Research Article
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First experiences in laparoscopic donor nephrectomy after completion of a clinical fellowship program

Year 2021, Volume: 13 Issue: 2, 32 - 37, 31.07.2021

Abstract

Objective: Kidney transplantation is the gold standard treatment method in patients with end-stage renal failure. The trend towards minimally invasive surgery in all areas of surgery has also manifested itself in kidney donor surgeries, and open donor nephrectomy has largely been replaced by laparoscopic donor nephrectomy. There are several ways to gain experience with laparoscopic donor nephrectomy. The first one is to receive an accredited kidney transplant minor branch education. In this study, we aimed to present the results of the first 12 cases performed by two surgeons who have received transplant surgery minor branch education abroad in a urology clinic that did not have previous kidney transplant and laparoscopic donor nephrectomy experience but advanced laparoscopic urological interventions.
Material And Methods: Laparoscopic donor nephrectomy cases performed between February 2017 and July 2019 were analyzed retrospectively. The database in which the preoperative, intraoperative and postoperative data of the patients were recorded was analyzed. All donor nephrectomy surgeries were performed with a pure laparoscopic transperitoneal approach.
Results: Six of the 12 patients (%50) who underwent laparoscopic donor nephrectomy were women and 6 (%50) were men. While the mean age of our patients was 45.0 ± 13.0 years, the age distribution ranged from 22 to 65, with the median being 49 years. In 11 out of 12 case (%91) for donor nephrectomy, the left kidney was preferred because the left renal vein and artery were longer than the right. The mean operation time of our patients was 96.0 ± 8.0 min and the mean warm ischemia time was 4.0 ± 2.0 min. The average length of hospital stay was 2.5 ± 0.5 days.
Conclusion: Laparoscopic donor nephrectomy should be performed by experienced or adequately trained surgeons. In a urology clinic without previous laparoscopic donor nephrectomy experience, cases of laparoscopic donor nephrectomy performed with the relevant minor branch training can provide safe and successful results in comparison with the literature.

