Continuous ambulatory peritoneal dialysis catheter insertion by open technique: 20-year experience from a single center.

Introduction: Continuous ambulatory peritoneal dialysis (CAPD) catheter placement is a part of renal replacement therapy. We describe our 20-year experience in using the open technique and assess its safety, efficacy, and outcome in the treatment of end-stage renal disease patients. Methods: In a retrospective study, we analyzed data of all patients who had a CAPD catheter placed using our open dissection technique using local anesthesia over the previous 20 years, with minimum 1 year of follow-up. Intraoperative data, postoperative data, and complications were noted. Results: A total of 1410 cases were included in the study. The mean duration of follow-up was 72 ± 18 months (range 12-120 months). The mean operative time was 19 ± 7.5 min and mean hospital stay was 3 ± 1 days. No major intraoperative complications were noted. We observed a peritonitis rate of 0.49 episodes/patient/year. The most common reason for permanent catheter removal was refractory peritonitis in 21%, followed by flow failure in 7%, and ultrafiltration failure in 6.5%. The death-censored technical survival rate was 94.3%, 83.2%, 75.9%, 69.2%, and 60.6% patients at 1 year, 2 years, 3 years, 4 years, and 5 years, respectively. Conclusions: The open dissection method of peritoneal dialysis catheter insertion using local anesthesia at well-experienced center is a simple, painless, and uncomplicated procedure with excellent outcomes. Optimal exposure, judicious use of energy source, and using appropriate technique provide good technical success rate with lesser complications.

Right Laparoscopic Donor Nephrectomy: A Large-Volume, Single-Center Experience.

OBJECTIVES: The right kidney is not commonly selected for donor nephrectomy compared with the left kidney. Most left donor nephrectomies are performed by laparoscopic approach, whereas open donor nephrectomies are preferred on the right side. We present our experience of right laparoscopic donor nephrectomy, which was a substantial percentage of all performed laparoscopic donor nephrectomies. MATERIALS AND METHODS: We retrospectively analyzed all the donor nephrectomies performed at a single center, including indicators for right side open donor nephrectomy, as well as the demographic details of donors and intraoperative events, complications, and hospital stay for right side laparoscopic donor nephrectomy. Recipients were evaluated for outcome and complications. RESULTS: We performed 850 donor nephrectomies, including 640 left donor nephrectomies and 210 right donor nephrectomies. Of 210 right donor nephrectomies, 160 cases were performed laparoscopically, and 50 cases were open surgeries. Common indications for choice of right open donor nephrectomy were related to the donor. Factors related to the recipient included obesity, left iliac fossa transplant, and robotic transplant to the recipient. The surgical outcomes or complication rates in right side laparoscopic donor nephrectomy were not significantly different. Regarding recipients, we found that graft function, perioperative parameters, and vascular complications did not differ much in right side laparoscopic donor nephrectomy. CONCLUSIONS: The right side laparoscopic donor nephrectomy is as safe as left laparoscopic donor nephrectomy or right side open donor nephrectomy. Careful consideration of recipient factors is very important along with donor factors before opting for an open or laparoscopic approach on the right side. Slight modifications in technique may provide a few additional millimeters of length, which can significantly increase the incentive to choose laparoscopic donor nephrectomy on the right side.

Comparison of open, laparoscopic and robot-assisted pyeloplasty for pelviureteric junction obstruction in adult patients.

Ureteropelvic junction obstruction (UPJO) is a frequently found congenital abnormality of the upper urinary tract treated with pyeloplasty. We hereby report a study to compare open pyeloplasty (OP), laparoscopic pyeloplasty (LP) and robotic assisted pyeloplasty (RAP) for UPJO in terms of functional and perioperative outcomes. 102 patients who underwent Anderson-Hynes dismembered pyeloplasty for UPJO were divided into three groups based on type of surgical techniques utilized as follows: OP (Group A; n = 34), LP (Group B; n = 34), and RAP (Group C; n = 34). Preoperative, intraoperative and postoperative data were recorded. The mean operative time was significantly more in the Group B (187.76 min) than the Group A (132.06 ± 30.1 min) and Group C (136.76 ± 25.1 min) (p < .001). Mean blood loss was more in OP group 86.47 ± 29. 35 ml versus 42.94 ± 20. 77 ml in RAP and 45.59 ± 20. 3 ml in the LP group (p < .001). The LP was found to be much tiring. Mean surgeon fatigue index (SFI) calculated was 7 ± 1.1 in the LP group compared to 4.12 ± 1.1 in RAP group and the difference was statistically significant (p< .001). Average VAS score in the first 2 days postoperatively was 6.66±1.58 in the OP group compared to 4.29 ± 1.16 in RAP group and 4.29 ± 1.31 in the LP group (p < 0.001). Pyeloplasty has a similar success rate and efficacy irrespective of the technique utilized. RAP improves the surgeons QOL (quality of life) and the fatigue scores, which is useful for surgeon longevity. RAP has become widely favorite and can be considered the approach of choice in the management of UPJO wherever infrastructure and finances allow.