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At least 685 records · Page 38Linked to original sources

PubMed2002

Endoscopic minilaparotomy partial nephrectomy for solitary renal cell carcinoma smaller than 4 cm.

BACKGROUND: For small, incidentally discovered renal cell carcinoma, partial nephrectomy is becoming more widely accepted as an alternative to radical nephrectomy and the need for minimally invasive approach is increasing. METHODS: We carried out endoscopic minilaparotomy partial nephrectomy in seven cases of solitary renal cell carcinoma smaller than 4 cm. Five of them were without renal pedicle clamping. All procedures were done through single skin incision (5-8 cm) using a 30 degrees telescope. Hemostasis was achieved with a harmonic scalpel, a microwave tissue coagulator, an argon beam coagulator and autologous fibrin glue. RESULTS: There were no perioperative complications. All patients had negative surgical margins. The operating time was 157-275 min (average 209 min). The blood loss was 20-1200 ml (average 525 ml). Postoperatively, renal function as assessed by serum creatinine was within normal limits. Neither local recurrences nor metastases were observed during a follow-up of 6-15 months. The postoperative course was markedly improved over that expected from standard open surgery. CONCLUSIONS: With minimal morbidity and complications, endoscopic minilaparotomy partial nephrectomy is feasible for small renal cell carcinoma.

Aged↗

PubMed1996

Bilateral nephrectomy simultaneously with renal allografting does not alleviate hypertension 3 months following living-donor transplantation.

Severe hypertension prior to renal transplantation has traditionally been an indication for bilateral nephrectomy. The reasons for hypertension after successful renal transplantation are however many, and the impact of simultaneous bilateral nephrectomy (BN) in this setting has not been well documented. We retrospectively evaluated 158 living-donor renal graft recipients. BN had been performed in 76 patients at the time of the transplantation and 82 were not nephrectomized (controls). All received a triple immunosuppressive drug regimen. Before transplantation, patients in the BN group used 1.8 +/- 0.9 (mean +/- SD) antihypertensive drugs/day, significantly more than in the control group (1.3 +/- 0.8; P < 0.05). Three months after renal transplantation no difference was found (0.9 +/- 1.0 drugs/day in the BN group vs 1.0 +/- 0.8 drugs/day in the control group). No difference was found with respect to serum creatinine, whole blood cyclosporin A (CsA) concentration or blood pressure between the groups. The number of blood transfusions during the first week after transplantation was significantly increased in the BN group (66 SAG units vs 4 SAG units). The median hospitalization length was also longer in the BN group (21 days vs 16 days). In order to circumscribe the pre-transplant difference in use of antihypertensive medication we studied a subgroup of 62 hypertensive recipients (BN/control = 31/31) matched for number of antihypertensive drugs at the time of transplantation (2.3 +/- 0.5 drugs/day in the BN group, 2.1 +/- 0.3 drugs/day in the control group). Three months after transplantation the use of antihypertensive drugs remained the same in the two groups (1.3 +/- 1.0 drugs/day in the BN group vs 1.3 +/- 0.9 drugs/day in the control group). At 3 months no difference was found between the two hypertensive subgroups regarding serum creatinine, whole blood CsA and haemoglobin concentration or systolic blood pressure. However, the BN patients were younger than the control group (38 +/- 10 years vs 49 +/- 11 years, P < 0.05) and this may explain the marginally lower diastolic blood pressure observed in the BN group (82 +/- 10 mmHg vs 87 +/- 7 mmHg, P < 0.05). It is concluded that, in recipients of living-donor grafts, bilateral nephrectomy performed at the time of transplantation did not influence the number of antihypertensive drugs used 3 months after a successful transplantation. Bilateral nephrectomy did however increase the need of blood transfusions during the first week after transplantation and also the hospitalization length.

Adult↗

PubMed1993

Small bowel obstruction after nephrectomy for Wilms' tumor. A report of the National Wilms' Tumor Study-3.

