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Background: Currently, either Hem-o-lok (HOL) clip or stapler is being used to control the renal vein in laparoscopic right living donor nephrectomy. The study aims to compare the quality of renal vein retrieved using either HOL clip or Endo TA 30 stapler (TAS) in laparoscopic right living donor nephrectomies. Materials and Methods: We retrospectively analyzed the perioperative data of right-living donor nephrectomies performed at our institute. For the venous control, either two HOL clips (15 mm) or an Endo TA-30 stapler (30 mm–2.5 mm, 3 rows of staples) were used. Perioperative variables from both the donor group and corresponding recipients were recorded and analyzed. A Student’s t-test was used to compare. Results: HOL was applied in 48 (n1) and TAS in 78 (n2) donors, for the control of renal vein. The retrieved length of right renal vein was significantly longer in TAS than in HOL (2.28 ± 0.24 vs. 1.76 ± 0.12 cm, P < 0.001). There was no statistically significant difference in warm ischemia time (5.82 ± 0.89 vs. 5.86 ± 0.91 min, P = 0.84), blood loss (103.65 ± 33.00 vs. 103.64 ± 33.62 mL, P = 0.87), and total surgery duration (139.74 ± 25.83 vs. 140.41 ± 26.33 min, P = 0.86) in both the group. Furthermore, there was no statistically significant difference in postoperative diuresis, acute tubular necrosis, and serum creatinine at 3 months (1.01 ± 0.20 vs. 0.97 ± 0.19 mg/dL, P = 0.67) in corresponding recipients. Conclusion: Endo TAS provides a comparatively longer allograft vein along with an edge of the inferior vena cava than the HOL clip.

Background: Right living donor nephrectomy is technically more demanding because of the anatomical differences. Patient safety is the utmost priority because it is performed on healthy donors. We hereby describe our experiences with surgical modifications to minimize donor morbidity and overcome surgical challenges in the cases of right living donor nephrectomy. Materials and Methods: In this retrospective comparative study, we analyzed the prospectively maintained perioperative and follow-up data of standard and modified right living donor nephrectomies performed in the recent past 10 years at our institute. We also compared the significant events in corresponding recipients. Student's t-tests were used to define statistical significance. Results: A total of 1530 laparoscopic living donor nephrectomies were performed between 2012 and 2021, of which 117 were on the right side. Of them, 62 donors underwent modified right laparoscopic donor nephrectomy (MRLDN) and 55 underwent standard right laparoscopic donor nephrectomy. The mean duration of surgery (103.44 ± 14.59 vs. 139.45 ± 25.99 min), warm ischemia time (4.30 ± 0.59 vs. 5.89 ± 0.91 min), and blood loss (90.24 ± 24.75 vs. 103.72 ± 33.37 mL) were significantly lower in modified as compared to standard donor nephrectomy (P < 0.05). There was no significant difference in postoperative diuresis, acute tubular necrosis, and serum creatinine at 3 months in the corresponding recipient group. Conclusion: MRLDN is a safe, reliable, and reproducible technique of right laparoscopic donor nephrectomy. [ABSTRACT FROM AUTHOR]

