Laparoscopic Living Donor Nephrectomy: A Look at Current Trends and Practice Patterns at Major Transplant Centers Across the United States

Wright, Andrew D.; Will, Thomas; Holt, David R.; Türk, Thomas; Perry, Kent T.

doi:10.1016/j.juro.2007.11.066

Cited by 50 publications

(38 citation statements)

References 18 publications

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“…This represents a dramatic decline in the involvement of urology in renal transplant since its inception, when it was almost entirely performed by urology. This mirrors the trend that has been well-demonstrated in the U.S. 9 The first published evidence of this trend dates back to 1986, when Novick et al described a diminishing role of urology in various transplant procedures, as well decreased resident exposure to renal transplant. 4 However, this movement likely began at least a decade prior, given the time between physician training and clinical practice.…”

Section: Discussionsupporting

confidence: 62%

“…3,4 However, in more modern times, with the increased complexity and specialization of Surgical representation in Canadian renal transplantation the transplant field, the role of urology in renal transplant has been declining. 3 This diminishing role of urology in renal transplant has been well-documented in the U.S. 4,5,[7][8][9] Anecdotally, it has been felt that a similar trend is being followed in Canada; however, this has yet to be demonstrated. This study aimed to characterize the training background and surgical practices of renal transplant surgeons across Canada.…”

Section: Discussionmentioning

confidence: 99%

“…8 However, when this was re-examined in 2008 by Wright et al, the trend towards decreasing urological involvement had progressed, with now only 32% of living donor nephrectomies being primarily performed by urology-trained surgeons. 9 This represented a rapid decline in urological involvement of approximately 30% over a 10-year span. 9,10 Our results show that the involvement of both general surgery and urology-trained surgeons is approximately equivalent for each of the specific renal transplant procedures.…”

Section: Discussionmentioning

confidence: 99%

“…9 This represented a rapid decline in urological involvement of approximately 30% over a 10-year span. 9,10 Our results show that the involvement of both general surgery and urology-trained surgeons is approximately equivalent for each of the specific renal transplant procedures. Specifically, for the recipient surgery, general surgery was primarily involved in 53.4% of these procedures.…”

Section: Discussionmentioning

confidence: 99%

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Changing of the guard? A glance at the surgical representation in the Canadian renal transplantation community

McGregor

Bjazevic

Patel

et al. 2016

CUAJ

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Introduction: Renal transplant is the gold standard treatment for end-stage renal disease (ESRD), and the prevalence of both ESRD and renal transplant has been steadily increasing over the past decade. However, involvement of urology in renal transplant has been declining. We examine the current state of urology involvement in renal transplant programs across Canada. Methods: A telephone survey of all surgical transplant centres in Canada was performed. Information regarding the number of transplant surgeons, their individual training background, and their involvement in specific procedures, including open and laparoscopic living donor nephrectomy, deceased donor nephrectomy, and recipient renal transplant were collected. Results: There are 59 Canadian transplant surgeons, including 27 (46%) who completed a urology residency and 32 (54%) with a general surgery background. With regards to procedures performed, 58 (98%) perform recipient renal transplant surgery, 36 (61%) perform laparoscopic donor nephrectomy, and 17 (29%) perform open donor nephrectomy. There was no significant difference in the number of surgeons that perform renal recipient surgery, laparoscopic or open donor nephrectomies, and deceased donor nephrectomies between surgeons of the two different training backgrounds. Conclusions: The role of urology in Canadian renal transplant has declined significantly over the past decade. Given the medical and surgical complexity of renal transplant, along with the growing need for renal transplants, a multidisciplinary team approach is imperative. Strong urology involvement with the transplant team is crucial for optimal care of these complex patients. IntroductionRenal transplantation remains the gold standard treatment for end-stage renal disease (ESRD) worldwide, offering improved survival and quality of life for transplant recipients.1 Here in Canada, a total of 2367 renal transplant surgeries were performed in 2013. 1 The incidence of ESRD, and number of renal transplants performed, has been steadily increasing in Canada since 2003, demonstrating the need for well-trained transplant surgeons.1 Naturally, renal surgery is second nature to the urologist, and historically all aspects of renal transplant surgery were overseen and performed by urologic surgeons.2,3 More recently, there has been a trend towards decreased involvement of urology in all aspects of the renal transplantation process, including the recipient transplant, donor nephrectomy, and the medical management of the recipient.3-6 However, limited data currently exists regarding the current environment of renal transplant in Canada. To gain a better idea of the current involvement of urology in the Canadian transplant arena, we performed a poll of all Canadian transplant programs to determine what surgical subspecialties were performing the transplant surgeries and to see if their involvement varied between the various components of the transplant process. MethodsFollowing approval from the University of Manitoba ethics review board, ...

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Changing of the guard? A glance at the surgical representation in the Canadian renal transplantation community

McGregor

Bjazevic

Patel

et al. 2016

CUAJ

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“…6 The technique is almost always done using a periumbilical midline incision for hand-assisted port placement, which results in an unsightly scar over the abdominal midline. An alternate approach, the low transverse incision, has been used less frequently.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Gwon

Jun²,

Kim³

et al. 2016

Exp Clin Transplant

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Objectives: Hand-assisted laparoscopic donor nephrectomy is performed in many centers for donor nephrectomy. A midline incision for hand-assisted port placement is generally used but produces an unsightly scar. In this study, patients who had handassisted laparoscopic donor nephrectomy with low transverse incision were compared with those who received a midline incision. Materials and Methods: Our study group included patients who received hand-assisted laparoscopic donor nephrectomy from February 2012 to December 2014 at Korea University Anam Hospital. We retrospectively compared outcomes of these patients based on midline incision (45 patients) versus low transverse incision (17 patients). Risk factors, including age, sex, body mass index, creatinine level, glomerular filtration rate of allograft, side of graft kidney, number of renal arteries, duration of surgical procedure, and warm ischemic time, were compared between the midline and low transverse incision groups. Results: When we compared the midline versus low transverse incision groups, duration of surgical procedure (P = .043), postoperative day 3 glomerular filtration rate (P = .017), and postoperative day 3 pain score (P = .049) were significantly higher in the low transverse incision group versus the midline incision group. Postoperative day 3 results for duration of hospitalization (P = .030) and pain score (P = .021) were also significantly higher in the low transverse versus midline incision groups when we focused on patients with left nephrectomy. Conclusions:Hand-assisted laparoscopic donor nephrectomy with low transverse incision is more painful and necessitates a longer hospital stay and longer surgical procedure. Despite these disadvantages, hand-assisted laparoscopic donor nephrectomy with low transverse incision can offer a better cosmetic outcome with no definitive differences regarding renal function compared with a midline incision. Surgeons should consider these aspects when deciding on the best method for donor nephrectomy.

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Laparoscopic, Laparoendoscopic Single‐site, and Robot‐assisted Living Donor Nephrectomy

Sivarajan

Munver

2018

Smith's Textbook of Endourology

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Laparoscopic Living Donor Nephrectomy: A Look at Current Trends and Practice Patterns at Major Transplant Centers Across the United States

Abstract: Our survey describes how most renal transplant centers with accredited fellowship programs in the United States approach laparoscopic living donor nephrectomy. Specifically trends are revealed regarding patient selection, laparoscopic access and surgical technique.

Cited by 50 publications

References 18 publications

Changing of the guard? A glance at the surgical representation in the Canadian renal transplantation community

Changing of the guard? A glance at the surgical representation in the Canadian renal transplantation community

Untitled

Laparoscopic, Laparoendoscopic Single‐site, and Robot‐assisted Living Donor Nephrectomy

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