A comparison of laparoendoscopic single-site surgery versus conventional procedures for laparoscopic donor nephrectomy: a Japanese multi-institutional retrospective study

LESS and RPS Research Group in Japanese Society of Endourology

Research output: Contribution to journalArticle

Abstract

Purpose: Laparoendoscopic single-site donor nephrectomy (LESSDN) is a feasible and effective procedure because of its non-invasiveness and better cosmetic outcomes. However, there have been few multi-institutional studies conducted by multiple surgeons on LESSDN. We retrospectively compared the clinical data and outcomes between LESSDN and conventional laparoscopic donor nephrectomy (LDN) at multiple institutes in Japan. Materials and methods: From 2009 to 2015, the clinical data of 223 donors who underwent LESSDN and 151 donors who underwent LDN were collected from 10 institutes. All LESSDNs were performed transperitoneally, whereas LDNs were performed transperitoneally (P-LDN) in 75 patients and retroperitoneally (R-LDN) in 76 patients. Results: In the LESSDN group, the single-incision site was pararectal in 155 (69.5%) patients and umbilical in 65 (29.1%) patients. Multiple surgeons (one to eight per institute) performed the LESSDN. No significant differences were observed between the three groups regarding estimated blood loss and warm ischemic time. The operative time was significantly shorter in the LESSDN group than in the R-LDN group (p = 0.018). No significant differences were observed regarding the rates of blood transfusion, open conversion, visceral injuries, and postoperative complications. Furthermore, no significant differences were observed regarding the dose of analgesic and the rate of delayed graft function. One patient required open conversion due to injury to the renal artery. Selection of LESS procedure was not an independent risk factor for the median serum creatinine level of above 1.27 mg/dL in recipients at 1 year after kidney transplantation. Conclusion: The results showed the technical feasibility of LESSDN compared with the standard LDNs in a multi-institutional and multi-surgeon setting. A few observed non-negligible complications and the significantly higher levels of serum creatinine in patients who underwent LESSDN indicate that this procedure should be employed cautiously when performed by surgeons without ample experience in performing LESS procedures.

Original languageEnglish
JournalSurgical Endoscopy
DOIs
Publication statusAccepted/In press - 2019 Jan 1

Fingerprint

Nephrectomy
Retrospective Studies
Tissue Donors
Creatinine
Delayed Graft Function
Umbilicus
Warm Ischemia
Wounds and Injuries
Renal Artery
Operative Time
Serum
Cosmetics
Blood Transfusion
Kidney Transplantation
Analgesics
Japan

Keywords

  • Complications
  • Donor nephrectomy
  • Feasibility
  • Graft function
  • Kidney transplantation
  • LESS surgery
  • Morbidity

ASJC Scopus subject areas

  • Surgery

Cite this

A comparison of laparoendoscopic single-site surgery versus conventional procedures for laparoscopic donor nephrectomy : a Japanese multi-institutional retrospective study. / LESS and RPS Research Group in Japanese Society of Endourology.

In: Surgical Endoscopy, 01.01.2019.

Research output: Contribution to journalArticle

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title = "A comparison of laparoendoscopic single-site surgery versus conventional procedures for laparoscopic donor nephrectomy: a Japanese multi-institutional retrospective study",
abstract = "Purpose: Laparoendoscopic single-site donor nephrectomy (LESSDN) is a feasible and effective procedure because of its non-invasiveness and better cosmetic outcomes. However, there have been few multi-institutional studies conducted by multiple surgeons on LESSDN. We retrospectively compared the clinical data and outcomes between LESSDN and conventional laparoscopic donor nephrectomy (LDN) at multiple institutes in Japan. Materials and methods: From 2009 to 2015, the clinical data of 223 donors who underwent LESSDN and 151 donors who underwent LDN were collected from 10 institutes. All LESSDNs were performed transperitoneally, whereas LDNs were performed transperitoneally (P-LDN) in 75 patients and retroperitoneally (R-LDN) in 76 patients. Results: In the LESSDN group, the single-incision site was pararectal in 155 (69.5{\%}) patients and umbilical in 65 (29.1{\%}) patients. Multiple surgeons (one to eight per institute) performed the LESSDN. No significant differences were observed between the three groups regarding estimated blood loss and warm ischemic time. The operative time was significantly shorter in the LESSDN group than in the R-LDN group (p = 0.018). No significant differences were observed regarding the rates of blood transfusion, open conversion, visceral injuries, and postoperative complications. Furthermore, no significant differences were observed regarding the dose of analgesic and the rate of delayed graft function. One patient required open conversion due to injury to the renal artery. Selection of LESS procedure was not an independent risk factor for the median serum creatinine level of above 1.27 mg/dL in recipients at 1 year after kidney transplantation. Conclusion: The results showed the technical feasibility of LESSDN compared with the standard LDNs in a multi-institutional and multi-surgeon setting. A few observed non-negligible complications and the significantly higher levels of serum creatinine in patients who underwent LESSDN indicate that this procedure should be employed cautiously when performed by surgeons without ample experience in performing LESS procedures.",
keywords = "Complications, Donor nephrectomy, Feasibility, Graft function, Kidney transplantation, LESS surgery, Morbidity",
author = "{LESS and RPS Research Group in Japanese Society of Endourology} and Takamitsu Inoue and Masayoshi Miura and Masaaki Yanishi and Junya Furukawa and Fuminori Sato and Masahiro Nitta and Koji Yoshimura and Jun Hagiuda and Kazunobu Shinoda and Takashi Kobayashi and Akira Miyajima and Ken Nakagawa and Mototsugu Oya and Osamu Ogawa and Hiromitsu Mimata and Kanayama, {Hiro omi} and Masato Fujisawa and Toshiro Terachi and Tadashi Matsuda and Tomonori Habuchi",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s00464-019-07119-9",
language = "English",
journal = "Surgical Endoscopy and Other Interventional Techniques",
issn = "0930-2794",
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T1 - A comparison of laparoendoscopic single-site surgery versus conventional procedures for laparoscopic donor nephrectomy

