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PubMed2003

Live donor nephrectomy and return to work: does the operative technique matter?

BACKGROUND: Several studies report an earlier return to work after minimal invasive kidney donation compared to open donor nephrectomy. However, this variation in outcome might be influenced by other factors than the surgical technique used, such as the advice given by the physician regarding return to work. In this study, we compare the absence from work after open (ODN), laparoscopic (LDN), and hand-assisted donor nephrectomy (HA) performed in the Netherlands, in relation to the advice given. METHODS: Questionnaires containing questions about return to work or return to daily activities were sent to 78 donors from three hospitals. In the HA and ODN hospitals, advice on full return to work was 3 months. In contrast, advice given in the LDN hospital was 6 weeks. RESULTS: After LDN, donors resumed their work after 6 weeks, 5 weeks faster compared to ODN (p = 0.002) and HA (p <0.001). Complete return to work occurred 9 weeks sooner in the LDN group compared to the ODN and HA groups (both p <0.001). In the unemployed group, there was no significant difference in length until full return to daily activities. CONCLUSION: Return to work is influenced by the advice on return to work given by the physician as well as the morbidity associated with the surgical approach.

Absenteeism↗

PubMed2003

Renal artery clip dislodgement during hand-assisted laparoscopic living donor nephrectomy.

The main reason for conversion in laparoscopic donor nephrectomy (LDN) is peroperative bleeding. One of the advantages of hand-assisted laparoscopic donor nephrectomy (HDLN) is facilitated control in case of bleeding. This report describes two methods to avert conversion in HLDN in the case of abrupt major arterial bleeding. In the first case, during left HLDN the clips placed on the renal artery dislodged, and the surgeon managed to control the bleeding by compressing the focus of the bleeding with his finger. A balloon occlusion catheter was inserted through a groin incision in the aorta and advanced to the origo of the renal artery. Due to control of the hemorrhage, it was possible to close the renal artery stump by laparoscopic suturing, and a conversion was averted. The patient was discharged after 5 days, without signs of damage to the remaining kidney. In the second case, during right HLDN, the clips on the renal artery dislodged during stapling of the renal vein. The bleeding was controlled by finger compression and new clips were placed. The cuff of the artery was long enough to be clipped again. The patient was discharged after 5 days. Graft function was excellent in both cases. Major arterial bleeding can be controlled and managed in hand-assisted laparoscopic surgery. The use of a balloon occlusion catheter is an elegant way to avert conversion.

Adult↗

PubMed2004

Periarterial application of papaverine during laparoscopic donor nephrectomy improves early graft function after kidney transplantation in pigs.

BACKGROUND: Laparoscopic donor nephrectomy (LDN) increases incentives to donation by subjects who might refuse an open operation. However, the incidence of delayed graft function is higher after LDN than after open operation. This may be caused by the reduction of renal perfusion as a result of the raised intraabdominal pressure and mechanically induced renal angiospasm during the operation. We conducted experiments to find out whether the application of papaverine around the renal artery during LDN could improve early graft function after transplantation. METHODS: Renal function was studied in 10 male pigs (weight approximately 25 kg). The left kidney was harvested laparoscopically (intraabdominal pressure 8 mmHg). Five animals were randomly selected to have perivascular application of 50 mg papaverine (treatment group) before preparation of the vessels. In controls no papaverine was used. After LDN and open right nephrectomy the left kidney was autotransplanted. The main outcome measures were volume of urine produced and creatinine clearance during the first 20 h after the transplant. RESULTS: The groups were comparable in respect of body weight, hemodynamic values, amount of infusions, warm and cold ischemia time, and duration of anastomosis. Urine output and creatinine clearance were significantly higher in pigs treated with papaverine than in controls. CONCLUSIONS: Papaverine substantially improved early graft function in pigs when applied around the renal artery during LDN. Whether this is applicable to procurement of human kidneys remains to be evaluated.

Animals↗

PubMed2004

Body image after laparoscopic or open donor nephrectomy.

