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Retroperitoneoscopic donor nephrectomy with a gel-sealed hand-assist access device: retroperitoneoscopic donor nephrectomy
Kei Arai, Tsutomu Nishiyama, Noboru Hara, Takashi Kasahara, Kazuhide Saito, Kota Takahashi
BMC Urology , 2013, DOI: 10.1186/1471-2490-13-7
Abstract: Seventy-five consecutive donors receiving this procedure were retrospectively studied. A 2-cm skin incision was made at the midpoint between the tip of the 12th rib and superior border of the iliac bone in the midaxillary line, through which retroperitoneal space was made. Preperitoneal wound with a 6 -- 7-cm pararectal incision in the upper abdominal region was connected to the retroperitoneal space. A GelPort was put inside the pararectal surgical wound. The principle was pure retroperitoneoscopic surgery; hand-assist was applied for retraction of the kidney in the renal vessel control and graft extraction.The mean operation time including waiting time for recipient preparation was 242.2+/-37.0 (range: 214.0--409.0) min, and the mean amount of blood loss was 164.3+/-146.6 (range: 10.0--1020.0) ml. The mean WIT was 2.8+/-1.0 (range: 1.0--6.0) min. The shortage of renal vessels or ureter was observed in none of the grafts. No donor experienced blood transfusion, open conversion, or injury of other organs. Blood loss was greater in patients with body mass index (BMI) of 25 kg/m2 or higher than in those with BMI of <25 kg/m2 (218.4+/-98.8 vs. 154.8+/-152.1 ml, P=0.031). No donor had postoperative ileus or reported wound pain leading to decreased activity of daily life or wound cosmetic problem.Retroperitoneoscopic hand-assisted donor nephrectomy with the mentioned approach was suggested to be a feasible option without compromising safety, although further improvement in surgical techniques is warranted.
Retroperitoneoscopic Nephrectomy for Treatment of a Case of Left Single Ectopic Ureter Accompanied by Dysplastic Kidney
Hara,Ryoei,Fujii,Tomohiro,Jo,Yoshimasa,Yokoyama,Teruhiko
Acta Medica Okayama , 2011,
Abstract: We report the case of a 7-year-old girl with a single ectopic ureter who was treated with retroperitoneoscopic nephrectomy for a chief complaint of urinary incontinence. Preoperative CT showed a contrasted dysplastic kidney of 1cm in the renal fossa and a left ureteral opening into the vagina. Retroperitoneoscopic left nephrectomy was conducted with opening of the lateroconal fascia to enable identification of the dysplastic kidney. No intraoperative complications were encountered. Urinary incontinence improved immediately after surgery. This case shows that a retroperitoneal approach can be used in nephrectomy if the position of the kidney can be determined preoperatively.
Retroperitoneoscopic nephrectomy has better perioperative outcomes than transperitoneal laparoscopic nephrectomy in obese patients  [cached]
Sel?uk Erdem,?ner ?anl?,Tzevat Tefik,Tayfun Oktar
Turkish Journal of Urology , 2012,
Abstract: Objective: This retrospective, case-controlled study compares the operative outcomes of retroperitoneoscopic nephrectomy (RN) and transperitoneal laparoscopic nephrectomy (TLN) in obese patients.Materials and Methods: A total of 202 operations, including 114 radical and 88 simple nephrectomies were identified from our prospectively collected institutional laparoscopic nephrectomy database. Patients were stratified into 3 groups according to the World Health Organization’s body mass index (BMI) classification: normal (Group 1-BMI <25 kg/m2, n=68), overweight (Group 2-25 kg/m2 ≤ BMI <30 kg/m2, n=88) and obese (Group 3-BMI ≥30 kg/m2, n=46). Furthermore, each group was divided into two subgroups according to the operation performed (RN or TLN). Perioperative parameters were compared statistically between the RN and TLN subgroups in all of the BMI-stratified categories.Results: The results for mean operative time (p<0.001, p=0.034 and p=0.005), estimated blood loss (p<0.001, p<0.001 and p=0.002) and length of hospital stay (p=0.005, p<0.001 and p<0.001) were all significantly in favor of RN in Groups 1, 2 and 3, respectively. The complication rate did not significantly differ between RN and TLN in the BMI-stratified groups. Conversely, the open conversion rate was significantly higher for TLN in Group 1 (p=0.024); this rate was similar for RN and TLN in Group 2 (p=0.22) and Group 3 (p=0.658). Conclusion: Retroperitoneoscopic nephrectomy has better perioperative outcomes in obese patients; these outcomes are similar to those seen in non-obese patients. However, both retroperitoneoscopic and transperitoneal laparoscopic operations can be safely performed, with the same complication and open conversion rates, in obese patients.
