Hand-assisted Laparoscopic Left Donor Nephrectomy Without a Hand-assisted Device: Is it Possible?

BACKGROUND: Live donor nephrectomy is an important donor source. Donor nephrectomy can be performed by laparoscopy or hand-assisted laparoscopy. Different types of hand port devices can be used for assistance. In the literature there are few studies about hand-assisted laparoscopy without a hand port. In this study, we aimed to evaluate the impact of not using a hand port for hand-assisted laparoscopic donor nephrectomy for kidney transplantation. METHODS: Patients who were operated on for kidney donation between January 2011 and June 2018 evaluated retrospectively. The patients were divided into 2 groups: group A, on whom a hand port was used, and group B, whose surgeries did not involve a hand port. The groups were compared for sex, age, body mass index, amount of intraoperative bleeding, warm ischemia time, duration of surgery, perioperative complications, duration of hospital stay, and postoperative complications. RESULTS: There were 159 patients in group A and 146 patients in group B. There was no difference between the groups considering intraoperative bleeding, warm ischemia time, duration of surgery and postoperative early complications (P > .05 for all). CONCLUSION: Hand-assisted laparoscopic donor nephrectomy without a hand port can be considered an easy and effective method of laparoscopic nephrectomy.

Coronary artery calcification and coronary ischaemia in renal transplant recipients.

BACKGROUND: Cardiovascular disease is the leading cause of mortality among renal transplant recipients. Data on the relationship between coronary artery calcification (CAC) and coronary ischaemia in renal transplantation patients are scant. We conducted a study to determine the prevalence and determinants of CAC in these patients; we also examined the frequency of coronary ischaemia in patients with moderate and severe CAC. METHODS: We used multi-detector spiral computed tomography to examine CAC in 178 consecutive renal transplant recipients. Angina pectoris was sought with the Rose questionnaire. The extent of calcification was measured by Agatston score. Myocardial perfusion scintigraphy was performed in patients with moderate and severe CAC. Multivariate logistic and linear regression analysis was used to evaluate the determinants of CAC presence and CAC score, respectively. RESULTS: CAC was present in 72 patients (40.4%), mean CAC score was 113.7±275.5 (median: 0 and range: 0-1712). Age, time on transplantation and Rose angina pectoris were the independent determinants of both CAC presence and high CAC scores in all multivariate models. Coronary ischaemia was detected in 17.1% of the patients with moderate-to-severe CAC. CONCLUSIONS: CAC is highly prevalent in renal transplant recipients; it is associated with symptoms of coronary ischaemia. Time on transplantation is an independent determinant of CAC. Future studies to evaluate the prognostic significance of CAC in these patients are necessary.

An effective omentoplasty technique in laparoscopic surgery for hydatid disease of the liver.

OBJECTIVES: The objectives of this study were to investigate the characteristics and outcome of patients with hydatid disease of the liver who were laparoscopically managed at our clinic and to define technical details including an effective method of omentoplasty with helical fasteners. METHODS: Between January 1998 and November 2000, 13 patients, mean age 36 years (range 23 to 63 years), with hydatid disease of the liver were considered for laparoscopic surgery in our department. All the patients underwent laparoscopic surgical interventions. RESULTS: In all patients, laparoscopic cystotomy, unroofing, and omentoplasty with helical fasteners, which were originally designed for endoscopic hernia repair procedures, were performed. No conversion to laparotomy was necessary. In 1 case, with a single cyst in the right lobe, bile leakage was observed. No radiological recurrence was observed in an average follow-up of 17 months (range 4 to 36 months). CONCLUSIONS: Obliteration of the residual cystic cavity decreases postoperative complication rates, so an effective omentoplasty is essential especially for laparoscopic procedures. Laparoscopy is quite feasible to perform in hydatid disease of the liver, and the use of helical fasteners allows effective omental flap fixation.

Total laparoscopic cystogastrostomy for the treatment of pancreatic pseudocyst.

Laparoscopic surgery may be performed for the treatment of pancreatic pseudocyst when decompression is indicated. Most of reported laparoscopic procedures are performed by inserting trocars via the anterior gastric wall and operating intraluminally with gastric insufflation and endoscopic guidance. We report a patient who was treated successfully with laparoscopic stapled cystogastrostomy and discuss the feasibility and features of such a technique performed with a totally abdominal approach.