References

  • 1997 Annual report of the U.S. sciensific registry for transplant recipient and the organ procurement and transplantition network. 1988-1996.
  • Şantaş G&Şantaş F. Türkiye’ de organ bağışının mevcut durumu ve organ bağışında stratejik iletişimin önemi. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi 2018; 9:163-168.
  • Fonouni H, Mehrabi A, Golriz M et al. Comparison of the laparoscopic versus open live donor nephrectomy: an overview of surgical complications and outcome. Langenbeck’s Arch. Surg. 2014; 399:543-551.
  • Serrano OK, Bangdiwala AS, Vock DM et al. Defining the tipping point in surgical performance for laparoscopic donor nephrectomy among transplant surgery fellows: A risk‐adjusted cumulative summation learning curve analysis. Am. J. Transplant. 2017; 17(7):1868-1878.
  • Reich DJ, Magee JC, Gifford, K et al. Transplant surgery fellow perceptions about training and the ensuing job market are the right number of surgeons being trained?. Am. J. Transplant. 2011; 2:253-260.
  • Rice T, Lewis H, Cuffy M, Ratner L, Diwan T. Changing Education Paradigms: Training Fellows for High Stake Procedures. J Surg Educ 2020; 77(4):847-847.
  • Taweemonkongsap T, Nualyong C, Amornvesukit T, Srinualnad S, Jitpraphai S, Premasathian N. Laparoscopic live-donor nephrectomy: a comparison with the open technique and how to reach quality standards: a single-center experience in Thailand. Transplant Proc. 2011 ;43(10):593-3598.
  • Iemsupakkul P, Kongchareonsombat W, Kijvikai K. Comparison of Pfannenstiel or extended iliac port site kidney extraction in laparoscopic donor nephrectomy: do we have consensus?. Exp Clin Transplant. 2017 ;15(2):138-142.
  • Friedman AL, Peters TG, Ratner LE. Regulatory failure contributing to deaths of live kidney donors. Am J Transplant. 2012 ;12(4):829-834.
  • Aktas F. Retroaortik sol renal venin klinik ve radyolojik önemi. Anadolu Klin 2019; 24(1):38-41.
  • Tuğcu V, Şahin S, Yiğitbaşı İ, Şener NC, Akbay FG, Taşçı Aİ. Laparoscopic donor nephrectomy, complications and management: a single center experience. Turk J Urol. 2017; 43(1):93.
  • Ratner LE, Montgomery RA, Kavoussi LR. Laparoscopic live donor nephrectomy: the four year Johns Hopkins University experience. Nephrol Dial Transplant. 1999; 14:2090-3.
  • Serrano OK, Kirchner V, Bangdiwala A, Vock DM, Dunn TB, Finger EB. Evolution of living donor nephrectomy at a single center: long-term outcomes with 4 different techniques in greater than 4000 donors over 50 years. Transplantation. 2016; 100(6):1299-1305.
  • Özden E, Yakupoğlu YK, Bostancı Y, Ataç F, Karataş A, Sarıkaya Ş. Retroperitoneoskopik Verici Nefrektomi Sonuçlarımız. Turk Neph Dial Transpl 2010; 19:180-5.
  • Greco F, Hoda MR, Alcaraz A, Bachmann A, Hakenberg OW, Fornara P. Laparoscopic living-donor nephrectomy: Analysis of the existing literature. Eur Urol. 2010; 58:498-509.
  • Meyer F, Santos LS, Neumaier MF, Michelotto JC, Varaschin AE, Pimpao BF. Laparoscopic Living Donor Nephrectomy: 10-Year Experience. Braz J Video-Sur 2013; 6:138-41.
  • Sozener U. Laparoscopic Live Donor Nephrectomy: Single-Center Experience of 200 Consecutive Cases. J Laparoendosc Adv Surg Tech A. 2021; 31(6):627-631.
  • Yuan H, Liu L, Zheng S, Yang L, Pu C, Wei Q, Han P. The safety and efficacy of laparoscopic donor nephrectomy for renal transplantation: an updated meta-analysis. Transplant Proc. 2013; 45(1):65-76.
  • Kaçar S, Gürkan A, Karaca C, Varılsüha C, Tilif S. Laparoskopik donör nefrektomi. Sözlü bildiri. Türkiye Organ Nakli Kuruluşları Koordinasyon Derneği 6. Kongresi, Erzurum, TR 2008.
  • Ratner LE, Hiller J, Sroka M, Weber R, Sikorsky I, Montgomery RA, et al. Laparoscopic live donor nephrectomy removes disincentives to live donation. Transplant Proc. 1997; 29:3402-3.
  • Yavascaoglu I, Dogan HS, Gursoy E, Kordan Y, Vuruskan H, Oktay B. Laparoscopic donor nephrectomy: our preliminary results. Turk J Urol. 2010; 36:61-6.
  • Krajewski, W., Dembowski, J., Kołodziej, A., Małkiewicz, B., Tupikowski, K., Matuszewski, M. Urological complications after renal transplantation–a single centre experience. Cent European J Urol. 2016; 69(3):306-311