BACKGROUND: Laparoscopic donor nephrectomy (LDN) is thought to result in a better cosmetic outcome for the altruistic healthy donor than open donor nephrectomy (ODN). To the authors' knowledge, no studies have established the opinion of donors with respect to their bodily appearance. This study investigates the body image of donors after ODN and LDN. METHODS: Donors who underwent surgery between 1994 and 2001 were invited to fill out a body image questionnaire. This questionnaire consists of two subscales: the body image scale (BIS) and the cosmetic scale (CS). A total of 56 LDN subjects and 69 ODN subjects responded to the questionnaire (72% of 174 donors). RESULTS: Both groups were comparable in terms of gender, current age, and body mass index (BMI). The time from donation until the time of this study (follow-up assessment) was significantly longer for the ODN groups. The BIS and CS were found to be comparable between the two groups. No associations were found between BIS or CS and follow-up duration. There also was no association between BIS or CS and gender, age and BMI. CONCLUSIONS: The body image ratings of donors do not significantly differ after ODN or LDN.

Adult↗

PubMed2005

Laparoscopic nephrectomy for unilateral multicystic dysplastic kidney in children.

The contemporary management of children with unilateral multicystic dysplastic kidney remains controversial. With the potential risks of hypertension, infection, and malignant transformation of the dysplastic kidney, conservative management necessitates long-term review with frequent ultrasound scans, urine analyses, and blood pressure checks. Operative management has traditionally used open nephrectomy with its associated patient morbidity. The introduction of laparoscopic procedures has allowed the development of techniques that reduce patient morbidity, hospital stay, and analgesia requirement. This article reports a series of 13 children who underwent elective laparoscopic nephrectomy for unilateral multicystic dysplastic kidney and discusses the advantages this procedure has to offer for their management.

Child↗

PubMed2004

Xanthogranulomatous pyelonephritis treated by partial nephrectomy.

Xanthogranulomatous pyelonephritis is an uncommon disease in children. We report of a 2-month-old girl with urinary tract infection and with a renal mass detected by ultrasound scan. The preoperative differential diagnoses were Wilms tumor, multicystic dysplastic kidney, renal abscess, and mesoplastic nephroma. The subsequent histopathological findings allowed the diagnosis of xanthogranulomatous pyelonephritis (XGP). Although XGP is rare at this age, it must be considered in the differential diagnosis of a child presenting with renal mass, either with or without associated urolithiasis, anemia, and elevated inflammatory markers. The long-standing mainstay of therapy for diffuse XGP has been nephrectomy. However, we report the successful preservation of renal mass with partial nephrectomy for diffuse XGP. The affected kidney grew normally and preserved residual function after the operation. Hence we strongly suggest parenchymal saving in pediatric cases of XGP to preserve renal function.

Antihypertensive Agents↗

PubMed2003

Solitary pancreatic metastasis from renal cell carcinoma concomitant with early gastric cancer 17 years after nephrectomy: report of a case.

The pancreas is an uncommon site for metastasis from renal cell carcinoma. We report the case of a 70-year-old man in whom a solitary pancreatic metastasis from renal cell carcinoma, found 17 years after nephrectomy, was successfully resected, combined with gastrectomy for early gastric cancer. We also discuss the relevant literature, including all the reports of pancreatic metastasis from renal cell carcinoma found in Medline. More than half the cases, like ours, were asymptomatic. A good prognosis can be expected once the pancreatic metastatic lesions are surgically excised, especially if it is a solitary metastasis. Therefore, surgical resection of pancreatic metastases is recommended to achieve the best chance of long-term survival. Special attention must be paid to the possibility of recurrence, even more than 10 years after nephrectomy for renal cell carcinoma, and imaging modalities should be part of the routine follow-up to detect metastases at an early stage.

Aged↗

PubMed2003

Two cases of pseudoaneurysm of the renal artery following laparoscopic partial nephrectomy for renal cell carcinoma: CT angiographic evaluation.

