristics and postoperative results between two groups. For proper comparison, propensity score matching was implemented.Results:There was no difference in graft function, survival, and postoperative complication rate between MIKT and CKT groups (all P > 0.05). The 5-year graft survival was 92.3% and 85.7% in MIKT and CKT groups, respectively (P = 0.786).Conclusions:Our results indicated that MIKT showed more favorable cosmetic results, and there were no statistical differences in various postoperative factors including graft function, survival, and complications compared with CKT. Hence, we suggested that MIKT is an appropriate method for selected patients in living KT.

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

“…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.…”

“…Despite some limitations in space in obese patients using the small incision technique, there is no drawback in performing the anastomoses in overweight patients up to a BMI of 30 kg/m 2 in Claas Brockschmidt's and >30 kg/m 2 in Oyen's report ( 4 , 6 ). However, in a subsequent study by Kim, a BMI <25 kg/m 2 was the inclusion criterion for MIKT recipients to ensure adequate exposure to the surgical field ( 5 ). Although SMIPKT has been proven successful in pediatric candidates with a BMI >25 kg/m 2 in our transplantation center, it should be noted that the majority of pediatric candidates in our group were lean, with a BMI of <20 kg/m 2 , which was much lower than the previously described results.…”

“…Oyen and Kim made a 7–9 cm transverse incision ( Figure 2F ). It is located 3–5 cm above the groin, with the medial endpoint of the incision 2–3 cm from the midline ( 5 , 6 ). The difference was that the graft artery was anastomosed to the internal iliac artery at our transplant center.…”

“…Compared with open, conventional operations in living donor nephrectomy, the advantages of MIS include reduced tissue trauma and postoperative pain, and pleasing cosmetic results ( 3 , 4 ). However, in the past few years, there have only been limited reports of minimally invasive techniques for adult kidney transplantation (MIKT) ( 5 , 6 ), but few publications on pediatric kidney transplantation (PKT). Considering the potential advantages of reducing incision/tissue trauma in immunosuppressed pediatric kidney transplant recipients, a super-minimal incision technique (~4–6 cm) in pediatric kidney transplantation (SMIPKT) was evaluated in our transplant center.…”

Minimally Invasive Reduction and Fixation in Orthopedic Trauma

“…Minimally invasive surgery (MIS) has gained its popularity in many specialties in the last two decades or so, due to its minimal invasion, fewer complications, quick recovery, and the reduced expense. [234] In the field of orthopedic trauma, minimally invasive reduction and fixation, which is the ultimate goal that patients and surgeons have been in persistent pursuit of for a long time, has been achieved, benefiting from sustained attention and the emerging of various new concepts and techniques. Among them, biological osteosynthesis (BO) is one of the currently and widely applied concepts in the management of orthopedic trauma.…”