BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparosc...BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparoscopic procedures,are well-established in high-income countries and are being increasingly adopted worldwide.Nevertheless,no studies have reported surgical outcomes of RALDN donor nephrectomy from a United Kingdom center to date.AIM To compare surgical outcomes between RALDN and HALDN laparoscopic donor nephrectomy in a United Kingdom high-volume living kidney donor transplant program.METHODS A case-control matching analysis was performed based on the following parameters:Sex,age,body mass index,procedure laterality,number of renal arteries,and previous abdominal surgeries.Key surgical outcomes,including primary warm ischemia time,operative duration,and post-operative recovery,were evaluated.RESULTS In this cohort of 140 living donors(70 RALDN vs 70 HALDN),donor and recipient outcomes were equivalent across key metrics:Pain scores,overall complication rates,readmissions,reoperations,and creatinine levels at 30 days and 1 year.Recipient long-term renal function did not differ between groups.Operative time for RALDN decreased significantly over the study period,indicating progressive improvement along the learning curve.Although RALDN was associated with a modestly longer mean warm ischaemia time(3.53 minutes vs 2.76 minutes,P<0.001)and extended hospital stay(4.21 days vs 3.17 days,P<0.001),these did not translate into any disadvantage in clinical outcomes.CONCLUSION In this first United Kingdom comparative cohort,RALDN demonstrated excellent safety and efficacy,even in the early phase of our programme,matching the outcomes of the well-established,gold-standard HALDN approach.Moreover,the pronounced learning-curve trajectory suggests considerable potential for further improvements in robotic surgical outcomes as the programme matures.展开更多
Objective:Robotic-assisted living donor nephrectomy(RALDN)has been shown to be a safe and feasible option,offering enhanced visualization and improved surgical dexterity,allowing for a potential increase in the living...Objective:Robotic-assisted living donor nephrectomy(RALDN)has been shown to be a safe and feasible option,offering enhanced visualization and improved surgical dexterity,allowing for a potential increase in the living donor pool to perform pediatric and adult kidney transplants,even in cases of grafts with anatomical variants.We report our recent experience in using RALDN for open kidney transplantation(OKT).Methods:Between August 2021 and July 2025,122 kidney transplant recipients underwent OKT using RALDN grafts obtained at the Miami Transplant Institute.Clinical outcomes,during the first12 months post-transplant,including the incidence of delayed graft function(DGF),surgical complications,estimated glomerular filtrationrate(eGFR),and graft loss,were evaluated.Results:Sixteen pediatric and 106 adult recipients were included.The median recipient and donor ages were 42.2 yr and 39.5 yr,respectively.Male recipients comprised 63.1%(77/122);female donors comprised 56.6%(69/122).Among the donors,no conversion to open surgery was needed,and no postoperative complications attributed to the RALDN procedure were observed.Thirty-one kidney grafts required back table reconstruction.The median cold and warm ischemia times were 55.5 min and 27.0 min,respectively.One case(0.8%)of DGF was observed.One recipient(0.8%)developed a postoperative vascular complication;five(4.1%)developed a urologic complication.The median eGFRs at 1 mo,3 mo,6 mo,and 12 mo post-transplant were 71.9,77.1,75.1,and 72.1 mL/min/1.73 m2,respectively.No cases of graft failure during the first12 months post-transplant were observed,and one patient died with a functioning graft.Conclusion:RALDN is a safe and effective technique that provides favorable outcomes among both donors and recipients.This minimally invasive approach should be offered as a safe alternative to living donor patients.展开更多
AIM To compare laparoscopic and open living donor neph-rectomy, based on the results from a single center during a decade.METHODS This is a retrospective review of all living donor neph-rectomies performed at the Mass...AIM To compare laparoscopic and open living donor neph-rectomy, based on the results from a single center during a decade.METHODS This is a retrospective review of all living donor neph-rectomies performed at the Massachusetts General Hospital, Harvard Medical School, Boston, between 1/1998 - 12/2009. Overall there were 490 living donors, with 279 undergoing laparoscopic living donor nephrectomy （LLDN） and 211 undergoing open donor nephrectomy （OLDN）. Demographic data, operating room time, the effect of the learning curve, the number of conversions from laparoscopic