Introduction. Long-term results of renal transplantation from living donors are much better than the results of cadaveric transplantations. Recently, because of the shortage of living donors, some centers have started using kidneys from living donors with asymptomatic stones as a potential solution for the problem. However, the optimal surgical solution for such situations has not yet been developed.Aim. To evaluate our obtained transplantation results of using the kidneys from living donors with nephrolithiasis and compare them with the literature data.Material and methods. In the period from 2012-2021, renal transplantations in our clinic were done in three patients from related donors with stones in the kidney. One donor underwent mini-percutaneous lithotripsy one month prior to nephrectomy. The other two underwent simultaneous retrograde lithotripsy and laparoscopic donor nephrectomy. In these cases a holmium or thulium laser was used for the destruction of calculi. All donors underwent laparoscopic retroperitoneal nephrectomy.Results. All stones were successfully removed. There were no surgical complications in donors during and after procedures. Warm ischemia time did not exceed 3.5 minutes. The general length of hospital stay was 10 days in case of predonation stone removal surgery and 6 and 4 days in the cases of simultaneous procedures, respectively. All grafts were transplanted to related recipients. One of the recipients was treated with hemodialysis before transplantation, the other one with peritoneal dialysis. The third recipient underwent preemptive transplantation (before the start of dialysis). The graft function in all cases was immediate. During the follow-up period (9-57 months), no signs of nephrolithiasis were seen in either donors, or recipients.Conclusions. Consideration of potential donors with stones in one kidney might increase the number of living donor renal transplantation. Simultaneous RIRS and laparoscopic donor nephrectomy can be considered as an alternative to sequential operations or ex vivo stone extraction. The presented technique is reproducible, safe and was not associated with an increased length of hospital stay.

Background: Right living donor nephrectomy is technically more demanding because of the anatomical differences. Patient safety is the utmost priority because it is performed on healthy donors. We hereby describe our experiences with surgical modifications to minimize donor morbidity and overcome surgical challenges in the cases of right living donor nephrectomy. Materials and Methods: In this retrospective comparative study, we analyzed the prospectively maintained perioperative and follow-up data of standard and modified right living donor nephrectomies performed in the recent past 10 years at our institute. We also compared the significant events in corresponding recipients. Student's t-tests were used to define statistical significance. Results: A total of 1530 laparoscopic living donor nephrectomies were performed between 2012 and 2021, of which 117 were on the right side. Of them, 62 donors underwent modified right laparoscopic donor nephrectomy (MRLDN) and 55 underwent standard right laparoscopic donor nephrectomy. The mean duration of surgery (103.44 ± 14.59 vs. 139.45 ± 25.99 min), warm ischemia time (4.30 ± 0.59 vs. 5.89 ± 0.91 min), and blood loss (90.24 ± 24.75 vs. 103.72 ± 33.37 mL) were significantly lower in modified as compared to standard donor nephrectomy (P < 0.05). There was no significant difference in postoperative diuresis, acute tubular necrosis, and serum creatinine at 3 months in the corresponding recipient group. Conclusion: MRLDN is a safe, reliable, and reproducible technique of right laparoscopic donor nephrectomy.

Laparoscopic donor nephrectomy (LDN) is the current gold standard in kidney donation. Mini-incision open donor nephrectomy (MINI) techniques have been used extensively but have become less popular. The aim of the present study was to compare the results and safety of a non-muscle-splitting MINI technique with the current gold standard of LDN. A single center retrospective cohort study of all living donor nephrectomies between 2011 and 2019 was used for the study. The primary outcome of this study was short term (

Abstract Background Kidney transplantation is the definitive treatment for end stage renal disease (ESRD), offering improved quality of life and survival benefit over remaining on dialysis. There is, however, a prevailing significant mismatch between patients awaiting transplantation and available donor kidneys. Over time, initial stringent donor criteria have broadened and organs from extended criteria donors (ECDs) and older donors are now being accepted for transplantation. The spectrum of living donors has also undergone a change from close family members to an increasingly non-related, non-directed altruistic donors, newly classified as ‘unspecified’ donors. Unspecified elderly donors could be a potential untapped resource to expanding the kidney donor pool globally. Case Presentation We present a case of an 85 year and 8 months old individual, who donated to an unrelated non-directed matched recipient in the national deceased donor transplant waiting list with excellent donor and recipient outcomes at 7 years. Conclusion To our knowledge she is one of the oldest reported unspecified living kidney donors in the world to date. This case illustrates that elderly donors in good health can come forward to donate, knowing that it is safe and valuable. Once the immediate perioperative challenges after kidney donation are managed, elderly donors rarely encounter long term sequelae. We therefore report this case to increase awareness and refocus attention of transplant teams on elderly donors as a potential untapped group to help address the organ shortage problem in renal transplantation.

