Our Summary

The research paper reviews different types of surgical cuts (incisions) used in minimally invasive kidney removal (donor nephrectomy) for kidney transplants. The researchers studied details from 29 different studies involving 4,702 patients. They particularly looked at six types of incisions: iliac, Pfannenstiel, midline hand-assisted laparoscopic (HAL), midline umbilical, flank, and transvaginal natural orifice transluminal endoscopic surgery (NOTES).

Key things they looked at were how long patients stayed in the hospital, how much pain relief (analgesic) they needed, and any complications after surgery. They also checked the time the kidney was without blood supply (warm ischemia time), the total time of the operation, and estimated blood loss.

Their findings showed that patients who had the flank incision stayed in the hospital longer than those with other types of incisions. The Pfannenstiel incision led to a slightly longer hospital stay than the iliac incision. The midline HAL incision resulted in the shortest operation time. The midline umbilical incision had longer periods of the kidney being without blood supply compared to the midline HAL and Pfannenstiel incisions.

The transvaginal NOTES method was found to be an effective technique for female donors. However, there were no major differences in the need for pain relief, post-surgery complications, or blood loss across the different incision types. The study concludes that these six incisions give similar short-term outcomes, but more research is needed on long-term outcomes.

FAQs

  1. What are the six types of incisions used in minimally invasive kidney removal?
  2. How did the different incision types compare in terms of hospital stay, operation time, and need for pain relief?
  3. What were the findings of the study regarding the transvaginal NOTES method for female donors?

Doctor’s Tip

A doctor might tell a patient undergoing a nephrectomy that there are various types of incisions that can be used during the surgery, each with its own advantages and considerations. They may explain that while certain incisions may result in slightly longer hospital stays or operation times, overall there are no major differences in terms of pain relief, complications, or blood loss. The doctor may also emphasize the importance of discussing with the surgical team to determine the best incision option for the individual patient’s specific situation.

Suitable For

Patients who are typically recommended for nephrectomy include those with kidney cancer, severe kidney damage or disease, kidney donation for transplantation, or to remove a non-functioning or poorly functioning kidney. The type of incision used in the surgery may vary depending on the specific patient’s condition and the surgeon’s preference.

Timeline

  • Before nephrectomy:
  1. Patient undergoes pre-operative evaluation and tests to assess their overall health and suitability for surgery.
  2. Patient may meet with a surgeon to discuss the procedure, potential risks and benefits, and what to expect during recovery.
  3. Patient may need to follow specific pre-operative instructions, such as fasting before surgery.
  4. Surgery date is scheduled and patient arrives at the hospital or surgical center for the procedure.
  • After nephrectomy:
  1. Patient wakes up in the recovery room and is monitored closely by medical staff.
  2. Patient may experience pain, which is managed with medication.
  3. Patient is typically kept in the hospital for a few days for observation and recovery.
  4. Patient may be discharged from the hospital once they are stable and able to manage their pain at home.
  5. Patient will have follow-up appointments with their surgeon to monitor their recovery and address any concerns.
  6. Patient may need to follow specific post-operative instructions, such as avoiding heavy lifting and gradually increasing activity levels.
  7. Patient may undergo additional tests to monitor kidney function and overall health in the weeks and months following surgery.

What to Ask Your Doctor

  1. What are the different types of incisions used in nephrectomy surgery and what are the potential benefits and drawbacks of each?

  2. How long can I expect to stay in the hospital after undergoing nephrectomy surgery with a specific type of incision?

  3. How much pain relief (analgesic) will I likely need following nephrectomy surgery with a specific type of incision?

  4. What are the potential complications associated with each type of incision for nephrectomy surgery?

  5. How long will my kidney be without blood supply (warm ischemia time) with a specific type of incision for nephrectomy surgery?

  6. What is the total estimated time of the operation with a specific type of incision for nephrectomy surgery?

  7. How much blood loss can I expect during nephrectomy surgery with a specific type of incision?

  8. Are there any specific considerations or recommendations for female donors considering the transvaginal NOTES method for nephrectomy surgery?

  9. Are there any long-term outcomes or potential risks associated with the different types of incisions used in nephrectomy surgery that I should be aware of?

  10. Are there any specific factors that may make one type of incision more suitable for me personally based on my individual health history or circumstances?

Reference

Authors: Fong KY, Foo JCH, Chan YH, Aslim EJ, Ng LG, Gan VHL, Lim EJ. Journal: Transplant Rev (Orlando). 2024 Jan;38(1):100813. doi: 10.1016/j.trre.2023.100813. Epub 2023 Nov 14. PMID: 37979238