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      Transition From Hand-Assisted to Pure Laparoscopic Donor Nephrectomy

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          Abstract

          Background and Objectives:

          We compared perioperative donor outcomes and early graft function of hand-assisted laparoscopic donor nephrectomy (HALDN) and pure laparoscopic donor nephrectomy (PLDN) performed by a single surgeon, to define the feasibility of technical transition from HALDN to PLDN.

          Methods:

          From October 1, 2012, through June 30, 2014, 60 donor nephrectomies were performed by a single surgeon who lacked experience with laparoscopic renal surgery: the first 30 by HALDN and the last 30 by PLDN. Operative and convalescence parameters were compared, as were intra- and postoperative complications within 90 days according to the Satava and Clavien-Dindo classifications, respectively. Binary logistic regression analysis was used to estimate the association of baseline characteristics with complications.

          Results:

          Baseline characteristics were similar in the 2 groups, except for American Society of Anesthesiologists score II (10.0% vs 43.3%; P = .007). All procedures were completed as planned. All operative and convalescence parameters of donors and graft outcomes were similar in the 2 groups, as were overall rates of intraoperative (43.3% vs 36.7%, P = .598) and postoperative (86.7% vs 70.0%; P = .209) complications. No factor was significantly predictive of intraoperative complications, whereas sex (female vs male, odds ratio, 0.183; P = .029) and learning curve (odds ratio, 0.602; P = .036) were significant determinants of postoperative complication.

          Conclusion:

          The technical transition from HALDN to PLDN does not involve a steep learning curve for surgeons less experienced with laparoscopic renal surgery and maintains similar perioperative donor and graft outcomes.

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          Most cited references 20

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          OPTN/SRTR 2012 Annual Data Report: kidney.

          For most end-stage renal disease patients, successful kidney transplant provides substantially longer survival and better quality of life than dialysis, and preemptive transplant is associated with better outcomes than transplants occurring after dialysis initiation. However, kidney transplant numbers in the us have not changed for a decade. Since 2004, the total number of candidates on the waiting list has increased annually. Median time to transplant for wait-listed adult patients increased from 2.7 years in 1998 to 4.2 years in 2008. The discard rate of deceased donor kidneys has also increased, and the annual number of living donor transplants has decreased. The number of pediatric transplants peaked at 899 in 2005, and has remained steady at approximately 750 over the past 3 years; 40.9% of pediatric candidates undergo transplant within 1 year of wait-listing. Graft survival continues to improve for both adult and pediatric recipients. Kidney transplant is one of the most cost-effective surgical interventions; however, average reimbursement for recipients with primary Medicare coverage from transplant through 1 year posttransplant was comparable to the 1-year cost of care for a dialysis patient. Rates of rehospitalization are high in the first year posttransplant; annual costs after the first year are lower.
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            Quality of life in patients undergoing hemodialysis and renal transplantation--a meta-analytic review.

            The purpose of this review was to determine the magnitude of effect of renal transplant on quality of life measures when compared with hemodialysis. Sixteen studies were analyzed, and the summary effect sizes were as follows: general quality of life was 0.98, physical functioning was 0.77, and psychosocial functioning was 0.39. Compared to hemodialysis, renal transplantation was significantly more effective in improving all three domains, particularly general overall quality of life and physical functioning.
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              Laparoscopic living-donor nephrectomy: analysis of the existing literature.

              Laparoscopic living-donor nephrectomy (LLDN) has achieved a permanent place in renal transplantation and in some centers has replaced open donor nephrectomy as the standard technique. To evaluate the published literature regarding the relative results and complications of open LLDN and the hybrid technique of hand-assisted LLDN. A systematic review of the literature was performed, searching PubMed and Web of Science. A "free text" protocol using the term living-donor nephrectomy was applied. Six hundred twenty-nine records were retrieved from the PubMed database and 686 records were retrieved from the Web of Science database. Fifty-seven comparative studies were identified in the literature search. The three techniques of open, laparoscopic, and hand-assisted laparoscopic donor nephrectomy were compared in terms of reported outcomes. With regard to the perioperative outcome parameters, laparoscopy was better than open surgery in terms of blood loss, analgesic requirements, and duration of hospital stay and convalescence. Postoperative graft function was not significantly different between the different forms of donor nephrectomy, although longer warm ischemia times are reported for laparoscopy. All three techniques of live-donor nephrectomy are standard of care. The laparoscopic techniques result in less postoperative pain and estimated blood loss with shorter hospital stay, while postoperative graft function is not inferior to that after open live-donor nephrectomy. Copyright 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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                Author and article information

                Contributors
                Journal
                JSLS
                JSLS
                jsls
                jsls
                JSLS
                JSLS : Journal of the Society of Laparoendoscopic Surgeons
                Society of Laparoendoscopic Surgeons (Miami, FL )
                1086-8089
                1938-3797
                Jul-Sep 2015
                : 19
                : 3
                Affiliations
                Departments of Urology
                Departments of Urology
                Departments of Urology
                Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
                Departments of Urology
                Author notes

                This work was supported by Grant 2014-576 from the Asan Institute for Life Sciences, Seoul, Korea.

                Address correspondence to: Dalsan You, MD, PhD, Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 138-736, Korea. E-mail: dalsanyou@ 123456amc.seoul.kr
                Article
                JSLS.2015.00044
                10.4293/JSLS.2015.00044
                4517067
                © 2015 by JSLS, Journal of the Society of Laparoendoscopic Surgeons.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License ( http://creativecommons.org/licenses/by-nc-nd/3.0/us/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.

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