Background : As the number of end-stage renal disease (ESRD) patients is increasing, but there are not enough living donors, it is necessary to broaden the criteria for candidates who can undergo donor nephrectomy. Thanks to surgeons' increasing experience with laparoscopic donor nephrectomy (LND), multiple renal artery grafts, previously considered a relative contraindication to donor nephrectomy, have become candidates for LDN. We aimed to compare the outcomes of donors and recipients with single artery and with multiple arteries in LDN. Methods: A total of 214 patients were included in the study. Patients were divided into two groups according to the number of donor arteries: donors with one artery (group 1) and donors with multiple arteries (group 2). The number of donor arteries, operative time, warm ischemia time (WIT), cold ischemia time (CIT), arterial anastomosis time, venous anastomosis time, the extent of bleeding, and preoperative complications were recorded to evaluate the preoperative data. Results: The mean operation time in group 1 was 90.3 ± 11.8 min, while in group 2, it was 102.1 ± 5.5 min (p = 0.000). WIT group 1 was 90.9 ± 4.3 s and group 2 100.6 ± 2.1 s (p = 0.000). Arterial anastomosis time was 12.25 ± 3.8 in group 1 and 22.5 ± 4.5 in group 2 (p = 0.000). No statistically significant difference was found between the two groups in other parameters. Conlusion: Increasing the number of donor arteries in renal transplantation (RT) operations prolonged the operation time on both the donor and recipient sides. Still, it had no negative impact on complications or graft function in the postoperative period. [ABSTRACT FROM AUTHOR]

Laparoscopic donor nephrectomy (LDN) is the current gold standard in kidney donation. Mini-incision open donor nephrectomy (MINI) techniques have been used extensively but have become less popular. The aim of the present study was to compare the results and safety of a non-muscle-splitting MINI technique with the current gold standard of LDN. A single center retrospective cohort study of all living donor nephrectomies between 2011 and 2019 was used for the study. The primary outcome of this study was short term (<30 days) with Clavien–Dindo grade complications. Secondary outcomes included multivariable regression analysis of perioperative data. No differences in complication rates were observed between MINI and LDN and also after correction for known confounders. As expected, the operative time and first warm ischemia were significantly shorter in the MINI group and less blood loss was observed in the LDN group. Complications and conversion rate (LDN to open) among the LDN patients were in line with recent published meta-analyses. This study confirms the perioperative safety of living kidney donation in modern practice. Complication rates of both MINI and LDN procedures are limited and not different between procedures. In specific circumstances, the MINI procedure can still be considered a safe and feasible alternative for living kidney donation. [ABSTRACT FROM AUTHOR]