OBJECTIVE: This study was undertaken to define the incidence and etiology of small bowel obstruction (SBO) after nephrectomy for Wilms' tumor. SUMMARY BACKGROUND DATA: Intestinal obstruction is one of the most common postoperative complications after nephrectomy for nephroblastoma. However, few reports have evaluated risk factors for SBO. Radiation therapy has been associated with increased intestinal complications in some adult cancer patients, but this has not been reported in children undergoing cancer surgery. METHODS: Postoperative SBO occurred in 131 of 1,910 children (6.9%) enrolled in the Third National Wilms' Tumor Study (NWTS). The etiology of the SBO was bowel adhesions in 104 cases, intussusception in 17, internal hernia in 2, and uncertain in the remaining 8 children. RESULTS: The factors found to be of potential importance in explaining the incidence of SBO were higher local tumor stage, extrarenal intravascular involvement, and en bloc resection of other organs at the time of nephrectomy. The incidence of postoperative SBO was not increased in children who received postoperative radiation therapy. CONCLUSIONS: Although the overall incidence of SBO after nephrectomy for Wilms' tumor is comparable to that after other major abdominal operations in children, it can be responsible for significant morbidity. There were 4 children among the 1,910 patients with infectious complications of SBO, which contributed to their death.

Child, Preschool↗

PubMed2000

Laparoscopic donor nephrectomy with a 23-hour stay: a new standard for transplantation surgery.

OBJECTIVE: To determine the outcomes associated with laparoscopic donor nephrectomy (LDN) performed as a 23-hour day surgery protocol. SUMMARY BACKGROUND DATA: Living donor renal transplantation is associated with immediate graft function and prolonged graft survival. The recent application of laparoscopic technology to living renal donation has refocused attention on the advantages of this donor source. LDN is associated with decreased donor pain, length of stay, time out of work, and opportunity costs. The authors hypothesized that LDN would be a viable 23-hour stay procedure. METHODS: All living donation procedures since May 1998 have been performed with LDN. The 23-hour protocol was initiated in January 1999. LDNs performed from May 1998 to December 1998 and traditional open donor nephrectomy procedures from May 1996 to May 1998 served as historical controls. The following variables were examined: donor sex, related versus nonrelated donation, operative time, blood loss, length of stay, time out of work, recipient and donor serum creatinine levels, hospital charges, and complications. RESULTS: The 23-hour LDN protocol was associated with high degrees of donor satisfaction. Thirty-six of the 41 donors were discharged within 23 hours; 1 was readmitted. Time out of work was equivalent to that of the control group; graft function was identical among all three comparison groups. Hospital charges were equivalent between the control group and the open nephrectomy group and were significantly decreased in the 23-hour group. CONCLUSIONS: Laparoscopic donor nephrectomy can be performed as a 23-hour stay procedure without incurring additional complications or donor dissatisfaction. By further decreasing opportunity costs and disincentives for donation, LDN may increase the number of potential donors appearing for evaluation.

Adult↗

PubMed2002

Impact of intraoperative donor management on short-term renal function after laparoscopic donor nephrectomy.

OBJECTIVE: To determine whether intraoperative diuresis, postoperative recovery, and early graft function differ between laparoscopic open nephrectomy (LDN) and open donor nephrectomy (ODN). SUMMARY BACKGROUND DATA: Laparoscopic donor nephrectomy can reduce donor complications in terms of decreased pain and shorter convalescence. Although its technical feasibility has been established, concerns have been raised about the impaired renal function resulting from pneumoperitoneum and short- and long-term function of kidneys removed by LDN. METHODS: Between December 1997 and December 2000, 89 LDNs were performed at the authors' institution. These were compared with 83 conventional ODNs performed between January 1994 and December 1997. Graft function, intraoperative variables, and clinical outcome were compared. RESULTS: Laparoscopic donor nephrectomy was attempted in 89 patients and completed in 91% (81/89). Length of hospital stay was significantly shorter in the laparoscopic group. During kidney dissection, the amount of fluids administered and intraoperative diuresis were significantly lower for LDN. In recipients, mean serum creatinine was higher after LDN compared with ODN 1 day after surgery. From postoperative days 2 until 28, there were no differences in serum creatinine. Graft survival rates were similar for LDN and ODN. CONCLUSIONS: Donors can benefit from an improvement in postoperative recovery after LDN. Assessment of an adequate perioperative hydration protocol is mandatory to ensure optimal kidney quality during laparoscopic procurement. The initial graft survival and function rates justify continued development and adoption of LDN.