to open surgery, donor preoperative glomerular fltration rate and creatinine （Cr）, donor and recipient postoperative Cr, delayed graft function and donor complications were analyzed. Statistical analysis was performed.RESULTSOverall there was no statistically significant differencebetween the LLDN and the OLDN groups regardingoperating time, donor preoperative renal function, donorand recipient postoperative kidney function, delayed graftfunction or the incidence of major complications. Whenthe last 100 laparoscopic cases were analyzed, there wasa statistically significant difference regarding operatingtime in favor of the LLDN, pointing out the importanceof the learning curve. Furthermore, another significantdifference between the two groups was the decreasedlength of stay for the LLDN （2.87 d for LLDN vs 3.6 d for OLDN）.CONCLUSION Recognizing the importance of the learning curve, this paper provides evidence that LLDN has a safety profle comparable to OLDN and decreased length of stay for the donor.展开更多
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 techni...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 theχ^(2)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.展开更多
Objective Robotic-assisted live donor nephrectomy(LDN)is being gradually adopted across transplant centers.The left donor kidney is preferred over right due to anatomical factors and ease of procurement.We aimed to st...Objective Robotic-assisted live donor nephrectomy(LDN)is being gradually adopted across transplant centers.The left donor kidney is preferred over right due to anatomical factors and ease of procurement.We aimed to study donor and recipient outcomes after robotic procurement and subsequent open implantation of right and left kidneys.Methods All fully robotic LDNs and their corresponding open kidney transplants performed at our center between February 2016 and December 2021 were retrospectively analyzed.Results Out of 196 robotic LDN(49[right]vs.147[left]),10(5.1%)donors had intra-operative events(6.1%[right]vs.4.8%[left],p=0.71).None of the LDN required conversion to open surgery.The operative times were comparable for the two groups.Nausea(13.3%)was the most common post-operative complication.There was no mortality in either LDN group.Herein,we report our outcomes on 156 recipients(39 right and 117 left allografts)excluding robotic implants,exports,and pediatric recipients.There were no significant differences between right and left kidney recipients with respect to 1-year post-transplant patient survival(100.0%vs.98.1%,p=0.45)or graft survival(93.9%vs.97.1%,p=0.11),or delayed graft function(7.7%vs.5.1%,p=0.55).Conclusion Non-hand-assisted robotic live donor nephrectomies can be safely performed with excellent outcomes.Right LDN was not associated with higher incidence of complications compared to left LDN.Open implantation of robotically procured right renal allografts was not associated with higher risk of recipient complications.展开更多
BACKGROUND With the increasing use of laparoscopic techniques in living-donor kidney transplantation,limitations in donor vessel length,particularly of the right renal vein,pose significant challenges for vascular ana...BACKGROUND With the increasing use of laparoscopic techniques in living-donor kidney transplantation,limitations in donor vessel length,particularly of the right renal vein,pose significant challenges for vascular anastomosis to the recipient’s external iliac vein.These anatomical constraints can complicate graft implantation and increase the risk of postoperative complications.CASE SUMMARY To address the issue of short right renal veins,several surgical strategies have been proposed.In this report,we describe our experience with three cases in which venous extension was successfully achieved using a venous cuff interposition technique during back-table reconstruction.This approach was used to facilitate secure vascular anastomosis and improve graft positioning in anatomically complex transplant scenarios.CONCLUSION Venous cuff interposition represents an effective technique for managing short renal veins in living-donor kidney transplantation.It provides additional length and flexibility,easing anastomotic tension and supporting successful transplantation.展开更多