T2 - a Japanese multi-institutional retrospective study

AU - LESS and RPS Research Group in Japanese Society of Endourology

AU - Inoue, Takamitsu

AU - Miura, Masayoshi

AU - Yanishi, Masaaki

AU - Furukawa, Junya

AU - Sato, Fuminori

AU - Nitta, Masahiro

AU - Yoshimura, Koji

AU - Hagiuda, Jun

AU - Shinoda, Kazunobu

AU - Kobayashi, Takashi

AU - Miyajima, Akira

AU - Nakagawa, Ken

AU - Oya, Mototsugu

AU - Ogawa, Osamu

AU - Mimata, Hiromitsu

AU - Kanayama, Hiro omi

AU - Fujisawa, Masato

AU - Terachi, Toshiro

AU - Matsuda, Tadashi

AU - Habuchi, Tomonori

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: Laparoendoscopic single-site donor nephrectomy (LESSDN) is a feasible and effective procedure because of its non-invasiveness and better cosmetic outcomes. However, there have been few multi-institutional studies conducted by multiple surgeons on LESSDN. We retrospectively compared the clinical data and outcomes between LESSDN and conventional laparoscopic donor nephrectomy (LDN) at multiple institutes in Japan. Materials and methods: From 2009 to 2015, the clinical data of 223 donors who underwent LESSDN and 151 donors who underwent LDN were collected from 10 institutes. All LESSDNs were performed transperitoneally, whereas LDNs were performed transperitoneally (P-LDN) in 75 patients and retroperitoneally (R-LDN) in 76 patients. Results: In the LESSDN group, the single-incision site was pararectal in 155 (69.5%) patients and umbilical in 65 (29.1%) patients. Multiple surgeons (one to eight per institute) performed the LESSDN. No significant differences were observed between the three groups regarding estimated blood loss and warm ischemic time. The operative time was significantly shorter in the LESSDN group than in the R-LDN group (p = 0.018). No significant differences were observed regarding the rates of blood transfusion, open conversion, visceral injuries, and postoperative complications. Furthermore, no significant differences were observed regarding the dose of analgesic and the rate of delayed graft function. One patient required open conversion due to injury to the renal artery. Selection of LESS procedure was not an independent risk factor for the median serum creatinine level of above 1.27 mg/dL in recipients at 1 year after kidney transplantation. Conclusion: The results showed the technical feasibility of LESSDN compared with the standard LDNs in a multi-institutional and multi-surgeon setting. A few observed non-negligible complications and the significantly higher levels of serum creatinine in patients who underwent LESSDN indicate that this procedure should be employed cautiously when performed by surgeons without ample experience in performing LESS procedures.

AB - Purpose: Laparoendoscopic single-site donor nephrectomy (LESSDN) is a feasible and effective procedure because of its non-invasiveness and better cosmetic outcomes. However, there have been few multi-institutional studies conducted by multiple surgeons on LESSDN. We retrospectively compared the clinical data and outcomes between LESSDN and conventional laparoscopic donor nephrectomy (LDN) at multiple institutes in Japan. Materials and methods: From 2009 to 2015, the clinical data of 223 donors who underwent LESSDN and 151 donors who underwent LDN were collected from 10 institutes. All LESSDNs were performed transperitoneally, whereas LDNs were performed transperitoneally (P-LDN) in 75 patients and retroperitoneally (R-LDN) in 76 patients. Results: In the LESSDN group, the single-incision site was pararectal in 155 (69.5%) patients and umbilical in 65 (29.1%) patients. Multiple surgeons (one to eight per institute) performed the LESSDN. No significant differences were observed between the three groups regarding estimated blood loss and warm ischemic time. The operative time was significantly shorter in the LESSDN group than in the R-LDN group (p = 0.018). No significant differences were observed regarding the rates of blood transfusion, open conversion, visceral injuries, and postoperative complications. Furthermore, no significant differences were observed regarding the dose of analgesic and the rate of delayed graft function. One patient required open conversion due to injury to the renal artery. Selection of LESS procedure was not an independent risk factor for the median serum creatinine level of above 1.27 mg/dL in recipients at 1 year after kidney transplantation. Conclusion: The results showed the technical feasibility of LESSDN compared with the standard LDNs in a multi-institutional and multi-surgeon setting. A few observed non-negligible complications and the significantly higher levels of serum creatinine in patients who underwent LESSDN indicate that this procedure should be employed cautiously when performed by surgeons without ample experience in performing LESS procedures.

KW - Complications

KW - Donor nephrectomy

KW - Feasibility

KW - Graft function

KW - Kidney transplantation

KW - LESS surgery

KW - Morbidity

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DO - 10.1007/s00464-019-07119-9

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AN - SCOPUS:85073963855

JO - Surgical Endoscopy and Other Interventional Techniques

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SN - 0930-2794

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