Klinik yan dal eğitimi sonrası laparoskopik donör nefrektomide ilk deneyimler

Year 2021, Volume: 13 Issue: 2, 32 - 37, 31.07.2021

Abstract

Amaç: Son dönem böbrek yetmezliği olan hastalarda böbrek nakli altın standart tedavi yöntemidir. Cerrahinin tüm alanlarında minimal invazif cerrahiye olan eğilim böbrek donör cerrahilerinde de kendisini göstermiş olup açık donör nefrektomi, yerini büyük oranda laparoskopik donör nefrektomiye bırakmıştır. Laparoskopik donör nefrektomi ile ilgili tecrübe kazanabilmenin çeşitli yolları vardır. Bunlardan ilki akredite bir böbrek nakli yan dal eğitimi görmektir. Bu çalışmada, daha önce böbrek nakli ve laparoskopik donör nefrektomi deneyimi olmayan ancak ileri laparoskopik ürolojik girişimlerin yapıldığı bir üroloji kliniğinde, yurtdışında transplant cerrahisi yan dal eğitimi almış olan iki cerrahın birlikte gerçekleştirdikleri ilk 12 vakanın sonuçlarını sunmayı amaçladık.
Gereç ve Yöntemler: Şubat 2017-Temmuz 2019 yılları arasında gerçekleştirilen laparoskopik donör nefrektomi olguları retrospektif olarak incelendi. Hastaların preoperatif, intraoperatif ve postoperatif verilerinin kayıtlı olduğu veritabanı analiz edildi. Tüm donör nefrektomi cerrahileri pür laparoskopik transperitoneal yaklaşımla yapıldı.
Bulgular: Laparoskopik donör nefrektomi uygulanan 12 hastanın 6’ sı (%50) kadın, 6’ sı (%50) erkekti. Hastalarımızın yaş ortalaması 45,0 ± 13,0 yıl iken, yaş dağılımı ortanca 49 yıl olmak üzere 22 ile 65 arasında değişiyordu. Donör nefrektomi için 12 vakanın 11’ inde (%91), sol böbrek renal veninin ve arterinin sağa göre daha uzun olması nedeniyle sol böbrek tercih edildi. Hastalarımızın ortalama ameliyat süresi 96,0 ± 8,0 dk, ortalama sıcak iskemi süresi 4,0 ± 2,0 dk olarak ölçüldü. Ortalama hastanede kalış süresi 2,5 ± 0,5 gün olarak saptandı.
Sonuç: Laparoskopik donör nefrektominin tecrübeli veya yeterli eğitim almış cerrahlar tarafından gerçekleştirilmesi gerekmektedir. Daha önce laparoskopik donör nefrektomi deneyimi olmayan bir üroloji kliniğinde, ilgili yan dal eğitimini almış olarak gerçekleştirilen laparoskopik donör nefrektomi vakaları literatür ile kıyaslanılabilir bir biçimde güvenli ve başarılı sonuçlar verebilmektedir.