Objective: Laparoscopic donor nephrectomy (LDN) is the most commonly used method for kidney removal in kidney transplantation and, various incisions are used for kidney extraction. In this study, we aimed to compare the results of LDN operations using iliac fossa incision and Pfannenstiel incision.Material and Method: LDN cases performed in our institute between June 2016 and February 2020 were retrospectively analyzed. Patients with previous abdominal surgery, bleeding coagulation disorders, ectopic kidneys and patients who were converted to perioperative open surgery were excluded. Demographic data of the patients, operation times, warm ischemia times, complications were recorded and the patients were divided into two groups according to incision types.Results: After the inclusion and exclusion criteria, 203 patients were included in the study. Iliac fossa incision was used in 65% of the patients and the Pfannenstiel incision was used in in 35% of the patients to remove the donor's kidney. There was no difference in age, body mass index, gender, and Charlson Comorbidity Index (CCI) scores between the two groups. Operation time and warm ischemia time were significantly longer in the Pfannenstiel group (p=0.001 and p=0.016 respectively). There was no significant difference between the two groups in terms of bleeding amount, length of hospital stay, need for narcotic analgesic, visual analog scale scores and postoperative complications.Conclusion: Both types of incisions can be used successfully and safely for the extraction of the kidney in LDN. Although WIT and operation time has been observed to be longer when a Pfannenstiel incision is made, complications and analgesic use are not different between Pfannenstiel incisions and iliac fossa incisions. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study is to report the difference in loss of length of the renal artery and vein between an open and laparoscopic renal donor nephrectomy. Methodology: We take 50 open and 50 laparoscopic renal donors for comparison of loss of length of the renal artery and vein. This is a single-blinded study. All patients considered for left donor nephrectomy with a single renal artery and vein are included in the study. Patients considered for right donor nephrectomy, abnormal renal artery and vein anatomy, atherosclerotic renal artery or vein are excluded from the study. Results: In our study, we take 50 open renal donor nephrectomies and 50 laparoscopic renal donor nephrectomies from a total of 115 renal donor nephrectomies from December 2020 to April 2021. For removing bias, we take only the left side nephrectomy which has a single artery and vein. We used study randomizer software which uses cluster randomization which decides case should be operated on either open or laparoscopy. Conclusions: In our study, the difference between preoperative and intraoperative artery length for open donor nephrectomy (ODN) was 0.3 cm, and vein length was 2.3 cm and the difference between preoperative and intraoperative artery length for laparoscopic donor nephrectomy (LDN) was 0.5 cm, and vein length was 2.5 cm. The difference between renal artery length in open versus LDN is 0.2 cm, and the difference between renal vein length in ODN versus LDN is 0.2 cm, which is statistically insignificant.

Context: Optimum main renal artery (RA) length before first branching needed to achieve single lumen during laparoscopic donor nephrectomy (LDN) is not known. Aims: The aim of the study is to identify optimal minimum length of RA before first branching which can be safely harvested as a single lumen in LDN. Settings and Design: This is a single institutional, retrospective study. Materials and Methods: Records of consecutive left LDNs performed at our institute from January 2016 to June 2019 were reviewed. RA length was measured from preoperative computed tomography angiogram. We clipped RA using two Hem-o-lok® and one titanium clip while maintaining constant mild upward traction. Primary outcome was to identify lowest RA length at which chances of achieving a single lumen were maximum. Secondary outcomes included minimum RA length below which single lumen could not be achieved and incidence of intraoperative vascular complications. Statistical Analyses: Receiver operator characteristic curve was plotted according to donor RA length. Likelihood ratio positive (LR+) was used to identify optimum length of RA above which chances of achieving single lumen were maximum. Results: Four hundred and eighty-eight donors with single RA underwent left LDN during study period. LR +of achieving single lumen after clipping was maximum at 10mm cutoff. Single lumen could not be achieved below 6–7 mm cutoff. There were no vascular complications or re-explorations. Conclusions: Main left RA length ≥10 mm before first branching is most likely to yield single lumen for implantation with our technique.