Impact of Right-Sided Nephrectomy on Long-Term Outcomes in Retroperitoneoscopic Live Donor Nephrectomy at Single Center  [PDF]
Kazuya Omoto,Taiji Nozaki,Masashi Inui,Tomokazu Shimizu,Toshihito Hirai,Yugo Sawada,Hideki Ishida,Kazunari Tanabe
Journal of Transplantation , 2013, DOI: 10.1155/2013/546373
Abstract: Objective. To assess the long-term graft survival of right-sided retroperitoneoscopic live donor nephrectomy (RPLDN), we compared the outcomes of right- and left-sided RPLDN. Methods. Five hundred and thirty-three patients underwent live donor renal transplantation with allografts procured by RPLDN from July 2001 to August 2010 at our institute. Of these, 24 (4.5%) cases were selected for right-sided RPLDN (R-RPLDN) according to our criteria for donor kidney selection. Study variables included peri- and postoperative clinical data. Results. No significant differences were found in the recipients' postoperative graft function and incidence of slow graft function. Despite significant increased warm ischemic time (WIT: mean 5.9?min versus 4.7?min, ) in R-RPLDN compared to that in L-RPLDN, there was no significant difference between the two groups regarding long-term patient and graft survival. The complication rate in R-RPLDN was not significantly different compared to that in L-RPLDN (17% versus 6.5%, ). No renal vein thrombosis was experienced in either groups. Conclusions. Although our study was retrospective and there was only a small number of R-RPLDN patients, R-RPLDN could be an option for laparoscopic live donor nephrectomy because of similar results, with the sole exception of WIT, in L-RPLDN, and its excellent long-term graft outcomes. 1. Introduction The first laparoscopic living-donor nephrectomy (LLDN) was performed by Ratner et al. [1]. Since then, there has been increased acceptance of the procedure in many countries. In Japan, the number of deceased donor kidneys available for transplantation has not shown any increase, but living donor kidney transplantation increases yearly [2]. Laparoscopic procurement can offer an advantage to living kidney donors. The recent outcome of laparoscopic donor nephrectomy seems to be greatly improved compared to that in the early years, but the procedure still remains challenging even for the most experienced laparoscopists [2–4]. This is apparent especially in contrast to open donor nephrectomy, in which the right kidney was removed in 24% to 35% of the patients. The rate of right-sided donor nephrectomy in various laparoscopic series ranges from 3.5% to 56.2% [5, 6]. According to the database from the United Network of Organ Sharing (UNOS), right LLDN represented only 10.5% of all LLDN in 2006 [7]. One reason for the reluctance to perform right-sided laparoscopic donor nephrectomy has been the high vascular complication rate and the technical difficulties reported in the initial series. Moreover,
Laparoscopic nephrectomy for benign non functioning kidneys  [cached]
Gupta Narmada,Gautam Gagan
Journal of Minimal Access Surgery , 2005,
Abstract: Laparoscopic nephrectomy has been established as the standard of care for the management of benign non-functioning kidneys and has gained worldwide popularity over the past decade. In this article, we have reviewed the current literature to elucidate the indications, contraindications, surgical techniques, results and complications of laparoscopic nephrectomy.
Retroperitoneoscopic radical nephrectomy with a small incision for renal cell carcinoma: Comparison with the conventional method
Hiroki Ito, Kazuhide Makiyama, Takashi Kawahara, Futoshi Sano, Takayuki Murakami, Narihiko Hayashi, Yasuhide Miyoshi, Noboru Nakaigawa, Masahiro Yao, Yoshinobu Kubota
Journal of Negative Results in BioMedicine , 2011, DOI: 10.1186/1477-5751-10-11
Abstract: Among the cases of T1N0M0 suspicious renal cell carcinoma treated at Yokohama City University between May 2003 and June 2009, the A method was performed in 51 cases and the B method was performed in 33 cases. The factors in the outcomes compared between the A and B methods were the duration of procedure, volume of bleeding, volume of transfusion, weight of the specimen, incidence of peritoneal injury, rate of conversion to open surgery, and perioperative complications.The duration of the procedure was 214.4 ± 46.9 minutes in the A method group and 208.1 ± 36.4 minutes in the B method group (p = 0.518). The volume of bleeding and the weight of the specimen were 105.5 ± 283.2 ml and 335.1 ± 137.4 g in the A method group and 44.8 ± 116 ml (p = 0.247) and 309.2 ± 126 g (p = 0.385) in the B method group. There was no significant difference in all factors analyzed.The A method would be highly possible to produce stable results, even during the introduction period when the staff and the institution are still unfamiliar with the retroperitoneoscopic surgery.The technical progress in laparoscopic surgery for renal cell carcinoma has been remarkable. Many institutions have introduced laparoscopic radical nephrectomy for