References

  • 1997 Annual report of the U.S. sciensific registry for transplant recipient and the organ procurement and transplantition network. 1988-1996.
  • Şantaş G&Şantaş F. Türkiye’ de organ bağışının mevcut durumu ve organ bağışında stratejik iletişimin önemi. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi 2018; 9:163-168.
  • Fonouni H, Mehrabi A, Golriz M et al. Comparison of the laparoscopic versus open live donor nephrectomy: an overview of surgical complications and outcome. Langenbeck’s Arch. Surg. 2014; 399:543-551.
  • Serrano OK, Bangdiwala AS, Vock DM et al. Defining the tipping point in surgical performance for laparoscopic donor nephrectomy among transplant surgery fellows: A risk‐adjusted cumulative summation learning curve analysis. Am. J. Transplant. 2017; 17(7):1868-1878.
  • Reich DJ, Magee JC, Gifford, K et al. Transplant surgery fellow perceptions about training and the ensuing job market are the right number of surgeons being trained?. Am. J. Transplant. 2011; 2:253-260.
  • Rice T, Lewis H, Cuffy M, Ratner L, Diwan T. Changing Education Paradigms: Training Fellows for High Stake Procedures. J Surg Educ 2020; 77(4):847-847.
  • Taweemonkongsap T, Nualyong C, Amornvesukit T, Srinualnad S, Jitpraphai S, Premasathian N. Laparoscopic live-donor nephrectomy: a comparison with the open technique and how to reach quality standards: a single-center experience in Thailand. Transplant Proc. 2011 ;43(10):593-3598.
  • Iemsupakkul P, Kongchareonsombat W, Kijvikai K. Comparison of Pfannenstiel or extended iliac port site kidney extraction in laparoscopic donor nephrectomy: do we have consensus?. Exp Clin Transplant. 2017 ;15(2):138-142.
  • Friedman AL, Peters TG, Ratner LE. Regulatory failure contributing to deaths of live kidney donors. Am J Transplant. 2012 ;12(4):829-834.
  • Aktas F. Retroaortik sol renal venin klinik ve radyolojik önemi. Anadolu Klin 2019; 24(1):38-41.
  • Tuğcu V, Şahin S, Yiğitbaşı İ, Şener NC, Akbay FG, Taşçı Aİ. Laparoscopic donor nephrectomy, complications and management: a single center experience. Turk J Urol. 2017; 43(1):93.
  • Ratner LE, Montgomery RA, Kavoussi LR. Laparoscopic live donor nephrectomy: the four year Johns Hopkins University experience. Nephrol Dial Transplant. 1999; 14:2090-3.
  • Serrano OK, Kirchner V, Bangdiwala A, Vock DM, Dunn TB, Finger EB. Evolution of living donor nephrectomy at a single center: long-term outcomes with 4 different techniques in greater than 4000 donors over 50 years. Transplantation. 2016; 100(6):1299-1305.
  • Özden E, Yakupoğlu YK, Bostancı Y, Ataç F, Karataş A, Sarıkaya Ş. Retroperitoneoskopik Verici Nefrektomi Sonuçlarımız. Turk Neph Dial Transpl 2010; 19:180-5.
  • Greco F, Hoda MR, Alcaraz A, Bachmann A, Hakenberg OW, Fornara P. Laparoscopic living-donor nephrectomy: Analysis of the existing literature. Eur Urol. 2010; 58:498-509.
  • Meyer F, Santos LS, Neumaier MF, Michelotto JC, Varaschin AE, Pimpao BF. Laparoscopic Living Donor Nephrectomy: 10-Year Experience. Braz J Video-Sur 2013; 6:138-41.
  • Sozener U. Laparoscopic Live Donor Nephrectomy: Single-Center Experience of 200 Consecutive Cases. J Laparoendosc Adv Surg Tech A. 2021; 31(6):627-631.
  • Yuan H, Liu L, Zheng S, Yang L, Pu C, Wei Q, Han P. The safety and efficacy of laparoscopic donor nephrectomy for renal transplantation: an updated meta-analysis. Transplant Proc. 2013; 45(1):65-76.
  • Kaçar S, Gürkan A, Karaca C, Varılsüha C, Tilif S. Laparoskopik donör nefrektomi. Sözlü bildiri. Türkiye Organ Nakli Kuruluşları Koordinasyon Derneği 6. Kongresi, Erzurum, TR 2008.
  • Ratner LE, Hiller J, Sroka M, Weber R, Sikorsky I, Montgomery RA, et al. Laparoscopic live donor nephrectomy removes disincentives to live donation. Transplant Proc. 1997; 29:3402-3.
  • Yavascaoglu I, Dogan HS, Gursoy E, Kordan Y, Vuruskan H, Oktay B. Laparoscopic donor nephrectomy: our preliminary results. Turk J Urol. 2010; 36:61-6.
  • Krajewski, W., Dembowski, J., Kołodziej, A., Małkiewicz, B., Tupikowski, K., Matuszewski, M. Urological complications after renal transplantation–a single centre experience. Cent European J Urol. 2016; 69(3):306-311
There are 22 citations in total.

Details

Primary Language Turkish
Subjects Urology
Journal Section Research Article
Authors

Mehmet Altan 0000-0002-0504-3988

Anar Aghayev This is me 0000-0002-2737-9730

Alihan Kokurcan This is me 0000-0003-3486-108X

Sanem Cimen 0000-0002-5266-9529

Sertaç Çimen 0000-0002-0252-8840

Hasan Nedim Göksel Göktuğ This is me 0000-0001-9762-0641

Publication Date July 31, 2021
Published in Issue Year 2021 Volume: 13 Issue: 2

Cite

Vancouver Altan M, Aghayev A, Kokurcan A, Cimen S, Çimen S, Göktuğ HNG. Klinik yan dal eğitimi sonrası laparoskopik donör nefrektomide ilk deneyimler. Endourol Bull. 2021;13(2):32-7.