Partial nephrectomy via a laparoscopic approach can be technically challenging, and associated vascular complications such as pseudoaneurysm may occur. CT with CT angiography is ideal for the noninvasive imaging of this process. This article reports two cases of pseudoaneurysm of the renal artery detected on CT as a complication of laparoscopic partial nephrectomy and demonstrates the usefulness of 3-D CT angiography in the evaluation of vascular pathology.

Aneurysm, False↗

PubMed2001

Laparoscopic nephrectomy for renal cell carcinoma.

Since the first reported case of laparoscopic nephrectomy by Clayman et al. in 1991, laparoscopy is gaining acceptance as a viable alternative to open surgery for renal cell carcinoma. The benefits of laparoscopy include improved quality of life and lower incidence of perioperative morbidity. The perceived risks of laparoscopic nephrectomy for renal cell carcinoma include port-site metastasis, increased operative time, and the concern for inadequate surgical resection. The preliminary data concerning laparoscopy in renal cell carcinoma, however, indicate that rates of tumor recurrence are equivalent to open surgery while resulting in better cosmesis, decreased level of perioperative analgesic use, and decreased length of time to full convalescence.

Carcinoma, Renal Cell↗

PubMed1975

Lethal complications of bilateral nephrectomy and splenectomy in hemodialyzed patients.

Routine bilateral nephrectomy and splenectomy (BNS) in uremic patients before transplantation are relatively safe procedures except when there is pre-existing sepsis, diabetes, or severe hypertension. A review of 421 patients undergoing routine pretransplantation BNS reveals that death before transplantation occurs in two definable groups of patients. In our series, the first group, those with juvenile onset diabetes, have a 15.4 per cent pretransplantation mortality (9.6 per cent operative and 5.8 per cent nonoperative) while being maintained on hemodialysis and awaiting transplantation. The second group, nondiabetic patients with other preoperatively definable risk factors such as severe hypertension and infected kidneys, had a 3.25 per cent pretransplantation mortality (1.9 per cent operative and 1.25 per cent nonoperative) while on hemodialysis. Paradoxically, these same factors are used as absolute criteria for pretransplantation nephrectomy at institutions where this operation is not a routine part of the pretransplantation regimen.

Cardiovascular Diseases↗

PubMed1977

Post-nephrectomy changes in adrenal angiotensin II receptors in the rat; influence of exogenous angiotensin and a competitive inhibitor.

3H-angiotensin binding sites have been studied in a particulate fraction prepared from rat adrenal glands. This binding is rapid and reversible, of high affinity (KD29 degrees C = 3-5 X 10(-9) M) and with demonstrable specificity for the angiotensin II octapeptide. The number of binding sites varies with endogenous angiotensin levels: nephrectomy is followed by an increase in number of binding sites. This increase can be prevented by chronic angiotensin II administration and, to a lesser extent, by administration of Sar1,Ala8-angiotensin II, a competitive antagonist of the hormone. No variation in the equilibrium dissociation constant accompanied these changes in binding capacity. The post-nephrectomy increase in capacity is time-dependent, with a lag period of 24-40 h. The observed changes in receptor concentration do not appear explicable on the basis of receptor occupancy. Accordingly, angiotensin II receptors in the rat adrenal appear to be dependent on circulating angiotensin levels as previously reported for rat uterus.

Adrenal Glands↗

PubMed1989

Decreased adrenal medullary catecholamines in adrenal transplanted parkinsonian patients compared to nephrectomy patients.

Adrenal medullary catecholamines were measured in tissue samples from eight patients who underwent autologous transplantation of the adrenal medulla to the caudate nucleus as a treatment for Parkinson's disease. These adrenal catecholamine levels were compared to a group of patients of similar age who underwent unilateral nephrectomy for renal cell carcinoma. The levels of each catecholamine, expressed as nanomoles per milligram wet weight tissue, were significantly lower (P less than or equal to 0.005) in the parkinsonian patients than in the nephrectomy patients. These observations support data reported previously from autopsy specimens and suggest that the adrenal medullae of parkinsonian patients may be a compromised source of dopamine-producing tissue; this may limit its effectiveness in eliciting maximum clinical improvement following transplantation.

