World J Urol DOI 10.1007/s00345-014-1360-z
ORIGINAL ARTICLE
Mini‑laparoscopic live donor nephrectomy with the use of 3‑mm instruments and laparoscope Alberto Breda · Ivan Schwartzmann · Esteban Emiliani · Oscar Rodriguez‑Faba · Lluis Gausa · Jorge Caffaratti · Xavier Ponce de León · Humberto Villavicencio
Received: 4 April 2014 / Accepted: 1 July 2014 © Springer-Verlag Berlin Heidelberg 2014
Abstract Purpose To analyze our preliminary outcomes on the use of 3 mm instruments for laparoscopic live donor nephrectomy (LLDN). Methods Our series includes thirteen patients, who underwent LLDN using 3-mm instruments and laparoscope and 5-mm transumbilical trocar. The patients were followed at 7 and 14 days from discharge and were specifically asked about their cosmetic satisfaction. At follow-up, the recipient graft function was controlled, as well as the donor’s cosmetic results. Eight months after surgery, all thirteen patients were asked to fill out the Patient Scar Assessment Questionnaire and Scoring System (PSAQ). Results All patients presented good recovery after surgery. Regarding cosmetic outcomes, the donors expressed their satisfaction toward the minimal incision size and optimal esthetic results at 7 and 14 days from discharge home. The low scores on each section of the PSAQ confirmed the favorable outcomes. Early graft function was satisfactory at 1 and 3 months after the kidney transplantation. Furthermore, there were no major complications in the recipients. Conclusions Our persistent positive results with the use of 3-mm instruments during LLDN support this technique as a good alternative to the standard laparoscopic approach for minimizing the incision site, while maintaining safety and excellent clinical outcomes. The fact that the general laparoscopic standards are maintained could make this approach a very attractive alternative to the other minimally invasive approaches for live donor nephrectomy. The hope
A. Breda (*) · I. Schwartzmann · E. Emiliani · O. Rodriguez‑Faba · L. Gausa · J. Caffaratti · X. P. de León · H. Villavicencio Urology Department, Fundació Puigvert, Barcelona, Spain e-mail: [email protected]
is in that the higher degree of satisfaction in the donor population demonstrated in this study may likely enhance living kidney donation. Keywords Laparoscopy · Mini-laparoscopy · Live donor nephrectomy · Kidney transplant
Introduction In the past decade, we have witnessed a shortage of deceased donor kidneys while gaining experience in live donor transplantation (LDT) [1–4]. It is now clear that the outcomes of LDT are excellent and far superior to those from deceased donors [5]. Furthermore, minimally invasive donor nephrectomy has been shown to be superior to open surgery in terms of shorter hospital stay, reduced morbidity, pain management, and better cosmetic outcomes while maintaining comparable immediate and long-term postoperative graft function [6–9]. For these reasons, laparoscopy has become the standard procedure for live donor nephrectomy (LDN) [10]. The attempts to reduce the morbidity of laparoscopic LDN (LLDN) have lead to novel techniques such as singleport surgery, transvaginal surgery, and robotic single-port surgery [11–13]. However, some of these techniques, such as the single-port approach, are technically challenging and therefore less reproducible than standard laparoscopy [14]. Little has been reported on the use of 3-mm instruments during LLDN, although small instrument surgery has shown cosmetic superiority to standard laparoscopy [15–17]. The advantage and goal of using small instruments would be to minimize incision size while maintaining the reproducibility of the standard laparoscopic approach. The aim of this study was to investigate the feasibility and safety of the use of 3-mm instruments and the laparoscope during LLDN.
