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Barandiaran Cornejo JF, Chin LT, Angelis M. From Carrel to Robotics: Renal Transplantation and the Evolution of its Surgical Technique. Curr Urol Rep 2025; 26:38. [PMID: 40257516 DOI: 10.1007/s11934-025-01265-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2025] [Indexed: 04/22/2025]
Abstract
PURPOSE OF REVIEW Renal transplantation has become the standard of care for patients with end-stage renal disease (ESRD) due to significant advancements across various medical and surgical fields. This review highlights the evolution of renal transplantation techniques, while also exploring the latest tools and practices that promise to further improve their outcomes. RECENT FINDINGS Since the first successful renal transplant, numerous innovations have been implemented in the various stages of renal graft implantation. These include improved techniques in vascular and urinary anastomoses, graft positioning, and the recent emergence of modern technologies such as robotics and artificial intelligence (AI) which have shown promise in enhancing surgical performance. The field of renal transplantation is continuously evolving. As new and more efficient technologies continue to emerge, these too will become the standard of care and training. It is essential for transplant surgeons to understand the key historical developments that have led to our current level of expertise, so we can make effective use of these tools in further advancing the field.
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Affiliation(s)
| | - L Thomas Chin
- AdventHealth Transplant Institute, 2415 North Orange Ave Suite 700, Orlando, FL, 32804, USA
| | - Michael Angelis
- AdventHealth Transplant Institute, 2415 North Orange Ave Suite 700, Orlando, FL, 32804, USA
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Khajeh E, Nikbakhsh R, Ramouz A, Majlesara A, Golriz M, Müller-Stich BP, Nickel F, Morath C, Zeier M, Mehrabi A. Robot-assisted versus laparoscopic living donor nephrectomy: superior outcomes after completion of the learning curve. J Robot Surg 2023; 17:2513-2526. [PMID: 37531044 PMCID: PMC10492879 DOI: 10.1007/s11701-023-01681-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/17/2023] [Indexed: 08/03/2023]
Abstract
The use of robots in donor nephrectomy has increased in recent years. However, whether robot-assisted methods have better outcomes than traditional laparoscopic methods and how surgical experience influences these outcomes remains unclear. This meta-analysis compares the outcomes of robot-assisted donor nephrectomy (RADN) with those of laparoscopic donor nephrectomy (LDN) and to investigate the effects of surgical experience on these outcomes. A systematic literature search was conducted in Medline (through PubMed) and Web of Science databases. Perioperative data were extracted for meta-analysis. To assess the impact of the learning curve, a subgroup analysis was performed to compare outcomes between inexperienced and experienced surgeons. Seventeen studies with 6970 donors were included. Blood loss was lower (mean difference [MD] = - 13.28, p < 0.01) and the warm ischemia time was shorter (MD = - 0.13, p < 0.05) in the LDN group than the RADN group. There were no significant differences in terms of conversion to open surgery, operation time, surgical complications, hospital stay, costs, and delayed graft function between the groups. Subgroup analysis revealed that operation time (MD = - 1.09, p < 0.01) and length of hospital stay (MD = - 1.54, p < 0.05) were shorter and the rate of conversion to open surgery (odds ratios [OR] = 0.14, p < 0.0001) and overall surgical complications (OR = 0.23, p < 0.05) were lower in experienced RADN surgeons than in experienced LDN surgeons. Surgical experience enhances the perioperative outcomes following RADN more than it does following LDN. This suggests that RADN could be the method of choice for living donor nephrectomy as soon as surgeons gain sufficient experience in robotic surgery.