Adult↗

PubMed1995

Nephrectomy for traumatic renal injuries.

During a 16-year period 2,521 patients presented to our institution with renal trauma. Renal exploration was performed in 195 patients (202 renal units), with 31 units requiring exploration alone, 145 repair and 26 nephrectomy, yielding an overall nephrectomy rate of 13%. A detailed review of these 26 patients identified them as a unique population: all had major renal injuries, and as a group they demonstrated significantly higher rates of shock, injury severity scores, transfusion requirements and death rates than those in whom exploration with renal salvage was possible. In no case was nephrectomy required as a complication of exploration or attempted repair. In the properly staged patient undergoing surgery for appropriate indications with early vascular control exploration of renal injuries is safe. It is not the exploration that results in the nephrectomy but the injury itself.

Adult↗

PubMed1995

Outpatient nephrectomy for nonfunctioning kidneys.

We describe a surgical approach that allows multicystic dysplastic and nonfunctioning hydronephrotic kidneys to be removed on an outpatient basis through a 2.5 to 3 cm. subcostal incision. In the last 5 years 40 children (age 4 months to 5 years, mean 8.2 months) were scheduled for outpatient nephrectomy in an ambulatory surgical unit in a hospital setting. Of the 40 patients 30 had a multicystic kidney. Renal size ranged from 3 x 2 to 9.5 x 7.2 cm. Operative time ranged from 20 to 70 minutes (mean 45.4). In 34 cases (85%) an intercostal block was also performed to provide analgesia for 18 to 24 hours. Nephrectomy was done on an outpatient basis in 39 of the 40 children (98%). Mean pain score (range 0 to 5) in the last 19 patients who underwent an intercostal block was 0.68 at discharge from the hospital, 0.85 at bedtime and 0.95, 24 hours later. We conclude that nephrectomy may be performed through a small incision on an outpatient basis with minimal morbidity, and that this approach offers an alternative to laparoscopic nephrectomy and nonsurgical management of these kidneys.

Ambulatory Surgical Procedures↗

PubMed1996

Unilateral nephrectomy induces the expression of the Wilms tumor gene in the contralateral kidney of the adult rat.

PURPOSE: The tumor suppressor gene WT-1 encodes a nuclear deoxyribonucleic acid binding protein that is a transcriptional regulator. This gene is commonly deleted or defective in Wilms tumors and the Denys-Drash syndrome. Recently WT-1 was demonstrated to be essential for the development of the urogenital tract. We determined whether we could induce WT-1 expression in mature kidneys induced to grow by performing contralateral nephrectomy in mature rats. MATERIALS AND METHODS: Northern analysis with a 32phosphorus-labeled antisense riboprobe synthesized by in vitro transcription of a 731 bp complementary deoxyribonucleic acid insert spanning exons 1 to 7 of the rat WT-1 in a pT7 Blue vector was used to demonstrate the expression of WT-1 in the developing and adult Sprague-Dawley rat kidney. RESULTS: Transcript levels of WT-1 in the rat kidney decreased from day 0 (day of birth) to day 16, after which WT-1 transcripts were undetectable in the normal rat kidney. Unilateral nephrectomy in the adult male Sprague-Dawley rat (250 to 300 gm.) induced the expression of WT-1 ribonucleic acid in the contralateral kidney to detectable levels by Northern analysis 0.25 hours after nephrectomy. Subsequently levels of WT-1 ribonucleic acid decreased progressively to undetectable by 3 hours after nephrectomy. Expression of this gene was not detected in the normal kidneys of adult rats or sham operated adult rats. CONCLUSIONS: These data suggest that the WT-1 gene product is involved in normal renal growth in the adult and developing rat kidney.