Background: Kidney transplantation is the definitive treatment for end stage renal disease (ESRD), offering improved quality of life and survival benefit over remaining on dialysis. There is, however, a prevailing significant mismatch between patients awaiting transplantation and available donor kidneys. Over time, initial stringent donor criteria have broadened and organs from extended criteria donors (ECDs) and older donors are now being accepted for transplantation. The spectrum of living donors has also undergone a change from close family members to an increasingly non-related, non-directed altruistic donors, newly classified as 'unspecified' donors. Unspecified elderly donors could be a potential untapped resource to expanding the kidney donor pool globally.Case Presentation: We present a case of an 85 year and 8 months old individual, who donated to an unrelated non-directed matched recipient in the national deceased donor transplant waiting list with excellent donor and recipient outcomes at 7 years.Conclusion: To our knowledge she is one of the oldest reported unspecified living kidney donors in the world to date. This case illustrates that elderly donors in good health can come forward to donate, knowing that it is safe and valuable. Once the immediate perioperative challenges after kidney donation are managed, elderly donors rarely encounter long term sequelae. We therefore report this case to increase awareness and refocus attention of transplant teams on elderly donors as a potential untapped group to help address the organ shortage problem in renal transplantation. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study is to report the difference in loss of length of the renal artery and vein between an open and laparoscopic renal donor nephrectomy. Methodology: We take 50 open and 50 laparoscopic renal donors for comparison of loss of length of the renal artery and vein. This is a single-blinded study. All patients considered for left donor nephrectomy with a single renal artery and vein are included in the study. Patients considered for right donor nephrectomy, abnormal renal artery and vein anatomy, atherosclerotic renal artery or vein are excluded from the study. Results: In our study, we take 50 open renal donor nephrectomies and 50 laparoscopic renal donor nephrectomies from a total of 115 renal donor nephrectomies from December 2020 to April 2021. For removing bias, we take only the left side nephrectomy which has a single artery and vein. We used study randomizer software which uses cluster randomization which decides case should be operated on either open or laparoscopy. Conclusions: In our study, the difference between preoperative and intraoperative artery length for open donor nephrectomy (ODN) was 0.3 cm, and vein length was 2.3 cm and the difference between preoperative and intraoperative artery length for laparoscopic donor nephrectomy (LDN) was 0.5 cm, and vein length was 2.5 cm. The difference between renal artery length in open versus LDN is 0.2 cm, and the difference between renal vein length in ODN versus LDN is 0.2 cm, which is statistically insignificant. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to compare the outcomes of right- and left-sided live donor nephrectomies using the inverted kidney transplantation technique for right live donor nephrectomy on transplantation. Material and methods: A retrospective review was done for the cases of live donor nephrectomy, either as open donor nephrectomy or laparoscopic donor nephrectomy between 2004 and 2019. Inverted kidney transplantation was used with right-sided grafts. The variables of the right- and left-sided live donor nephrectomies were compared. Results: There were 202 live donor nephrectomies including 71 (35.1%) open donor nephrectomies and 131 (64.9%) laparoscopic donor nephrectomies with 4 cases of conversion to open donor nephrectomy. There were 119 (58.9%) right-sided and 83 (41.1%) left-sided live donor nephrectomies with insignificantly different mean operative time (123 and 127 minutes; P = .09), mean warm ischemia time (82.3 and 84.5 seconds; P = .32), and mean blood loss (73 and 78 mL; P = .18), respectively. Inverted kidney transplantation was performed for 86% of grafts from right live donor nephrectomies. Discharge from hospital was on an average of 4.3 days postoperatively. There were only 3 complications (1 in right live donor nephrectomy and 2 in left live donor nephrectomies) with grade 2 according to Clavien--Dindo Classification. Incidence of delayed graft function (P = .09), transplant vein thrombosis (1 case in each group), 1-year graft survival rate (93.2% vs. 94.8%; P = .12), and 1-year serum creatinine levels (1.4 ± 0.3 vs. 1.3 ± 0.2; P = .09) revealed statistically insignificant differences. Conclusion: Regardless of the surgical technique, the right live donor nephrectomy seems to be technically as safe as the left live donor nephrectomy for both the donors and the recipients. Using inverted kidney transplantation provided convenient extensions of graft's vessels to full length with no significant increased incidence of vascular thrombosis. [ABSTRACT FROM AUTHOR]

Context: Optimum main renal artery (RA) length before first branching needed to achieve single lumen during laparoscopic donor nephrectomy (LDN) is not known. Aims: The aim of the study is to identify optimal minimum length of RA before first branching which can be safely harvested as a single lumen in LDN. Settings and Design: This is a single institutional, retrospective study. Materials and Methods: Records of consecutive left LDNs performed at our institute from January 2016 to June 2019 were reviewed. RA length was measured from preoperative computed tomography angiogram. We clipped RA using two Hem-o-lok® and one titanium clip while maintaining constant mild upward traction. Primary outcome was to identify lowest RA length at which chances of achieving a single lumen were maximum. Secondary outcomes included minimum RA length below which single lumen could not be achieved and incidence of intraoperative vascular complications. Statistical Analyses: Receiver operator characteristic curve was plotted according to donor RA length. Likelihood ratio positive (LR+) was used to identify optimum length of RA above which chances of achieving single lumen were maximum. Results: Four hundred and eighty-eight donors with single RA underwent left LDN during study period. LR +of achieving single lumen after clipping was maximum at 10mm cutoff. Single lumen could not be achieved below 6--7 mm cutoff. There were no vascular complications or re-explorations. Conclusions: Main left RA length ≥10 mm before first branching is most likely to yield single lumen for implantation with our technique. [ABSTRACT FROM AUTHOR]