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Affiliation(s)
- Elias Khajeh
- Head of the Division for Abdominal Transplantation, Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Rajan Nikbakhsh
- Head of the Division for Abdominal Transplantation, Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Ali Ramouz
- Head of the Division for Abdominal Transplantation, Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Ali Majlesara
- Head of the Division for Abdominal Transplantation, Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Mohammad Golriz
- Head of the Division for Abdominal Transplantation, Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Beat P Müller-Stich
- Head of the Division for Abdominal Transplantation, Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Felix Nickel
- Head of the Division for Abdominal Transplantation, Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Christian Morath
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Martin Zeier
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Head of the Division for Abdominal Transplantation, Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
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Rowaiee R, Gholami M, Concepcion W, Vedayar H, Janahi F. Retroperitoneal robot-assisted live-donor nephrectomy: A single-center study. FRONTIERS IN TRANSPLANTATION 2023; 2:1062240. [PMID: 38993900 PMCID: PMC11235276 DOI: 10.3389/frtra.2023.1062240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 04/10/2023] [Indexed: 07/13/2024]
Abstract
Background As the demand for kidney transplants continues to increase globally, healthcare institutions face a challenge to bridge the gap between patients waitlisted for kidney transplants and the number of donors. A major factor influencing the donor's decision is the operative risk and potential complications of the surgery. Open surgical approaches have been vastly replaced with laparoscopic donor nephrectomies as the standard of practice. However, there is a growing body of evidence pointing towards its potential superiority over laparoscopic methods. In this study, we aim to present our experience on outcomes of Robotic-Assisted Live Donor Nephrectomies (RALDN), the first series of its kind in the United Arab Emirates (UAE). Methods We retrospectively collected data from patients who underwent RALDN at Mediclinc City Hospital. Demographic data, laboratory investigations, and operative details were collected and analyzed. Results Seven patients underwent RALDN between 2021 and April 2022 at our facility. Four donors were male while three were female. Median length of hospital stay was 4 days. In our study, one of the patients suffered from a Clavien-Dindo grade IV complication which necessitated prolonged admission. Conclusion We conclude that RALDN is a safe method for donor kidney procurement, carrying a low risk of morbidity and mortality. This method could potentially evolve the number of kidney donors to address the issue of high kidney transplant demand.
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Affiliation(s)
- Rashed Rowaiee
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Mandana Gholami
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Waldo Concepcion
- Department of General Surgery, Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Hemant Vedayar
- Department of General Surgery, Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Farhad Janahi
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, Dubai, United Arab Emirates
- Department of Urology, Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates
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Mankiev B, Cimen SG, Kaya IO, Cimen S, Eraslan A. Current practice of live donor nephrectomy in Turkey. World J Transplant 2022; 12:405-414. [PMID: 36570407 PMCID: PMC9782686 DOI: 10.5500/wjt.v12.i12.405] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/31/2022] [Accepted: 12/06/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Over the last few years, the deceased donor organ donation rate was declined or remained stable, whereas the live donor organ donation rate has increased to compensate for the demand. Minimally invasive techniques for live donor nephrectomy (LDN) have also improved the live donor kidney donation rates. This increase has led to an interest in the surgical procedures used for LDN.
AIM To evaluate the LDN techniques performed in Turkey, the structure of surgical teams, and the training received. Additionally, the number of kidney transplantations at different centers, the surgeon experience level, differences in surgical approach during donor surgeries, and outcomes were assessed.
METHODS A questionnaire was sent to the Turkish Ministry of Health-accredited transplant centers. It inquired of the number of LDN surgeries, surgical techniques, complications, optimization protocols, the experience of surgeons, and the training. Descriptive statistics were outlined as follows: Discrete numeric variables were expressed as medians (minimum-maximum), while categorical variables were shown as numbers and percentages. As a result of the goodness-of-fit tests, if the significance of the differences between the groups in discrete numerical variables for which the parametric test statistical assumptions were not met, data were analyzed with the Mann Whitney U test and the χ2 test.
RESULTS The questionnaire was sent to 72 transplant centers, all of which replied. Five centers that reported not performing LDN procedures were excluded. Responses from the remaining 67 centers were analyzed. In 2019, the median number of kidney transplants performed was 45, and the median number of kidney transplants from living donors was 28 (1-238). Eleven (16.5%) centers performed 5-10, while 34 (50.7%) centers performed more than 100 live donor kidney transplants in 2019. While 19 (28.4%) centers performed the LDN procedures using the open technique, 48 (71.6%) centers implemented minimally invasive techniques. Among the centers preferring minimally invasive techniques for LDN, eight (16.6%) used more than one surgical technique. The most and the least common surgical techniques were transperitoneal laparoscopic (43 centers, 89.6%) and single port laparoscopic LDN (1 center, 2.1%) techniques, respectively. A positive association was found between the performance of minimally invasive techniques and the case volume of a transplant center, both in the total number and live donor kidney transplants (15 vs 55, P = 0.001 and 9 vs 42, P ≤ 0001 respectively). The most frequently reported complication was postoperative atelectasis (n = 33, 49.2%). There was no difference between the techniques concerning complications except for the chyle leak.
CONCLUSION Turkish transplant centers performed LDN surgeries successfully through various techniques. Centers implementing minimally invasive techniques had a relatively higher number of live donor kidney transplants in 2019.