renal cell carcinoma and even retroperitoneoscopic radical nephrectomy for renal cell carcinoma [1]. In recent years, these surgical methods are in widespread use, and the number of reports [2,3] about complications associated with surgery is rising. It has become important to identify how such a surgery can be completed in a safe manner during the introduction period when institutions and staff are still unfamiliar with these surgical methods.When retroperitoneoscopic radical nephrectomy for renal cell carcinoma was introduced into our institution, we performed a combined small skin incision method in our hospital. That's because we thought that the combined small skin incision method was safer than the conventional method that all procedures were performed w
Hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy: HARP-trial
Leonienke FC Dols, Niels FM Kok, Turkan Terkivatan, TC Khe Tran, Frank CH d'Ancona, Johan F Langenhuijsen, Ingrid RAM zur borg, Ian PJ Alwayn, Mark P Hendriks, Ine M Dooper, Willem Weimar, Jan NM IJzermans
BMC Surgery , 2010, DOI: 10.1186/1471-2482-10-11
Abstract: The HARP-trial is a multi-centre randomised controlled, single-blind trial. The study compares the hand-assisted retroperitoneoscopic approach with standard laparoscopic donor nephrectomy. The objective is to determine the best approach for live donor nephrectomy to optimise donor's safety and comfort while reducing donation related costs.This study will contribute to the evidence on any benefits of hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy.Dutch Trial Register NTR1433Transplantation is the only treatment offering long-term benefit to patients with chronic kidney failure. As the number of patients suffering end stage renal disease (ESRD) increases, the recruitment of more kidney donors is important [1]. Live kidney donation is the most realistic option to reduce donor shortage on short- and long-term. Increasing the number of donors will decrease the number of patients on the waiting list and consequently reduce patient's mortality. Implementation of live donation offers the possibility to transplant before the kidney disease reaches the terminal phase, necessitating dialysis. Thus, this so called pre-emptive transplantation may prevent unnecessary surgical interventions to establish dialysis (including costs and mortality) and dialysis related complications. In the last decade the number of non-related live kidney donations is rising. Among these donors are family and friends of the recipient, and even anonymous donors; the ethical basis for live kidney donation is altering. The looser the connection between the donor and recipient is, the less clear the profit for the donor is.Live donor nephrectomy is performed on healthy individuals who do not receive direct therapeutic benefit of the procedure themselves. In order to guarantee safety for the donors, it is important to optimise the surgical approach. Recently we demonstrated the benefit of laparoscopic nephrectomy (LDN) to the donor. However, this method is characterised b
Retroperitoneoscopic laparo-endoscopic single-site radical nephrectomy (RLESS-RN): initial experience with a homemade port
Shiu-Dong Chung, Chao-Yuan Huang, Yao-Chou Tsai, Shih-Chieh Chueh, Shun-Fa Hung, Shuo-Meng Wang, Chun-Hou Liao, Hong-Jeng Yu
World Journal of Surgical Oncology , 2011, DOI: 10.1186/1477-7819-9-138
Abstract: The novel technique laparoendoscopic single-site surgery (LESS) have been successfully performed in various urological operations that aim at performing laparoscopic surgery by consolidating all ports within a single skin incision, often concealed within the umbilicus and the transperitoneal route is typically employed [1-3]. The most obvious advantage of LESS is its cosmetic outcome when compared with conventional laparoscopic procedure [4]. Traditional laparoscopic techniques for radical nephrectomy usually need four to five trocars because retraction of intraabdominal organs is necessary [5-7]. There have been only limited reports of retroperitoneoscopic LESS procedures, and retroperitoneoscopic LESS nephrectomy was only reported very rarely, with limited case numbers, using variable LESS access platforms [8-10]. The present study retrospectively reviewed our experience of evaluating the feasibility and safety of retroperitoneoscopic LESS radical nephrectomy (RLESS-RN).Since June 2010, retroperitoneal LESS radical nephrectomy (RLESS-RN) has been performed in 6 patients. Perioperative data were collected retrospectively into our institutional review board-approved data registry and informed patient consent. All procedures were performed through the retroperitoneal approach.After the induction of general endotracheal anaesthesia, the patient was placed in a full flank position. The operating table was flexed at the waist level and the patient was securely fixed on the operating table with all pressure points well padded. Both the operator and the first assistant as the camera holder stood on the back side of the patient. All RLESS-RN was started from establishing retroperitoneoscopic working space by our previous reported method [11], with the open Hasson's technique and the modification that the space was dilated with the Preperitoneal Dissector Balloon (PDB 1000; Covidien, Mansfield, MA, USA) under the direct vision of a 0° 10-mm telescope instead of the original
