Can robot-assisted kidney transplantation provide higher quality of life than open kidney transplantation during the early postoperative period?

PURPOSE: Purpose of this study is to investigate the quality of life (QoL) in patients with end-stage renal disease who underwent open or robot-assisted kidney transplantation (OKT and RAKT). MATERIALS AND METHODS: Patients who underwent OKT and RAKT at Bakirkoy Sadi Konuk Training and Research Hospital between June 2016 and December 2018 constituted the target population of this study. The patient group was divided into two groups as per the surgical technique (ie, open vs. robot-assisted). Demographic data, preoperative and postoperative data of all patients were collected prospectively. The QoL of the patients was assessed preoperatively and on the postoperative 30th day. RESULTS: Sixty-seven patients who underwent OKT and 60 patients who underwent RAKT were included. The mean patient age and BMI were calculated as 40.9 ± 11.6 years and 24.4 ± 2.9 kg/m2 , respectively. Patients in the RAKT group were significantly younger than the patients in the OKT group (P = .002). There were no significant differences between the two groups in terms of gender, BMI, ASA and the ratio of premptive patients. The mean preoperative hemoglobin level was significantly higher in the OKT group than the RAKT group (P = .003). While mean total ischemia time was shorter in the "open" group, intraoperative blood loss and incision length were shorter in the RAKT group. Duration of surgical drainage and hospital stay was shorter in the "robot-assisted" group. There was no significant difference between the groups in terms of SF-36 subparameters preoperatively. The physical component scores of the QoL questionnaire revealed that postoperative impairment of quality of life in the early postoperative period was more significant in the OKT than the RAKT. CONCLUSION: Patients who underwent RAKT have a higher QoL than the patients who were treated with OKT as per their self-reported QoL scores in the early postoperative period.

Laparoscopic donor nephrectomy, complications and management: a single center experience.

OBJECTIVE: To present our experience with laparoscopic donor nephrectomy (LDN), our complications and management modalities. Material and methods: Fifty-one transperitoneal LDNs performed in our clinic between the years 2011, and 2015, were evaluated retrospectively. Demographic characteristics of the patients, operative and postoperative data and complications were evaluated. RESULTS: Nineteen female and 32 male patients with ages ranging from 24 to 65 years underwent left- (n=44), and right-sided (n=7) LDNs. Six patients had two, and one patient three renal arteries. Mean operation time was 115±11 (min-max: 90-150) minutes, and mean warm ischemia time 111±9 (min-max: 90-140 sec) seconds. Mean hospital stay was found to be 2.5±0.5 days. No patient needed to switch to open surgery. In one patient, lumbar vein was ruptured, and hemostatic control was achieved laparoscopically. Postoperative paralytic ileus developed in two patients. Three patients had postoperative atelectasis, and a febrile (38.1°C) episode. CONCLUSION: LDN is a minimally invasive method with advantages of short hospital stay, less analgesic requirement, and better cosmetic results. However it should be performed by surgeons with advanced laparoscopic experience.

A rare cause of acute post renal failure: Retroperitoneal fibrosis.

Retroperitoneal fibrosis is an inflammatory process which may cause acute renal failure. In patients who admitted to emergency services with obstructive uropathy, retroperitoneal fibrosis should be considered in the differential diagnosis. We present our ten cases who admitted to emergency department with obstructive acute renal failure related to retroperitoneal fibrosis.

Robotic kidney transplantation: The Bakirköy experience.

OBJECTIVE: Robotic kidney transplantation, first described by Hoznek and colleagues, and has been improved by investigators like Oberholzer and Menon. We realized the first robotic kidney transplant (RKT) in our clinic in December 2015. In this study, we aimed to present the first 15 cases we performed within 3 months. MATERIAL AND METHODS: Starting from January 2016, we performed 15 RKTs in our hospital. Before surgery, the whole robotic procedure was thoroughly explained to the patients and their informed consents were taken. RESULTS: We performed RKT in 7 male and 8 female patients. Mean patient age was 37.4±10.8 years. Mean body mass index of the patients was 22.6±3.35 kg/m2. Mean preoperative creatinine and hemoglobin levels were 6.14±2.12 mg/dL and 10.04±1.64 g/dL, respectively. Mean operative time was 300.3±104.2 minutes. Mean warm ischemia and re-warming times were 1.9±0.54 minutes and 73.3±30.7 minutes, respectively. We did not need any necessity to switch to open surgery, and any intraoperative complication did not develop in any patient. Lymphocele which is one of the most frequently encountered complications was not observed in our series. CONCLUSION: We think that using a minimally invasive approach greater number of patients will be able to benefit from this treatment modality, and this important health issue may decrease significantly.