Minimal incision living donor nephrectomy compared to the hand-assisted laparoscopic living donor nephrectomy

Greenstein, Marc; Harkaway, Richard C.; Badosa, Francisco; Ginsberg, Phillip C.; Yang, Shuin-Lin

doi:10.1007/s00345-002-0310-3

Cited by 20 publications

(6 citation statements)

References 6 publications

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“…However, there is no question that the incision can entail some very significant postoperative problems including prolonged postoperative pain, scarring, permanent flank bulge due to relaxation of the abdominal wall muscles, subcostal nerve injury or pleural irritation [3]. Correspondingly, minimal flank incision living donor nephrectomy was introduced as an alternative to the standard open approach [6]. It appears that the main argument for choosing this technique is to avoid the well-known learning curve associated with laparoscopic donor nephrectomy.…”

Section: Discussionmentioning

confidence: 99%

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Retroperitoneoscopic donor nephrectomy: donor outcome and complication rate in comparison with three different techniques

et al. 2006

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Four surgical techniques for living donor nephrectomy were analyzed retrospectively in terms of perioperative outcome and early complication rate. A total of 182 donor nephrectomies including 69 open (OLDN), 14 fully laparoscopic (LDN), 34 hand-assisted laparoscopic (HLDN) and 65 retroperitoneoscopic (RLDN) nephrectomies were analyzed. There was a significant difference in mean operating time (OPT) between the OLDN (160 min) and RLDN (150 min) as compared to the LDN (212 min) and HLDN group (192 min) (P < 0.001). Mean warm ischemia time (WIT) was significantly shorter with OLDN (114 s), RLDN (121 s) and HLDN (128 s) when compared to LDN (238 s) (P < 0.001). Major complication rate was comparable among the groups. Independent of the preferred technique, donor nephrectomy is associated with complication rates. RLDN is comparable to OLDN in terms of OPT, WIT. Learning endoscopic donor nephrectomy could be associated with a higher complication rate.

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Section: Discussionmentioning

confidence: 99%

“…But the great variety of techniques that are still competing with the standard open approach suggests that the optimal minimally-invasive alternative to OLDN has not yet been determined [6,9,15,17,19]. We started endoscopic living donor nephrectomy in 1997 using a full laparoscopic approach.…”

Section: Discussionmentioning

confidence: 99%

Retroperitoneoscopic donor nephrectomy: donor outcome and complication rate in comparison with three different techniques

et al. 2006

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“…[27][28][29][30][31][32][33][34][35][36][37]. Two papers were excluded because the control groups were drawn from results in the literature from other institutions [38,39]. Three papers had to be excluded because the references did not correspond to the journal articles cited and despite thorough database searches no similar articles could be found [40][41][42].…”

Section: Eligible Studiesmentioning

confidence: 99%

A meta-analysis of mini-open versus standard open and laparoscopic living donor nephrectomy

Antcliffe¹,

Nanidis²,

Darzi³

et al. 2009

Transplant International

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Summary Mini‐open donor nephrectomy (MODN) potentially combines advantages of standard open (SODN) and laparoscopic techniques (LDN). This article is a comparison of these techniques. A literature search was performed for studies comparing MODN with SODN or LDN. Nine studies met our selection criteria. Of the 1038 patients, 433 (42%) underwent MODN, 389 (37%) SODN and 216 (21%) LDN. MODN versus SODN: Operative time (P = 0.17), warm ischemia time (P = 0.20) and blood loss (P = 0.30) were not significantly different. Hospital stay and time to return to work were shorter for MODN by 1.67 days (P < 0.001) and 5 weeks (P = 0.03). Analgesia requirement and overall complications were less in the MODN group (P < 0.001) and (P = 0.03). Ureteric complications (P = 0.21) and 1‐year graft survival (P = 0.28) were not significantly different. MODN versus LDN: Operative and warm ischemia times were significantly shorter for the MODN by 55 min (P = 0.005) and 147 s (P < 0.001). Analgesia requirement was greater for the MODN group by 9.62 mEq morphine (P = 0.04). No significant differences were found for blood loss (P = 0.8), hospital stay (P = 0.35), donor complications (P = 0.40) or ureteric complications (P = 0.83). MODN appears to provide advantages for the donor in comparison to SODN and also has a shorter operative time when compared with the LDN.

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“…Other studies have compared mini-incision open nephrectomy to laparoscopic access, demonstrating comparable safety with both procedures 15,17,18. In terms of cost, previous studies have demonstrated that a subcostal mini incision costs less than a laparoscopy.…”

Section: Discussionmentioning

confidence: 99%

Subcostal mini incision: a good option for donor nephrectomy

Kanashiro

Falci

Piovisan

et al. 2010

Clinics

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OBJECTIVESWe describe the results of over one hundred nephrectomies performed using a subcostal mini incision.INTRODUCTIONA major effort has been undertaken to encourage living donor renal transplantation. New techniques that use minimally invasive approaches to perform donor nephrectomy have been progressively accepted. Among these new procedures is the mini-incision approach.METHODSWe prospectively analyzed one hundred and seventeen consecutive donors that were subjected to subcostal mini-incision nephrectomy at a single center. Surgical time, warm and cold ischemia time, intraoperative complications, time until hospital discharge, presence of infection, bleeding, the need for a second operation, and death were analyzed. Eventual loss of donor renal function was indicated by increases in serum creatinine and proteinuria.RESULTSThe mean time of surgery was 180.5 ± 26.2 minutes. The mean warm ischemia time was 93 ±8.3 seconds, while the mean cold ischemia time was 85.9 (±23.5) minutes. We had one case with an intraoperative complication, and only two patients required another operation. An intra-abdominal abscess occurred in one patient (0.85%), proteinuria occurred in one patient (0.85%), and a transitory increase of creatinine levels occurred in two patients (1.7%).DISCUSSIONReducing the length of the abdominal incision did not influence surgical time or result in an increase in intraoperative complications relative to our historical data or literature reports. Organ preparation was accomplished successfully with a brief warm ischemia time. Additionally, the mean hospital stay was short, and few surgical complications occurred.CONCLUSIONThe use of a subcostal mini incision is both safe and similar to conventional techniques previously described in the literature.

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Minimal incision living donor nephrectomy compared to the hand-assisted laparoscopic living donor nephrectomy

Cited by 20 publications

References 6 publications

Retroperitoneoscopic donor nephrectomy: donor outcome and complication rate in comparison with three different techniques

Retroperitoneoscopic donor nephrectomy: donor outcome and complication rate in comparison with three different techniques

A meta-analysis of mini-open versus standard open and laparoscopic living donor nephrectomy

Subcostal mini incision: a good option for donor nephrectomy

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