BACKGROUND Brugada syndrome(BS)is a rare disorder affecting approximately 5 in every 10000 people.Reports of kidney donation in individuals with BS are exceptionally uncommon.CASE SUMMARY The decision to permit live k...BACKGROUND Brugada syndrome(BS)is a rare disorder affecting approximately 5 in every 10000 people.Reports of kidney donation in individuals with BS are exceptionally uncommon.CASE SUMMARY The decision to permit live kidney donation places significant responsibility on clinicians.Donors must adapt to life with a single kidney.While the risk of developing chronic kidney disease post-donation is minimal,it remains higher than in matched healthy individuals.Additionally,the theoretical risk of electrolyte imbalances in kidney donors with BS may have important clinical implications.We present a case of successful kidney donation by a donor with an incidental diagnosis of a sporadic case of BS type 1.An extensive electrophysiological evaluation was conducted to assess the risk of arrhythmia to approval for donation.Anesthetic management was meticulously planned,and the donor was monitored postoperatively in a coronary care unit for 48 hours.This case underscores the ethical considerations and the multidisciplinary approach necessary to ensure donor safety.CONCLUSION Kidney donation in individuals with BS requires careful evaluation to mitigate the risk of fatal arrhythmias during surgical and anesthetic stress.With comprehensive preoperative assessment and vigilant perioperative management,kidney donation can be performed safely.展开更多
文摘BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparoscopic procedures,are well-established in high-income countries and are being increasingly adopted worldwide.Nevertheless,no studies have reported surgical outcomes of RALDN donor nephrectomy from a United Kingdom center to date.AIM To compare surgical outcomes between RALDN and HALDN laparoscopic donor nephrectomy in a United Kingdom high-volume living kidney donor transplant program.METHODS A case-control matching analysis was performed based on the following parameters:Sex,age,body mass index,procedure laterality,number of renal arteries,and previous abdominal surgeries.Key surgical outcomes,including primary warm ischemia time,operative duration,and post-operative recovery,were evaluated.RESULTS In this cohort of 140 living donors(70 RALDN vs 70 HALDN),donor and recipient outcomes were equivalent across key metrics:Pain scores,overall complication rates,readmissions,reoperations,and creatinine levels at 30 days and 1 year.Recipient long-term renal function did not differ between groups.Operative time for RALDN decreased significantly over the study period,indicating progressive improvement along the learning curve.Although RALDN was associated with a modestly longer mean warm ischaemia time(3.53 minutes vs 2.76 minutes,P<0.001)and extended hospital stay(4.21 days vs 3.17 days,P<0.001),these did not translate into any disadvantage in clinical outcomes.CONCLUSION In this first United Kingdom comparative cohort,RALDN demonstrated excellent safety and efficacy,even in the early phase of our programme,matching the outcomes of the well-established,gold-standard HALDN approach.Moreover,the pronounced learning-curve trajectory suggests considerable potential for further improvements in robotic surgical outcomes as the programme matures.
文摘Objective:Robotic-assisted living donor nephrectomy(RALDN)has been shown to be a safe and feasible option,offering enhanced visualization and improved surgical dexterity,allowing for a potential increase in the living donor pool to perform pediatric and adult kidney transplants,even in cases of grafts with anatomical variants.We report our recent experience in using RALDN for open kidney transplantation(OKT).Methods:Between August 2021 and July 2025,122 kidney transplant recipients underwent OKT using RALDN grafts obtained at the Miami Transplant Institute.Clinical outcomes,during the first12 months post-transplant,including the incidence of delayed graft function(DGF),surgical complications,estimated glomerular filtrationrate(eGFR),and graft loss,were evaluated.Results:Sixteen pediatric and 106 adult recipients were included.The median recipient and donor ages were 42.2 yr and 39.5 yr,respectively.Male recipients comprised 63.1%(77/122);female donors comprised 56.6%(69/122).Among the donors,no conversion to open surgery was needed,and no postoperative complications attributed to the RALDN procedure were observed.Thirty-one kidney grafts required back table reconstruction.The median cold and warm ischemia times were 55.5 min and 27.0 min,respectively.One case(0.8%)of DGF was observed.One recipient(0.8%)developed a postoperative vascular complication;five(4.1%)developed a urologic complication.The median eGFRs at 1 mo,3 mo,6 mo,and 12 mo post-transplant were 71.9,77.1,75.1,and 72.1 mL/min/1.73 m2,respectively.No cases of graft failure during the first12 months post-transplant were observed,and one patient died with a functioning graft.Conclusion:RALDN is a safe and effective technique that provides favorable outcomes among both donors and recipients.This minimally invasive approach should be offered as a safe alternative to living donor patients.