Age Factors↗

PubMed1997

Microscopic vascular invasion is the most relevant prognosticator after radical nephrectomy for clinically nonmetastatic renal cell carcinoma.

PURPOSE: Although many factors have been considered to predict the outcome after radical nephrectomy, renal cell carcinoma continues to behave unpredictably. In a retrospective study the correlation between microvascular tumor invasion and disease-free survival after surgery for renal cell carcinoma was analyzed. MATERIALS AND METHODS: Between 1980 and 1993, 180 patients (mean age 60 years) were followed for a mean of 52 months after radical or partial nephrectomy for clinically localized renal cell carcinoma. The relevance of microscopic vascular invasion was compared to classical tumor staging, grade and tumor diameter. RESULTS: Microscopic vascular invasion was found in 51 patients (28.3%), including 20 (39.2%) with progression (mean interval to progression 72 months). Of 129 patients with no pathological evidence of microscopic vascular invasion only 8 (6.2%) showed progression at a mean interval of more than 160 months. The difference in disease-free survival as a function of microvascular invasion was statistically highly significant (log rank p < 0.00001) and on multivariate analysis this parameter was by far the most relevant predictor of progression. CONCLUSIONS: In patients who underwent radical nephrectomy for clinically nonmetastatic renal cell carcinoma with microvascular invasion but without lymph node involvement or macroscopic vascular invasion the chance of disease progression is estimated at 45% within 1 year. Microvascular invasion is the single most relevant prognosticator after presumed curative radical nephrectomy for renal cell carcinoma.

Adolescent↗

PubMed1997

Increased cell proliferation of urothelium in rat bladder following unilateral nephrectomy.

PURPOSE: The aim of this study is to investigate the effect of unilateral nephrectomy on cell proliferation of normal urinary bladder epithelium in adult rats. MATERIALS AND METHODS: Following unilateral nephrectomy or sham operation 5 rats for each time point were sacrificed and their bladders were removed at 6 and 12 hours and also on 1, 2, 4, 7, 14, 28, and 56 days. Another 5 rats were not operated and served as the control. The percent number of proliferating cell nuclear antigen (PCNA) positive cells and the number of argyrophilic nucleolar organizer regions (AgNORs) were determined for each bladder. RESULTS: In the nephrectomized groups, a significant increase of PCNA expression in urothelial cells of the bladder was found at each sacrifice time with the exception of 28 and 56 days when compared with that of the control and corresponding sham-operated groups. Percent PCNA labeling index (PCNA-LI) reached a peak value of approximately 9.1% on day 2 post operation. From day 4 post nephrectomy, however, PCNA-LI decreased gradually reaching control levels by day 28. No significant difference was found between the control and sham-operated groups. The mean number of AgNOR dots in nephrectomized rats sacrificed on day 1, 2, 4, 7 and 14 post operation was significantly larger than that of the control and corresponding sham-operated groups. CONCLUSION: The results suggest that unilateral nephrectomy temporarily enhances normal urothelial cell proliferation in adult rat bladder.

Animals↗

PubMed1999

Live donor nephrectomy in patients with fibromuscular dysplasia of the renal arteries.