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Affiliation(s)
- Bakytbek Mankiev
- Department of General Surgery, Sağlık Bilimleri Üniversitesi, Ankara 65100, Turkey
| | - Sanem Guler Cimen
- Department of General Surgery, Sağlık Bilimleri Üniversitesi, Ankara 65100, Turkey
| | - Ismail Oskay Kaya
- Departments of Surgery, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara 65100, Turkey
| | - Sertac Cimen
- Department of Urology, Saglık Bilimleri Universitesi, Ankara 65100, Turkey
| | - Asir Eraslan
- Department of Urology, Somalia Turkish Training and Research Hospital, Mogadishu 23451, Somalia
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Pelegrin T, Champy CM, Gerbaud F, Miro-Padovani M, Grimbert P, Matignon MB, Durrbach A, De La Taille A, Ingels A. Robotic-assisted laparoscopy living donor nephrectomy: Technique and results of a monocentric retrospective series. Prog Urol 2022; 32:567-576. [PMID: 35623941 DOI: 10.1016/j.purol.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Robot-assisted nephrectomy for living kidney donation (LKD) has been described in the literature as a safe and reproducible technique in high volume centers with extensive robotic surgery experience. Any surgical procedure in a healthy individual ought to be safe in regards to complications. The objective of this study was to evaluate the Robotic-assisted Living Donor Nephrectomy (RLDN) experience in a robotic surgery expert center. METHODS This is a retrospective study from 11/2011 and 12/2019. In total, 118 consecutive Living Donor (LD) kidney transplants were performed at our institution. All the procedures were performed by robotic-assisted laparoscopic approach. Extraction was performed by iliac (IE), vaginal (VE) or umbilical extraction (UE). The left kidney was preferred even if the vascular anatomy was not modal. RESULTS For donors: the median operative time was 120min with 50mL of blood loss. The median warm ischemia time was 4min, with a non-significant shorter duration with the UE (4min) in comparison with IE or VE (5min). Nine patients had postoperative complications including 1 grade II (blood transfusion) and 1 grade IIIb (vaginal bleeding after VE). None of our procedures were converted to open surgeries and no deaths were reported. For the recipients: 1.7% presented delayed graft function; their median GFR at 1 year was 61mL/min/1.73m2. CONCLUSION RLDN in an expert center appears to be a safe technique. The advantages of the robot device in terms of ergonomy don't hamper the surgical outcomes. Donor, recipient and graft survivals seem comparable to the reported laparoscopic outcomes in the literature. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- T Pelegrin
- Service d'urologie, UPEC, hôpital Henri-Mondor, Créteil, France.
| | - C M Champy
- Service d'urologie, UPEC, hôpital Henri-Mondor, Créteil, France
| | - F Gerbaud
- Service d'urologie, UPEC, hôpital Henri-Mondor, Créteil, France
| | - M Miro-Padovani
- Service d'urologie, UPEC, hôpital Henri-Mondor, Créteil, France
| | - P Grimbert
- Service de néphrologie, UPEC, hôpital Henri-Mondor, Créteil, France
| | - M-B Matignon
- Service de néphrologie, UPEC, hôpital Henri-Mondor, Créteil, France
| | - A Durrbach
- Service de néphrologie, UPEC, hôpital Henri-Mondor, Créteil, France
| | - A De La Taille
- Service d'urologie, UPEC, hôpital Henri-Mondor, Créteil, France
| | - A Ingels
- Service d'urologie, UPEC, hôpital Henri-Mondor, Créteil, France
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Glatz T, Brinkmann S, Bausch D. [Robot-assisted Living Donor Nephrectomy - Technical Aspects and Initial Evidence]. Zentralbl Chir 2021; 146:400-406. [PMID: 33782928 DOI: 10.1055/a-1346-0304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Minimally invasive donor nephrectomy has become the standard procedure in most transplant centres over the past two decades and has contributed to a reduction in postoperative morbidity for the donor. Robot-assisted technology is an alternative to conventional (hand-assisted) laparoscopic technology and will find increasing use in the future. In this review article, we address technical aspects of robotic-assisted donor nephrectomy, in accordance with our own experience and will provide an overview of the currently available literature. Robot-assisted living kidney donation is a safe procedure with a very low postoperative complication rate. The procedure offers advantages over the open surgical technique with respect to the reduction in the postoperative need for analgesia and the duration of hospital stay, with longer operating times and warm ischemia times, but without a measurable effect on transplant function. The postoperative outcome parameters are comparable to those of the laparoscopic technique, indicating a further acceleration of postoperative convalescence. The advantages of robot-assisted technology, due to the better exposure options, are most relevant in patients with a high BMI and multiple renal arteries, as well as in right-sided nephrectomies in which a longer transplant artery can be obtained. Robot-assisted living kidney donation will play a major role in the future of transplant surgery and is a serious alternative to conventional laparoscopic technology.