Prospective comparative study between retroperitoneoscopic and hand-assisted laparoscopic approach for radical nephrectomy
Tobias-Machado, Marcos;Ravizzini, Pedro I.;Pertusier, Leonardo O.;Pedroso, Eduardo;Wroclawski, Eric R.;
International braz j urol , 2009, DOI: 10.1590/S1677-55382009000300004
Abstract: objective: no consensus has yet been established regarding the best minimally invasive access for radical ablation of renal tumors. our objective was to prospectively compare the surgical results and oncologic management of two currently used endoscopic techniques. material and methods: over a four-year period, 50 patients with renal tumors and clinical stage t1b-t2, smaller than 12 cm, underwent a radical nephrectomy at two reference institutions, 25 underwent retroperitoneoscopic radical nephrectomy (rrn) and 25 a hand-assisted laparoscopic radical nephrectomy (halrn). mean follow-up of both cohorts was 50 months. operative parameters and oncological management were compared. results: the mean operative time was 180 min in rrn and 108 min in halrn (p < 0.001). the time required to access the renal pedicle in rrn was 30 min. and in halrn 40 min., learning curve was shorter in halrn than rrn. mean blood loss was 100 ml in rrn and 242 ml in halrn. mean incision size for specimen retrieval in rrn was 6.5 cm and in halrn 7.5 cm. one patient with intra operative occurrence of ascites and subsequent pathological stage pt2n0m0 grade 3 operated via halrn, had neoplasic implants in the hand-port incision 3 months after surgery followed by death 4 months after recurrence. one patient, with pathological stage pt3n0m0 grade 3 in rrn had metastasis after 36 months. conclusion: both, rrn and halrn techniques are accepted minimally invasive options for endoscopic radical nephrectomy with equivalent long term oncological outcome in the treatment of renal tumors.
TOTAL THYROIDECTOMY IN THE TREATMENT OF BENIGN PATHOLOGY  [PDF]
M. Saviano
Jurnalul de Chirurgie , 2010,
Abstract: Total thyroidectomy or subtotal thyroidectomy performed in benign pathology of thyroid? Methods: To answer this question we performed a retrospective study on 1103 cases with this pathology: 1082 cases first intervention and 51 cases for relapse pathology. Preoperative diagnosis included: evaluation of the functionality of the thyroid by lab tests, endocrinology exam, ORL exam, anhéstesiologique exam, chest radiograph, CT/MRI neck and thorax, ultrasound, scintigraphy, fine-needle aspiration cytologic diagnoses. Results: Preoperative diagnosis was multinodular goiter (1040 cs.) and Basedow (63 cs.) and surgical procedures performed were total thyroidectomy in 865 cs and subtotal thyroidectomy in 238 cs. In 92 cs were diving goiter and in 157 patients were diagnosed with large nodular goiter (>100 gr). The surgery made by 123 patients with thyroid carcinoma and 980 patients with benign pathology. Mean postoperative hospital stay was 2.5 days. In the group of 1032 patients without preoperative suspicion of neoplasia (cytology not performed preoperatively or negative) hidden carcinomas were 11.7% (121 patients) what requiring 11 surgical reinterventions for radicalization of subtotal thyroidectomy. In the group of 71 patients with preoperative suspicion of neoplasia by fine-needle aspiration papillary carcinoma were 2.8%, the rest being benign thyroid pathology. In the postoperative complications, recurrent nerve lesions were encountered in 78 cs (3.76% of 2206 nerves at risk). Bilateral paralysis immediate was encountered in 5 cs (0.4%): 2 cs after total thyroidectomy and 3 cs after subtotal thyroidectomy with permanent bilateral paralysis in all cases. The immediate unilateral paralysis was encountered in 73 patients, (6.6%/3.3% nerves): 40 cs (4.6%) after total thyroidectomy and 33 cs (13.8%) after subtotal thyroidectomy (p <0.0001). But permanent unilateral paralysis was recorded in 16 patients (1.4%/0.7% nerves): 9 cs (1.0%/0.5% nerves) after total thyroidectomy and 7 (2.9%/1.4% nerves) after subtotal thyroidectomy with insignificant p 0.030. Postoperative hypocalcemia secondary lesions of parathyroid glands was recorded in 222 patients. The permanent hypocalcemia was encountered in 52 cs (6%) after total thyroidectomy and 14 cs (5.8%) after subtotal thyroidectomy with insignificant p 0.8311. Conclusions: The incidence of recurrent nerve lesions, not higher even than in the total thyroidectomy versus subtotal thyroidectomy. The incidence of residual permanent hypoparathyroidism superimposable between the two techniques. The high incidence of carcinomas
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