Comparison of Incision Types Used for Kidney Extraction in Laparoscopic Donor Nephrectomy: A Retrospective Study Incision types for kidney extraction
Urology Journal,
Vol. 20 No. 01 (2023),
25 Dey 2022
,
Page 11-16
https://doi.org/10.22037/uj.v20i01.7233
Abstract
Purpose: 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 35% of the patients to remove the donor’s kidney. There were 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.
- Laparoscopic donor nephrectomy, kidney transplantation, pfannenstiel incision, iliac fossa incision
How to Cite
References
Ratner LE, Ciseck LJ, Moore RG, Cigarroa FG, Kaufman HS, Kavoussi LR. Laparoscopic live donor nephrectomy. Transplantation. 1995;60:1047-9
Ng ZQ, He B. A proposed classification system and therapeutic strategy for chyle leak after laparoscopic living-donor nephrectomy: A single-center experience and review of the literature. Exp Clin Transplant. 2018;16:143-9
Hellegering J, Visser J, Kloke HJ, D'Ancona FC, Hoitsma AJ, van der Vliet JA, et al. Deleterious influence of prolonged warm ischemia in living donor kidney transplantation. Transplant Proc. 2012;44:1222–6.
Marzouk K, Lawen J, Alwayn I, Kiberd BA. The impact of vascular anastomosis time on early kidney transplant outcomes. Transplant Res. 2013;2:8–12
Su LM, Ratner LE, Montgomery RA, Jarrett TW, Trock BJ, Sinkov V, et al. Laparoscopic live donor nephrectomy: Trends in donor and recipient morbidity following 381 consecutive cases. Ann Surg. 2004;240:358–63.
Øyen O, Andersen M, Mathisen L, Kvarstein G, Edwin B, Line PD, et al. Laparoscopic versus open living donor nephrectomy: experiences from a prospective, randomized, single center study focusing on donor safety. Transplantation 2005;79:1236– 40.
Dubey D, Shrinivas RP, Srikanth G. Transumbilical laparoendoscopic single-site donor nephrectomy: Without the use of a single port access device. Indian J Urol. 2011;27:180-4.
Allaf ME, Singer A, Shen W, Green I, Womer K, Segev DL, et al. Laparoscopic live donor nephrectomy with vaginal extraction: Initial report. Am J Transplant 2010;10:1473-7
Silva ANS, Georgiades F, Bath MF, Hosgood SA, Nicholson ML. Iliac fossa muscle splitting incision in laparoscopic donor nephrectomy: a comparison with the suprapubic approach. Urology. 2020;143:142-6.
Adiyat KT, Tharun BK, Shetty A, Samavedi S. Comparison of three different techniques of extraction in laparoscopic donor nephrectomy. Indian J Urol. 2013;29:184-7.
Gupta M, Singh P, Dubey D, Srivastava A, Kapoor R, Kumar A. A comparison of kidney retrieval incisions in laparoscopic transperitoneal donor nephrectomy. Urol Int. 2008;81:296-300
Iemsupakkul P, Kongchareonsombat W, Kijvikai K. Comparison of Pfannenstiel or extended iliac port site kidney extraction in laparoscopic donor nephrectomy: Do we have consensus? Exp Clin Transplant. 2017;15:138‐42.
Deshmukh CS, Ganpule AP, Sudharsan SB, Singh AG, Sabnis RB, Desai MR. Iliac fossa vs Pfannenstiel retrieval incision in laparoscopic donor nephrectomy: A critical analysis. Arab J Urol. 2019;17:318‐25.
Serrano OK, Bangdiwala AS, Vock DM, Berglund D, Dunn TB, Finger EB, et al. Defining the tipping point in surgical performance for laparoscopic donor nephrectomy among transplant surgery fellows: A risk-adjusted cumulative summation learning curve analysis. Am J Transplant. 2017;17:1868-78.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13
Amer T, Biju RD, Hutton R, Alsawi M, Aboumarzouk O, Hasan R, et al. Laparoscopic nephrectomy – Pfannenstiel or expanded port site specimen extraction: a systematic review and meta-analysis. Cent European J Urol. 2015;68:322-9
Simforoosh N, Hosseini Sharifi SH, Valipour R, Narouie B, Kamranmanesh MR, Soltani MH. Minilaparoscopy vs. standard laparoscopic donor nephrectomy: comparison of safety, efficacy and cosmetic outcomes in a randomized clinical trial. Urol J. 2015;12:2223-7.
Simforoosh N, Basiri A, Tabibi A, Javanmard B, Kashi AH, Soltani MH, Obeid K. Living Unrelated Versus Related Kidney Transplantation: A 25-Year Experience with 3716 Cases. Urol J. 2016;13:2546-51.
- Abstract Viewed: 412 times
- 7233/pdf Downloaded: 304 times