Adrenal Medulla↗

PubMed1995

Hepatocyte growth factor remains as an inactive single chain after partial hepatectomy or unilateral nephrectomy.

Hepatocyte growth factor (HGF) is a potent mitogen for hepatocytes and renal tubular epithelial cells. HGF is proteolytically activated in the tissue injured by hepatotoxin or nephrotoxin, suggesting that HGF functions as a crucial growth factor for tissue regeneration following hepatotoxin- or nephrotoxin-induced injury. In this study, we analyzed the molecular form of HGF after partial hepatectomy or after unilateral nephrectomy. The active form of HGF was not detected under our experimental conditions after these operations. Thus, HGF may play little role in liver regeneration after partial hepatectomy and in compensatory renal enlargement after unilateral nephrectomy.

Animals↗

PubMed1992

Nephrectomy and a newly identified binding site for angiotensin II in the rat adrenal cortex.

Angiotensin II (Ang II) binding sites in adrenal glands of nephrectomized rats were investigated by in vitro autoradiography using 125I-[Sar1,Ile8]Ang II as ligands. Ang II binding site was increased to 161% in the cortex and decreased to 67% in the medulla 48 h after nephrectomy. In the medulla, the AT2 antagonist (PD123177, 5 microM) inhibited specific binding by 90% whereas the AT1 antagonist (DuP753, 5 microM) inhibited by only 10%. In contrast, in the cortex, neither DuP753 (5 microM) nor PD123177 (5 microM) substantially inhibited the binding. Binding in the presence of either the AT1 or AT2 antagonist was abolished by the simultaneous presence of both antagonists. These results suggest the presence of a new Ang II binding site with unique pharmacological properties and differing from currently known subtypes of Ang II receptors, in the adrenal cortex after nephrectomy.

Adrenal Cortex↗

PubMed1975

Reversal of hypercoagulable state by bilateral nephrectomy.

The hypercoagulable state associated with select cases of glomerulonephritis is difficult to diagnose by standard laboratory techniques but is clinically manifested by recurrent shunt and fistula thrombosis which may be refractory to anticoagulant therapy. Bilateral nephrectomy reversed this hypercoagulable state. After renal allograft, however, the patient experienced hyperacute rejection, and transplant nephrectomy was required to cure the recurrent hypercoagulable state. The mechanism of this previously unreported phenomenon and its implications with regard to renal transplantation are discussed.

Adult↗

PubMed1977

Nephrectomy for renal cell carcinoma with metastases.

The percentage of patients with renal cell carcinoma who also have identifiable metastases when first seen is increasing. In the past metastases were considered justification for excluding nephrectomy in the management of the patient. However, numerous opportunities for therapy which are abetted by removal of the primary tumor are presented. It is concluded, depending on several variables, that the advantages of nephrectomy usually justify the procedure.

Adenocarcinoma↗

PubMed1980

Ruptured congenital mesoblastic nephroma: chemotherapy and irradiation as adjuvants to nephrectomy.

A neonate underwent nephrectomy for a congenital mesoblastic nephroma which was found to be ruptured at the time of removal. Two years after operation there is no evidence of recurrent tumor. Present evidence is that nephrectomy alone is adequate treatment for mesoblastic nephroma, but close observation is mandatory if rupture has occurred. Recurrence should be countered with adjunctive chemotherapy.

Humans↗

PubMed1985

Living-related donor nephrectomy by eleventh rib intraperitoneal extrapleural incision.

Living-related kidney transplants continue to yield the best results. The two primary approaches for living-related donor nephrectomy are the intraperitoneal and extraperitoneal operations. We herein describe a series of 8 cases in which an eleventh rib intraperitoneal extrapleural incision was used for living-related donor nephrectomy. The advantages of the operation in terms of improved ability to manage vascular anomalies is described. No complication has been encountered.

Humans↗