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Fig. 1 Comparison of different trocar sizes. a Oblique view. b Frontal view
World J Urol
Fig. 2 Comparison of laparoscope sizes. a Upper view. b Frontal view
Patients and methods Between November 1, 2010, and December 15, 2012, all kidney donors accepted as good candidates for donation at our institution were evaluated to undergo LLDN with the use of 5- or 3-mm instruments (Karl Storz, Tuttlingen, Germany) (Figs. 1a, b, 2a, b, 3). As general rule, patients with a body mass index (BMI) >30 were selected to undergo an LLDN with the use of 5-mm instruments, while donors with a BMI
ORIGINAL ARTICLE
Mini‑laparoscopic live donor nephrectomy with the use of 3‑mm instruments and laparoscope Alberto Breda · Ivan Schwartzmann · Esteban Emiliani · Oscar Rodriguez‑Faba · Lluis Gausa · Jorge Caffaratti · Xavier Ponce de León · Humberto Villavicencio
Received: 4 April 2014 / Accepted: 1 July 2014 © Springer-Verlag Berlin Heidelberg 2014
Abstract Purpose To analyze our preliminary outcomes on the use of 3 mm instruments for laparoscopic live donor nephrectomy (LLDN). Methods Our series includes thirteen patients, who underwent LLDN using 3-mm instruments and laparoscope and 5-mm transumbilical trocar. The patients were followed at 7 and 14 days from discharge and were specifically asked about their cosmetic satisfaction. At follow-up, the recipient graft function was controlled, as well as the donor’s cosmetic results. Eight months after surgery, all thirteen patients were asked to fill out the Patient Scar Assessment Questionnaire and Scoring System (PSAQ). Results All patients presented good recovery after surgery. Regarding cosmetic outcomes, the donors expressed their satisfaction toward the minimal incision size and optimal esthetic results at 7 and 14 days from discharge home. The low scores on each section of the PSAQ confirmed the favorable outcomes. Early graft function was satisfactory at 1 and 3 months after the kidney transplantation. Furthermore, there were no major complications in the recipients. Conclusions Our persistent positive results with the use of 3-mm instruments during LLDN support this technique as a good alternative to the standard laparoscopic approach for minimizing the incision site, while maintaining safety and excellent clinical outcomes. The fact that the general laparoscopic standards are maintained could make this approach a very attractive alternative to the other minimally invasive approaches for live donor nephrectomy. The hope
A. Breda (*) · I. Schwartzmann · E. Emiliani · O. Rodriguez‑Faba · L. Gausa · J. Caffaratti · X. P. de León · H. Villavicencio Urology Department, Fundació Puigvert, Barcelona, Spain e-mail: [email protected]
is in that the higher degree of satisfaction in the donor population demonstrated in this study may likely enhance living kidney donation. Keywords Laparoscopy · Mini-laparoscopy · Live donor nephrectomy · Kidney transplant
Introduction In the past decade, we have witnessed a shortage of deceased donor kidneys while gaining experience in live donor transplantation (LDT) [1–4]. It is now clear that the outcomes of LDT are excellent and far superior to those from deceased donors [5]. Furthermore, minimally invasive donor nephrectomy has been shown to be superior to open surgery in terms of shorter hospital stay, reduced morbidity, pain management, and better cosmetic outcomes while maintaining comparable immediate and long-term postoperative graft function [6–9]. For these reasons, laparoscopy has become the standard procedure for live donor nephrectomy (LDN) [10]. The attempts to reduce the morbidity of laparoscopic LDN (LLDN) have lead to novel techniques such as singleport surgery, transvaginal surgery, and robotic single-port surgery [11–13]. However, some of these techniques, such as the single-port approach, are technically challenging and therefore less reproducible than standard laparoscopy [14]. Little has been reported on the use of 3-mm instruments during LLDN, although small instrument surgery has shown cosmetic superiority to standard laparoscopy [15–17]. The advantage and goal of using small instruments would be to minimize incision size while maintaining the reproducibility of the standard laparoscopic approach. The aim of this study was to investigate the feasibility and safety of the use of 3-mm instruments and the laparoscope during LLDN.
13
Fig. 1 Comparison of different trocar sizes. a Oblique view. b Frontal view
World J Urol
Fig. 2 Comparison of laparoscope sizes. a Upper view. b Frontal view
Patients and methods Between November 1, 2010, and December 15, 2012, all kidney donors accepted as good candidates for donation at our institution were evaluated to undergo LLDN with the use of 5- or 3-mm instruments (Karl Storz, Tuttlingen, Germany) (Figs. 1a, b, 2a, b, 3). As general rule, patients with a body mass index (BMI) >30 were selected to undergo an LLDN with the use of 5-mm instruments, while donors with a BMI