Postoperative chylous ascites is a well-known complication of retroperitoneal lymph node dissection for testicular malignancies. This complication is now being reported increasingly with laparoscopic nephrectomies as well. A 33-year-old woman with no comorbidities underwent laparoscopic left donor nephrectomy. She had an uneventful postoperative recovery and was discharged on the 5th postoperative day. She reported on the 11th postoperative day with abdominal distension. Clinical examination revealed free fluid in the peritoneal cavity, and she was evaluated further. Imaging revealed mild ascites, which was aspirated, yielding milky fluid. Biochemical analysis of the fluid revealed triglycerides and chylomicrons, consistent with chyle. She was admitted, and an intra-abdominal drain placed under ultrasound guidance. Subsequently, she underwent lymphangiography and embolization. Her drain output came down, and she remained asymptomatic following drain removal. There was no further chylous leak on subsequent follow-up. Chylous ascites following laparoscopic nephrectomy is more common on the left side. Chylous leaks have been attributed to incomplete sealing of lymphatics with energy devices. Precise surgical technique of division of lymphatics between clips can prevent this complication. Most small leaks settle with a conservative care. Those that do not settle require open ligation. Percutaneous lymphatic embolization is an effective minimally invasive modality in managing such patients. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to compare the long-term graft outcomes of left-versus-right donor nephrectomy with multiple renal arteries (MRAs), and therefore creating a reference for the expansion of the potential living kidney donor pool. Methods: Laparoscopic live donor nephrectomy cases between May 2010 and October 2020 were included in this retrospective cross-sectional study. The data relating to donor and recipient demographics, surgical and anatomical characteristics, recipient, and graft status were retrieved and compared using nonparametric statistical methods and multivariate regression. Analyses were fit for survival factors. Results: A total of 1,009 recipients were included in this retrospective cross-sectional study with their donors. 16.7% of the donors had been discovered to have more than one renal artery supplying the donated kidney. The acute rejection rate was 12.8%. Death-censored graft survival at postoperative year 5 for single renal artery (SRA) transplants was 89.6%, 89.5% for left-sided MRAs, and 88.2% for right-sided ones. Conclusions: Both right donor nephrectomy and left donor nephrectomy are safe procedures with no significant negatively impacted rates for neither survival nor complications of the recipients in the long-term, compared to SRA ones. [ABSTRACT FROM AUTHOR]

Background: Laparoendoscopic single-site surgery is performed during laparoscopic donor nephrectomy (LDN) to reduce donor invasiveness. However, the procedure is difficult and does not improve cosmesis when the incision is made at the umbilicus. Therefore, we proposed a minimally invasive LDN with a Pfannenstiel incision using size-reduced trocars (mLDN) to achieve cosmesis and operability and aimed to assess its efficacy and safety., Methods: A total of 27 patients who underwent mLDN were recruited. Data on estimated blood loss, operative time, pneumoperitoneum time, warm ischemic time (WIT), complication rate, non-steroidal anti-inflammatory drugs (NSAIDs) used, and recipient serum creatinine levels were collected retrospectively. In mLDN, the Pfannenstiel position was incised to approximately 6 cm to retrieve the kidney, and three size-reduced trocars were placed in the left upper abdomen (2.5 mm and 5 mm) and umbilicus (5 mm)., Results: The median operation time and pneumoperitoneum time were 245 and 194 minutes, respectively. The median WIT was 276 seconds, and the serum creatinine levels of the recipients at seven days and one, three, six, and 12 months were significantly improved compared with baseline. No intra- and postoperative complications (Clavien-Dindo grade ≥ 2) were observed, and no patients used additional NSAIDs after the operation. The scarring in the mLDN group was unnoticeable postoperatively., Conclusions: mLDN can be performed safely, with high cosmesis, and with operability similar to that of conventional LDN. Although the WIT tended to be long, the function of the harvested kidney was maintained, and the use of analgesic NSAIDs was lower in this procedure. Our procedure should be considered as an option for LDN., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ichikawa General Hospital Scientific Council and ethics committee issued approval I 22-18. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Hagiuda et al.)