PURPOSE: We determine the suitability of patients with fibromuscular dysplasia of the renal arteries as renal donors. MATERIALS AND METHODS: We evaluated 37 patients with fibromuscular dysplasia who were potential renal donors. Renal artery lesions were graded I (mild) to IV (severe). Of the patients 19 underwent donor nephrectomy and 18 were rejected as donors. Reasons for rejection included severity of disease or availability of a better donor. Nephrectomy was performed on the side with fibromuscular dysplasia when disease was unilateral or on the side with more advanced disease when the lesions were bilateral. Patients were followed at 1 month, 1 year and then yearly. RESULTS: Of the 19 patients undergoing donor nephrectomy serum creatinine increased by a mean of 0.4 mg./dl. (range 0.1 to 1.1) on postoperative day 1. Effective renal plasma flow of the remaining kidney increased by 25% on postoperative day 5 and by 29% after 1 year. After a mean followup of 4.5 years no patient had hypertension, proteinuria or any significant change in serum creatinine compared to baseline values. Of the 18 patients not undergoing nephrectomy 11 were contacted at a mean followup of 4 years, and none had hypertension, proteinuria or abnormal serum creatinine. CONCLUSIONS: Patients with fibromuscular dysplasia may be acceptable renal donors. The decision to use a patient with fibromuscular dysplasia as a donor is based on patient age, the availability of other suitable donors, and the extent and severity of disease.

Adult↗

PubMed2000

Does the absorbable fibrin adhesive bandage facilitate partial nephrectomy?

PURPOSE: To evaluate the ability of the absorbable fibrin adhesive bandage (AFAB), a prototype product comprising lyophilized fibrinogen and thrombin on a VicrylTM mesh backing, to seal the collecting system and control bleeding after partial nephrectomy. MATERIALS AND METHODS: Growing female pigs (n = 18) underwent left nephrectomy and a 40% (by length) right lower pole partial nephrectomy. One of three treatments was immediately applied: Conventional-closure of the collecting system, ligation of visible segmental vessels, application of SurgicelTM with bolstering sutures to the renal capsule; AFAB-application of up to two 4 x 4-inch AFABs held under pressure for 60 seconds; Placebo-application of a hemostatically inert VicrylTM bandage, visually identical to the AFAB. Blood loss and ischemic and total operative times were recorded, and abdominal computerized tomography (CT) was performed on postoperative day 6. Animals were sacrificed at 6 weeks to evaluate the remaining renal mass histologically. RESULTS: Compared with conventional therapy, use of the AFAB resulted in significantly less bleeding (13 versus 68 ml., p <0.001) and lower operative (7.2 versus 16.3 minutes, p <0.001) and ischemic times (3.4 versus 7.8 minutes, p <0.001). Estimated blood loss in the placebo bandage group was dramatically higher (357 ml., p <0.001). Postoperative CT and histological sectioning suggested that the AFAB produces a stable, durable clot and that healing is at least as successful as with conventional treatment. CONCLUSION: Use of the AFAB facilitated performance of partial nephrectomy by reducing blood loss and ischemic and total operative times. The AFAB appears equivalent to conventional surgery in its ability to seal the collecting system.

Absorbable Implants↗

PubMed2001

The long-term outcome of laparoscopic radical nephrectomy for small renal cell carcinoma.

PURPOSE: To evaluate the efficacy of laparoscopic radical nephrectomy in patients with small renal cell carcinoma, we analyzed the long-term results in those treated with laparoscopy and those undergoing open surgery. MATERIALS AND METHODS: A total of 149 patients with tumors less than 5 cm. in diameter enrolled in a radical nephrectomy program between January 1992 and March 2000. Of these patients 103 were treated laparoscopically and the remaining 46 underwent open surgery. Patient followup was until June 30, 2000. RESULTS: Laparoscopy followup was from 3 to 95 months (median 29). A total of 100 patients survived, 2 died without any recurrent disease in months 34 and 45, respectively, and 1 dropped out in postoperative month 3. Seeding of the port sites did not develop in any of the patients. There were 3 patients who had metastatic disease in months 3, 19 and 61, respectively, and 1 had local recurrence in postoperative month 43. The 5-year disease-free and patient survival rates were 95.1%, and 95.0%, respectively. Except for 2 patients who dropped out in months 10 and 16, respectively, 44 who underwent open surgery were followed from 11 to 101 months (median). Of the 44 patients 41 survived without any recurrent disease, 1 also survived with metastasis and 2 died of metastatic disease in months 7 and 11, respectively. The 5-year disease-free and patient survival rates were 89.7% and 95.6%, respectively. CONCLUSIONS: Laparoscopic radical nephrectomy can be an alternative to open nephrectomy in patients with localized small renal cell carcinoma.

