Laparoscopic live‐donor nephrectomy: modifications for developing nations

Kumar, Ashok; Chaudhary, Himanshu; Srivastava, Aneesh; Raghavendran, M.

doi:10.1111/j.1464-410x.2004.04823.x

Cited by 33 publications

(24 citation statements)

References 23 publications

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“…Three surgeons performed all the surgeries. Surgeon A, who headed the program, described the modified iliac fossa incision technique [8] . Surgeons B and C also removed the kidney via this incision but preferred the Pfannenstiel incision.…”

Section: Methodsmentioning

confidence: 99%

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A Comparison of Kidney Retrieval Incisions in Laparoscopic Transperitoneal Donor Nephrectomy

Gupta¹,

Singh²,

Dubey³

et al. 2008

Urol Int

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Objective: To compare the modified iliac fossa and Pfannenstiel incisions for retrieving the kidney in laparoscopic transperitoneal donor nephrectomy. Patients and Methods: Two different incisions for retrieving the donor kidney were studied from January 2002 to December 2006. A total of 343 laparoscopic transperitoneal donor nephrectomies were performed. 110 kidneys were removed via our modified iliac fossa incision and 233 kidneys were retrieved using a Pfannenstiel incision. The warm ischemia time, analgesic requirement and hospital stay were compared. Other parameters studied were the length of incisions, total number of incisions (port and retrieval), and complications associated with them. Results: The warm ischemia time (3 vs. 3.5 min), mean hospital stay (3.35 vs. 3.8 days) and analgesic requirement were comparable. The mean length of incisions was 5.8 vs. 7.3 cm, respectively, and this difference was found to be statistically significant. The total number of incisions (port and retrieval) was 4 when the iliac fossa incision was used, whereas it was 5 when the kidney was retrieved using a Pfannenstiel incision. Two patients had bladder injury and 1 patient had bowel injury while making the Pfannenstiel incision. There was less morbidity associated with the iliac fossa incision. Conclusion: The iliac fossa incision had less morbidity whereas the Pfannenstiel incision scored in terms of cosmesis.

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Section: Methodsmentioning

confidence: 99%

“…A fourth 5-mm laparoscopic port was used for retraction and was placed 4 cm below the costal margin in anterior axillary line. Dissection was carried out by our technique as described before and the renal pedicle and ureter were readied for division [8] . The lower polar fat was left intact to ease the delivery of the kidney.…”

Section: Methodsmentioning

confidence: 99%

A Comparison of Kidney Retrieval Incisions in Laparoscopic Transperitoneal Donor Nephrectomy

Gupta¹,

Singh²,

Dubey³

et al. 2008

Urol Int

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“…At least 3-4 liters of fluid was given during surgery to negate the effect of pneumoperitoneum [8] . The adrenal and lumbar veins were clipped and divided, and the renal vein was mobilized.…”

Section: Technique Of the Left Transperitoneal Approachmentioning

confidence: 99%

“…In the initial part of our experience (42 cases), we used suture ties to take control of renal vessels, and kidney was extracted from an incision in the flank overlying the fourth port. Later on in the series (17 cases) Endo GI stapler and further on (283 cases) Hem-o-lock clips were used to control renal vessels, and kidney was extracted via the 2-finger technique through the third port [8] . A fan retractor was used to push the kidney down towards the iliac fossa, enabling it to reach the spinoumbilical port.…”

Section: Technique Of the Left Transperitoneal Approachmentioning

confidence: 99%

Evolution of the Technique of Laparoscopic Live Donor Nephrectomy at a Single Center: Experience with More than 350 Cases

Srivastava

Gupta²,

Kumar³

2008

Urol Int

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Aim: To present our experience with laparoscopic live donor nephrectomy (LLDN), evolution of the technique and analysis with respect to the cost-effective modifications. Materials and Methods: This is a retrospective review of all the LLDNs performed at our institute from January 2001 to November 2006. Few of the cost-effective modifications to the procedure include use of metallic autoclavable ports and instruments, Hem-o-lock clips for ureter, renal artery and vein, and extraction of the graft manually without use of a specimen retrieval bag. Results: From January 2001 to December 2001, 42 laparoscopy-assisted LLDNs, and since December 2001 380 LLDNs were performed, which includes 342 cases of transperitoneal and 38 cases of retroperitoneal LLDN. The mean operative time was 180 ± 45 and 192 ± 35 min, mean blood loss was 85 ± 50 and 115 ± 50 ml, warm ischemia time was 4.5 ± 2 and 3.5 ± 1.5 min in transperitoneal and retroperitoneal LLDNs, respectively. The total number of conversions was 14, with 12 in the transperitoneal group and 2 in the retroperitoneal group. Mean hospital stay was 3.14 ± 1.5 days. Recipient mean serum creatinine at days 1, 3 and 7 was 2.56 ± 0.91, 1.63 ± 0.46 and 1.72 ± 0.25, respectively. The total cost incurred by the patient at our institute for LLDN including stay in the hospital was USD 500 ± 150. Conclusion: LLDN provides all the benefits of minimally invasive therapy to the donors while preserving allograft function in the recipients. Few technical modifications can make the procedure more cost-effective for routine use.

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“…Multiple studies have shown both related and unrelated living donors have similar results in graft and patient outcomes as long as an adequate immunosuppressive protocol is followed [23][24][25][26]. Where local conditions allow, laparoscopic living-donor nephrectomy could be the preferred method as it is as cost-effective as open procedures [27] even in low to middle-income countries [28,29].…”

Section: Discussionmentioning

confidence: 99%

An overview of renal replacement therapy and health care personnel deficiencies in sub-Saharan Africa

Pozo¹,

Leow²,

Groen³

et al. 2012

Transplant International

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Summary Chronic kidney disease (CKD) is a public health problem in sub‐Saharan Africa (SSA) but there is limited data to guide programs or plan interventions. To help set priorities and understand the needs for renal replacement therapy a baseline assessment is required. World Health Organization (WHO) databases and Medline were searched to determine the number of physicians, nephrologists, and dialysis centers and patients in SSA. Data on renal transplant (RTx) programs were collected from the WHO Global Observatory on Donation & Transplantation database for deceased‐donor and living‐donor RTx. Of the 47 countries in SSA only 15 had recent data with most rates of physicians per 10 000 population under 2.0. Nigeria and South Africa had the greatest absolute numbers of physicians and nephrologists but Mauritius had the greatest proportion to population. South Africa had the most dialysis patients. Kenya, Nigeria and South Africa were the only countries with RTx programs and reported rates per million population of 0.60, 0.23 and 5.12, respectively. Treatment for patients with CKD in SSA is limited by a lack of physicians, nephrologists, and dialysis centers. Few countries are performing RTx. Resources are needed to increase the health workforce and increase RTx programs in SSA.

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Laparoscopic live‐donor nephrectomy: modifications for developing nations

Cited by 33 publications

References 23 publications

A Comparison of Kidney Retrieval Incisions in Laparoscopic Transperitoneal Donor Nephrectomy

A Comparison of Kidney Retrieval Incisions in Laparoscopic Transperitoneal Donor Nephrectomy

Evolution of the Technique of Laparoscopic Live Donor Nephrectomy at a Single Center: Experience with More than 350 Cases

An overview of renal replacement therapy and health care personnel deficiencies in sub-Saharan Africa

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