文摘AIM To compare laparoscopic and open living donor neph-rectomy, based on the results from a single center during a decade.METHODS This is a retrospective review of all living donor neph-rectomies performed at the Massachusetts General Hospital, Harvard Medical School, Boston, between 1/1998 - 12/2009. Overall there were 490 living donors, with 279 undergoing laparoscopic living donor nephrectomy （LLDN） and 211 undergoing open donor nephrectomy （OLDN）. Demographic data, operating room time, the effect of the learning curve, the number of conversions from laparoscopic to open surgery, donor preoperative glomerular fltration rate and creatinine （Cr）, donor and recipient postoperative Cr, delayed graft function and donor complications were analyzed. Statistical analysis was performed.RESULTSOverall there was no statistically significant differencebetween the LLDN and the OLDN groups regardingoperating time, donor preoperative renal function, donorand recipient postoperative kidney function, delayed graftfunction or the incidence of major complications. Whenthe last 100 laparoscopic cases were analyzed, there wasa statistically significant difference regarding operatingtime in favor of the LLDN, pointing out the importanceof the learning curve. Furthermore, another significantdifference between the two groups was the decreasedlength of stay for the LLDN （2.87 d for LLDN vs 3.6 d for OLDN）.CONCLUSION Recognizing the importance of the learning curve, this paper provides evidence that LLDN has a safety profle comparable to OLDN and decreased length of stay for the donor.
文摘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 theχ^(2)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.
文摘Objective Robotic-assisted live donor nephrectomy(LDN)is being gradually adopted across transplant centers.The left donor kidney is preferred over right due to anatomical factors and ease of procurement.We aimed to study donor and recipient outcomes after robotic procurement and subsequent open implantation of right and left kidneys.Methods All fully robotic LDNs and their corresponding open kidney transplants performed at our center between February 2016 and December 2021 were retrospectively analyzed.Results Out of 196 robotic LDN(49[right]vs.147[left]),10(5.1%)donors had intra-operative events(6.1%[right]vs.4.8%[left],p=0.71).None of the LDN required conversion to open surgery.The operative times were comparable for the two groups.Nausea(13.3%)was the most common post-operative complication.There was no mortality in either LDN group.Herein,we report our outcomes on 156 recipients(39 right and 117 left allografts)excluding robotic implants,exports,and pediatric recipients.There were no significant differences between right and left kidney recipients with respect to 1-year post-transplant patient survival(100.0%vs.98.1%,p=0.45)or graft survival(93.9%vs.97.1%,p=0.11),or delayed graft function(7.7%vs.5.1%,p=0.55).Conclusion Non-hand-assisted robotic live donor nephrectomies can be safely performed with excellent outcomes.Right LDN was not associated with higher incidence of complications compared to left LDN.Open implantation of robotically procured right renal allografts was not associated with higher risk of recipient complications.
文摘BACKGROUND With the increasing use of laparoscopic techniques in living-donor kidney transplantation,limitations in donor vessel length,particularly of the right renal vein,pose significant challenges for vascular anastomosis to the recipient’s external iliac vein.These anatomical constraints can complicate graft implantation and increase the risk of postoperative complications.CASE SUMMARY To address the issue of short right renal veins,several surgical strategies have been proposed.In this report,we describe our experience with three cases in which venous extension was successfully achieved using a venous cuff interposition technique during back-table reconstruction.This approach was used to facilitate secure vascular anastomosis and improve graft positioning in anatomically complex transplant scenarios.CONCLUSION Venous cuff interposition represents an effective technique for managing short renal veins in living-donor kidney transplantation.It provides additional length and flexibility,easing anastomotic tension and supporting successful transplantation.
文摘BACKGROUND Brugada syndrome(BS)is a rare disorder affecting approximately 5 in every 10000 people.Reports of kidney donation in individuals with BS are exceptionally uncommon.CASE SUMMARY The decision to permit live kidney donation places significant responsibility on clinicians.Donors must adapt to life with a single kidney.While the risk of developing chronic kidney disease post-donation is minimal,it remains higher than in matched healthy individuals.Additionally,the theoretical risk of electrolyte imbalances in kidney donors with BS may have important clinical implications.We present a case of successful kidney donation by a donor with an incidental diagnosis of a sporadic case of BS type 1.An extensive electrophysiological evaluation was conducted to assess the risk of arrhythmia to approval for donation.Anesthetic management was meticulously planned,and the donor was monitored postoperatively in a coronary care unit for 48 hours.This case underscores the ethical considerations and the multidisciplinary approach necessary to ensure donor safety.CONCLUSION Kidney donation in individuals with BS requires careful evaluation to mitigate the risk of fatal arrhythmias during surgical and anesthetic stress.With comprehensive preoperative assessment and vigilant perioperative management,kidney donation can be performed safely.