Adult↗

PubMed2001

Laparoscopic partial nephrectomy with a microwave tissue coagulator for small renal tumor.

PURPOSE: Laparoscopic partial nephrectomy is a challenging procedure due to the risk of excessive bleeding. We evaluated the usefulness of a microwave tissue coagulator during laparoscopic partial nephrectomy for small renal tumor. MATERIALS AND METHODS: From January to July 2000, 6 patients with small renal tumors, from 11 to 25 mm. in diameter, underwent laparoscopic partial nephrectomy with a microwave tissue coagulator without renal pedicle clamping. There were 4 patients who underwent the transperitoneal and 2 who underwent the retroperitoneal approaches. RESULTS: Mean operating time was 186 minutes (range 131 to 239), and blood loss was minimal. Complications were mild and tolerable, and there was no significant deterioration of renal function. CONCLUSIONS: Laparoscopic partial nephrectomy with a microwave tissue coagulator is a useful and less invasive method for treatment of select small renal tumors. Long-term followup of patients is warranted to determine the potential for cancer control with this method.

Adult↗

PubMed1979

Effect of ureteral ligation and nephrectomy on granulocyte-macrophage progenitor cells and azathioprine toxicity.

Using an in vitro quantitative clonal culture technique of bone marrow granulocyte-macrophage progenitor cells (colony-forming units culture (CFU-c)), we studied the hematopoietic toxicity of azathioprine after unilateral and bilateral ureteral ligation, unilateral and bilateral nephrectomy, and splenectomy in C57BL/6 mice. Analysis of femoral bone marrow 18 hr after i.p. injection of azathioprine (300 mg/m2) revealed increased CFU-c toxicity in comparison to controls as follows: (1) bilateral ureteral ligation, P less than 0.01; (2) bilateral nephrectomy, P less than 0.01; (3) unilateral ureteral ligation, P greater than 0.05 less than 0.1; (4) unilateral nephrectomy, P, not significant; and (5) splenectomy, P, not significant. Extrapolation from a dose-response curve for the toxicity of azathioprine on the bone marrow CFU-c indicated that bilateral ureteral ligation and bilateral nephrectomy had the effect of a 25 to 50% increase in the azathioprine dose. After bilateral ureteral ligation, serum granulocyte-macrophage colony-stimulating factor levels were increased and in vitro tritiated thymidine suicide studies showed an increased proliferative rate of the CFU-c. Since azathioprine is a predominantly cell cycle-specific agent, we suggest that increased sensitivity to azathioprine is related to the increased proliferative rate of the CFU-c. The findings provide a rationale for a clinical policy of azathioprine reduction when there is depressed renal function.

Animals↗

PubMed1984

The association of pretransplant native nephrectomy with decreased renal allograft rejection.

Analysis of 2808 first and 823 second or subsequent cadaveric renal allograft recipients transplanted between June 1977 and July 1982 as part of the Southeastern Organ Procurement Foundation (SEOPF) Prospective Study was performed to determine the influence of pretransplant bilateral native nephrectomy (BNN) on graft and patient outcome. A highly significant increase in overall graft survival was associated with BNN in first transplant recipients (P less than 0.003) but not in regrafted patients. However, no increased graft survival was seen in patients receiving BNN at the time of the transplant operation. Interestingly, the improvement in graft survival associated with BNN appeared to be the result of a significant decrease in the incidence of graft loss caused by rejection--and especially accelerated acute rejection (P less than 0.007). Comparing actuarial graft survival for first graft recipients that had BNN prior to transplantation (n = 434) with those who had no nephrectomy (n = 2240) showed differences of 62% +/- 3 vs. 52% +/- 1 and 46% +/- 3 vs. 38% +/- 2 at one and three years, respectively. Analysis of first graft survival stratified for other factors known to influence outcome showed that the beneficial influence of BNN was independent of transfusion status or the number of transfusions given, use of antilymphocyte serum, pretransplant splenectomy, HLA match, or time on dialysis. The most striking increase in graft survival associated with BNN was seen in patients with evidence of presensitization as manifested by a positive panel reactive antibody (PRA) and in patients having delayed function (ATN) posttransplantation. The beneficial association of BNN was also found to be independent of the primary cause of renal failure or the specific indication leading to nephrectomy. These results suggest that patients receiving native bilateral nephrectomy prior to transplantation have a reduced incidence of graft loss from rejection by some as yet unexplained mechanism.