Background: A limited number of publications are available in the literature regarding laparoscopic living donor nephrectomy with vaginal extraction (LLDN-VE) for kidney transplantation. The aim of this study was to compare long-term recipient outcomes of standard laparoscopic living donor nephrectomy (S-LLDN) and LLDN-VE. Methods: A total of 652 patients [119 LLDN-VE (18.3%) and 533 S-LLDN (81.7%)] were included in this retrospective cross-sectional study. The data related to donor and recipient demographics, surgical and anatomical characteristics, and recipient and graft status were retrieved and compared using nonparametric statistical methods. Kaplan-Meier and Cox proportional hazards regression analyses were applied to compute survival according to the surgical technique. Results: The mean follow-up duration was 73.0 ± 25.4 months for S-LLDN and 69.8 ± 20.4 months for LLDN-VE recipients. The main determinants of long-term outcomes were the serum creatinine (SCr) levels, death-censored graft survival, and recipient survival at the end of the post-op 5th year. LLDN-VE recipients' discharge SCr was found to be statistically lower (P = .049) than S-LLDN patients. Graft survival rates censored for death were 93.8% for the S-LLDN and 93.3% for the LLDN-VE recipients. Cox regression analysis showed significance for younger donor age (P = .010) with the application of 17 parameters, indicating better graft survival outcomes for kidney recipients with younger donors. Conclusions: Compared with the standard method, the long-term results of LLDN-VE are in accordance with or could even be more advantageous than S-LLDN in certain aspects. LLDN-VE appears to be a feasible, safe, and cosmetically superior approach with no negative postoperative sexual or morbid effects on the donor. [ABSTRACT FROM AUTHOR]

Background: We aimed to explore differences in outcomes of robotic and laparoscopic donor nephrectomies (LDN)., Methods: This study compared robotic and laparoscopic surgical techniques for live donor nephrectomies in 153 patients at a single centre., Results: Left nephrectomies were more common in both groups, but with no significant difference between the groups (76.6% vs. 77.6%, p = 0.88). The robotic donor nephrectomies (RDN) group experienced significantly less blood loss (60 vs. 134 mL, p < 0.01), but warm ischaemia time was similar between groups (3.2 vs. 3.7 min, p = 0.54).The RDN group had decreased subjective pain scores (3.54 vs. 4.21, p = 0.04) and shorter length of hospitalisation (2.22 vs. 3.04 days, p < 0.01).There were also fewer complications in the RDN than the LDN group (4 vs. 8, p = 0.186)., Conclusion: This study demonstrated that RDN is a safe and alternative to LDN. Decreased blood loss and hospital stays and fewer complications may reflect decreased tissue manipulation with robotic assistance., (© 2023 John Wiley & Sons Ltd.)