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Affiliation(s)
- Torben Glatz
- Chirurgische Klinik, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Herne, Deutschland
| | - Sebastian Brinkmann
- Chirurgische Klinik, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Herne, Deutschland
| | - Dirk Bausch
- Chirurgische Klinik, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Herne, Deutschland
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Xiao Q, Fu B, Song K, Chen S, Li J, Xiao J. Comparison of Surgical Techniques in Living Donor Nephrectomy: A Systematic Review and Bayesian Network Meta-Analysis. Ann Transplant 2020; 25:e926677. [PMID: 33122621 PMCID: PMC7607668 DOI: 10.12659/aot.926677] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The aim of this study was to compare and evaluate surgical techniques used for living donor nephrectomy (LDN). Material/Methods We performed a meta-analysis to compare 4 surgical techniques: open LDN (OLDN), laparoscopic LDN (LLDN), hand-assisted LLDN (HALLDN), and robot-assisted LLDN (RLDN). Results No significant differences were found among these surgical techniques in terms of BMI, donor postoperative complications, 1-year graft survival, and DGF. Compared to the OLDN, the other 3 surgical techniques preferred to harvest the left kidney. When the right kidney was chosen as a donor, OLDN was the first-choice surgical technique. EBL was significantly lower in the HALLDN, LLDN, and RLDN groups when compared to the OLDN group. However, operative time and WIT were significantly shorter in the OLDN group. The RLDN group had an increased rate of donor intraoperative complications and a significantly lower VAS on day 1. The OLDN group required more morphine intake than the LLDN group. The length of hospital stay was significantly longer and AR was significantly higher in the OLDN group than in the LLDN and HALLDN groups. Conclusions There are no significant differences in donor postoperative complications, recipient DGF, and graft survival among the 4 surgical techniques. OLDN reduces WIT and operation time, but increases EBL and AR. RLDN and LLDN reduce the length of hospital stay, morphine intake, and VAS, and thus accelerate recovery. However, RLDN is associated with increased intraoperative complications.
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Affiliation(s)
- Qi Xiao
- Department of Transplantation, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Biqi Fu
- Department of Rheumatology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Keqin Song
- Department of Transplantation, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Sufen Chen
- Department of Transplantation, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Jianfeng Li
- Department of Transplantation, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Jiansheng Xiao
- Department of Transplantation, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China (mainland)
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Creta M, Calogero A, Sagnelli C, Peluso G, Incollingo P, Candida M, Minieri G, Longo N, Fusco F, Tammaro V, Dodaro CA, Mangiapia F, Carlomagno N. Donor and Recipient Outcomes following Robotic-Assisted Laparoscopic Living Donor Nephrectomy: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1729138. [PMID: 31143770 PMCID: PMC6501265 DOI: 10.1155/2019/1729138] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 04/14/2019] [Indexed: 01/30/2023]
Abstract
AIMS We aimed to summarize available lines of evidence about intraoperative and postoperative donor outcomes following robotic-assisted laparoscopic donor nephrectomy (RALDN) as well as outcomes of graft and recipients. METHODS A systematic review of PubMed/Medline, ISI Web of Knowledge, and Scopus databases was performed in May 2018. The following search terms were combined: nephrectomy, robotic, and living donor. We included full papers that met the following criteria: original research; English language; human studies; enrolling patients undergoing RALDN. RESULTS Eighteen studies involving 910 patients were included in the final analysis. Mean overall operative and warm ischemia times ranged from 139 to 306 minutes and from 1.5 to 5.8 minutes, respectively. Mean estimated blood loss varied from 30 to 146 mL and the incidence of intraoperative complications ranged from 0% to 6.7%. Conversion rate varied from 0% to 5%. The mean hospital length of stay varied from 1 to 5.8 days and incidence of early postoperative complications varied from 0% to 15.7%. No donor mortality was observed. The incidence of delayed graft function was reported in 7 cases. The one- and 10-year graft loss rates were 1% and 22%, respectively. CONCLUSIONS Based on preliminary data, RALDN appears as a safe and effective procedure.