Adult↗

PubMed1985

Pregnancy after donor nephrectomy.

The use of living-related kidney donors has been a routine practice in most major transplant centers in the United States for more than 20 years. Concern has arisen regarding the potential for developing hypertension and progressive renal dysfunction after renal donation. Pregnancy results in hyperfiltration and might be an added risk for the development of hypertension, proteinuria, or renal insufficiency in donors. From 1963 until 1984, the Cleveland Clinic Foundation performed 1031 renal transplants, 355 from living donors. Of these 355 living donors, 191 were female, and of these, 23 successfully conceived after kidney donation. Prenatal and delivery records of all 23 were reviewed. There were 39 pregnancies in 23 women with 32 viable births. Conception ranged from 2 weeks to more than 9 years postnephrectomy. Mean blood pressure at the time of donor evaluation was 120/75 mm Hg (SD: +/- 11/8 mm Hg). Mean blood pressure during pregnancy was 114/68 mm Hg (SD: +/- 7/6 mm Hg). One plus proteinuria was detected in 2 women during the third trimester and trace proteinuria was seen in 7 pregnancies; this proteinuria disappeared after delivery. Thirteen of twenty women who carried to term were reevaluated 2-14 years after donor nephrectomy. All parameters studied were normal. Mean length of follow-up after donor nephrectomy was 7.9 years. These data suggest that, after donor nephrectomy, women can have a normal pregnancy without significant problems related to the kidney donation. Also, hyperfiltration associated with the combination of unilateral nephrectomy and pregnancy does not lead to significant hypertension, proteinuria, change in glomerular filtration rate, or abnormalities of the urinary sediment.

Adult↗

PubMed1999

Laparoscopic living donor nephrectomy: advantages of the hand-assisted method.

INTRODUCTION: The laparoscopic technique for living donor nephrectomy is a technically difficult procedure that has not yet gained widespread acceptance in the transplant community. The procedure may be more acceptable if alterations to the technique made it easier to perform and decreased operative times. METHODS: In August 1998, we altered the laparoscopic procedure to include the use of a device allowing hand assistance. Subsequently, all living donor nephrectomies have been done using the hand-assisted method. In this article, the results of 10 cases performed using the original laparoscopic technique are compared with the results of 12 cases using the hand-assisted technique, and a brief description of modifications to the original technique is given. RESULTS: No patients where turned down as living donors, and no contraindications to the pure or hand-assisted laparoscopic techniques where found. The hand-assisted technique significantly reduced the operative time (2.02+/-0.44 vs. 3.12+/-0.36 hr, P<0.05) and the warm ischemic time (1.23+/-0.54 vs. 3.91+/-0.53 min, P<0.05). The length of stay and recovery time to normal activities were not different between the pure laparoscopic and hand-assisted groups. CONCLUSION: The advantages of the hand-assisted technique include the ability to use tactile sense to facilitate dissection, retraction, and exposure. In addition, the final stages of vascular stapling and kidney removal are more sure and rapid. The modifications of the laparoscopic technique presented here provide measurable and subjective improvements to laparoscopic living donor nephrectomy. The hand-assisted method of laparoscopic nephrectomy may make the operation available to more transplant centers.

Adolescent↗