We performed laparoscopic live donor nephrectomy (LDN) on approximately 200 patients in Ehime Prefectural Center Hospital between 2003 and 2016. In 2016, a fifty-something woman who was a donor candidate for her husband was revealed to have a horseshoe kidney through contrast-enhanced computed tomography; other LDN procedures used a retroperitoneal approach, but this one used a transperitoneal approach since the latter approach allowed for a more favorable visual field. The left kidney was selected since renal scintigraphy showed equal bilateral renal function and renal arteries are simpler on the left side. The kidney was removed after the isthmus was successfully transected without ischemia. The opened calyx in the left kidney was sutured via bench surgery, and the kidney was transplanted to the recipient. Postoperative courses of both donor and recipient were good.

Objective: To assess the first experience of 3D imaging for laparoscopic donor nephrectomy., Material and Methods: The study included 28 laparoscopic donor nephrectomies and 28 subsequent transplantations to related recipients. Of these, 14 laparoscopic donor nephrectomies were performed using 3D camera. The main intraoperative parameters and information about postoperative period in donors and recipients were compared with similar data on previous laparoscopic donor nephrectomies and kidney transplantations with traditional 2D imaging. There were 15 left-sided and 13 right-sided nephrectomies. Twenty and eight laparoscopic nephrectomies were performed via retroperitoneal and transperitoneal access, respectively. There were no significant between-group differences in age, sex ratio, BMI, side of surgery and number of renal arteries., Results: Surgery time (119.28±9.18 and 124.85±7.49 min, respectively) and blood loss (106.78±16.12 and 119.28±19.79 ml, respectively) were similar. Laparoscopic nephrectomy with 3D imaging was followed by significantly shorter primary warm ischemia (2.41±0.79 and 3.23±0.57 min, respectively, p =0.004) and time of extracorporeal preparation of the transplant (back table) under cold preservation (27.21±5.42 and 32.36±5.33 min, respectively, p =0.02)., Conclusion: Initial experience of video systems with 3D imaging in laparoscopic donor nephrectomy has not yet led to significant reduction of surgery time and improvement of transplant function compared to traditional 2D imaging. At the same time, there was a shorter period of primary warm ischemia and back table time. Further analysis is needed to assess possible benefits of 3D imaging in laparoscopic donor nephrectomy.

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 the χ 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., Competing Interests: Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article., (©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)

Introduction Laparoscopic Live Donor Nephrectomy(LLDN) is becoming an increasingly frequent procedure. The rise in intracranial pressure(ICP) during LLDN has not been measured yet. ICP can be evaluated by measuring ultrasonographic optic nerve sheath diameter(ONSD). Acetazolamide has been found to provide effective analgesia following LLDN. It also helps lowering the raised ICP. Therefore, we planned to study effect of orogastric Acetazolamide on ONSD in patients undergoing LLDN. Methods Forty Donors scheduled for LLDN were randomized preoperatively either into Group A receiving acetazolamide 5mg/kg or Group S receiving normal saline. ONSD was measured at time points:Time 0: In supine position before induction of GA, Time 1: 5 minutes after induction of GA but before giving orogastric acetazolamide, Time 2: 10 minutes after creating pneumoperitoneum, Time 3: 60 minutes after creating pneumoperitoneum, Time 4: Towards end of surgery, just before taking out specimen in modified flank position, Time 5: after extubating in supine position. Results Mean ONSD of left eye(4.42 ± 0.48) in Group S was significantly more than mean ONSD of left eye(4.16 ± 0.15; p-0.036) in Group A at 10 mins after creating pneumoperitoneum in modified flank position. Mean ONSD showed significant increase in group S at 10 and 60 minutes(4.374 ± 0.433mm in group S vs 4.151 ± 0.168 in group A; p-0.042 at 10 mins and 4.336 ± 0.301mm in group S vs 4.149 ± 0.282mm in group A; p-0.050 at 60 mins) after creating pneumoperitoneum as compared to group A. Conclusion Orogastric acetazolamide 5 mg/kg was found to be beneficial in preventing rise in ONSD from 10 minutes to 1 hour of creating pneumoperitoneum in patients undergoing laparoscopic donor nephrectomy under general anaesthesia. Acetazolamide was also found to be effective in reducing postoperative pain., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Sen et al.)