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Affiliation(s)
- Massimiliano Creta
- Department of Neurosciences, Human Reproduction and Odontostomatology, University Federico II, Naples, Italy
| | - Armando Calogero
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Italy
| | - Gaia Peluso
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Paola Incollingo
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Maria Candida
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Gianluca Minieri
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Nicola Longo
- Department of Neurosciences, Human Reproduction and Odontostomatology, University Federico II, Naples, Italy
| | - Ferdinando Fusco
- Department of Neurosciences, Human Reproduction and Odontostomatology, University Federico II, Naples, Italy
| | - Vincenzo Tammaro
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Concetta Anna Dodaro
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Francesco Mangiapia
- Department of Neurosciences, Human Reproduction and Odontostomatology, University Federico II, Naples, Italy
| | - Nicola Carlomagno
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
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Wang H, Chen R, Li T, Peng L. Robot-assisted laparoscopic vs laparoscopic donor nephrectomy in renal transplantation: A meta-analysis. Clin Transplant 2019; 33:e13451. [PMID: 30461073 DOI: 10.1111/ctr.13451] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/02/2018] [Accepted: 11/09/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Haifeng Wang
- Department of Urological Organ Transplantation; Center of Organ Transplantation; The Second Xiangya Hospital of Central South University; Changsha P. R. China
| | - Rao Chen
- Department of Urological Organ Transplantation; Center of Organ Transplantation; The Second Xiangya Hospital of Central South University; Changsha P. R. China
| | - Tengfang Li
- Department of Urological Organ Transplantation; Center of Organ Transplantation; The Second Xiangya Hospital of Central South University; Changsha P. R. China
| | - Longkai Peng
- Department of Urological Organ Transplantation; Center of Organ Transplantation; The Second Xiangya Hospital of Central South University; Changsha P. R. China
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Perioperative Events and Complications in Minimally Invasive Live Donor Nephrectomy: A Systematic Review and Meta-Analysis. Transplantation 2017; 100:2264-2275. [PMID: 27428715 DOI: 10.1097/tp.0000000000001327] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Minimally invasive live donor nephrectomy has become a fully implemented and accepted procedure. Donors have to be well educated about all risks and details during the informed consent process. For this to be successful, more information regarding short-term outcome is necessary. METHODS A literature search was performed; all studies discussing short-term complications after minimally invasive live donor nephrectomy were included. Outcomes evaluated were intraoperative and postoperative complications, conversions, operative and warm ischemia times, blood loss, length of hospital stay, pain score, convalescence, quality of life, and costs. RESULTS One hundred ninety articles were included in the systematic review, 41 in the meta-analysis. Conversion rate was 1.1%. Intraoperative complication rate was 2.3%, mainly bleeding (1.5%). Postoperative complications occurred in 7.3% of donors, including infectious complications (2.6%), of which mainly wound infection (1.6%) and bleeding (1.0%). Reported mortality rate was 0.01%. All minimally invasive techniques were comparable with regard to complication or conversion rate. CONCLUSIONS The used techniques for minimally invasive live donor nephrectomy are safe and associated with low complication rates and minimal risk of mortality. These data may be helpful to develop a standardized, donor-tailored informed consent procedure for live donor nephrectomy.
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Abstract
PURPOSE We describe a technique of complete intracorporeal renal autotransplantation with donor nephrectomy and transplantation performed in a minimally invasive fashion without extracting the kidney. MATERIALS AND METHODS We developed this technique of a completely intracorporeal robotic renal autotransplantation and determined the feasibility of this novel procedure. This includes a method of intracorporeal transarterial hypothermic renal perfusion using a perfusion catheter through a laparoscopic port. The procedure was successfully applied in a 56-year-old man with extensive left ureteral loss after failed ureteroscopy for ureterolithiasis. RESULTS Robotic donor nephrectomy was performed with a warm ischemia time of 2.3 minutes. Subsequently cold ischemia was achieved by intracorporeal hypothermic renal perfusion for 95.5 minutes. Vascular anastomoses and ureteroureterostomy in the ipsilateral pelvis were completed after donor nephrectomy with a total overall surgeon console time of 334 minutes. Venous and arterial anastomosis times were 17.3 and 21.3 minutes, respectively. Estimated blood loss was less than 50 ml. There were no complications and the patient was discharged home on postoperative day 1 after normal Doppler transplant renal ultrasound. Postoperative renal scan at 6 weeks, intravenous urogram at 8 weeks and computerized tomography urography at 5 months revealed normal function and successful ureteral reconstruction. CONCLUSIONS We report the feasibility of a technique of a completely intracorporeal robotic renal autotransplantation. This operation may be considered in select patients in the hands of experienced robotic surgeons. However, further refinement is required as this novel procedure is cautiously reproduced and adopted by others.
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