Vipin Tyagi

Robotic-assisted versus laparoscopic partial nephrectomy: An experience with a novel technique of suturing

This study was conducted to evaluate whether robotic-assisted laparoscopic partial nephrectomy (RALPN) is superior to laparoscopic partial nephrectomy (LPN) with regard to warm ischemia time and complications and, in addition, to report our novel technique of suturing in partial nephrectomy (PN). This was a prospective study carried out over a period of six years at our institute. A single surgeon performed PNs laparoscopically (17) and with robotic assistance (16). Only exophytic tumors were included and a novel technique of knotless and bolster-less suturing using Hem-o-loc clips was used to close the renal defect. There was no difference in intra-operative and post-operative blood loss between the two groups. However, LPN patients had significantly longer mean warm ischemia time (24.1 vs. 30.1 min, P <0.001) and operating time (157.5 vs. 192.5 min, P <0.001). Also, hospital stay was comparable between the two groups. RALPN is technically easier and also safer than LPN because of its advanced degrees of freedom, decreased warm ischemia time and reduction in the total operating time. However, these observations need further validation by larger and randomized trials. Based on our study, we recommend RALPN wherever there is availability of robot and if cost is not an issue.

A study to evaluate the effect of ratio of donor kidney weight to recipient body weight on renal graft function

Aim and Objectives: To study the effect of the ratio of donor kidney weight (dkw) to recipient body weight (rbw) on short and long term graft function in live donor kidney transplant patients. Materials and Methods: It was a prospective study of 79 live donor kidney transplant recipients. Patients were divided into three groups depending on the ratio of dkw in grams to rbw in kilograms. Serum creatinine in milligrams percent on the day of surgery, 7th day, 1 month, 6 months, 1 year, and 3 years after the surgery was recorded and their means compared. Results: The comparison showed that the decrease in mean creatinine level was more in group three patients as compared with group 2 and one patients at 7 days (1.04,1.44 and 1.59 in group 3,2 and 1 respectively) and 30 days (1.12,1.36 and 1.45 in group 3,2 and 1 respectively), showing that higher dkw/rbw ratio is beneficial with respect to the early graft function. However this decrease was not statistically significant (P value –0.256 and 0.358 respectively on 7th and 30th day). Furthermore long-term function was not different among these three groups. Conclusion: The ratio of dkw to rbw does not have a significant effect on long-term graft function inspite of an early improvement in the function with increased dkw to rbw ratio.

Postpercutaneous Nephrolithotomy Nephrostogram: Is It Mandatory? A Single Center Experience

Aims and Objective. “Postpercutaneous nephrolithotomy nephrostogram” (PPNN) is routinely performed in most of the centers. No published series could be found in the literature without post percutaneous nephrolithotomy nephrostogram. Hence, the aim of our study is to highlight that post percutaneous nephrolithotomy nephrostogram is not mandatory and it only adds to cost and morbidity without adding any information in the management of such patients. Methods. It was a prospective study from 2005 to 2012, conducted in our institute. It included 119 patients of renal stones who underwent percutaneous nephrolithotomy performed under the guidance of a single surgeon. Postoperative nephrostogram was not done in any of the patients. Results. Complete stone clearance was achieved in 97.5% of patients and 2.5% of patients needed two to three sessions of ESWL later on. None of the patients needed second look percutaneous nephrolithotomy or nephrostogram. Conclusion. Postpercutaneous nephrolithotomy nephrostogram increases chances of infection, inconvenience, contrast related complications, and cost, with no added advantage over plain X-ray KUB, and it should not be done as a routine investigation prior to the removal of PCN tube in patients with complete stone clearance.

External iliac artery polytetrafluoroethylene graft interposition: An effective rescuer for kidney transplant in progressive intimal dissection of external iliac artery.

Aims and Objective: The aim of this study is to highlight the use of polytetrafluoroethylene (PTFE) interposition graft as an important salvage procedure in case of irreparable intimal injury of external iliac artery during renal transplant recipient surgery. Materials and Methods: Since 1987, we encountered irreparable intimal dissection of external iliac artery in five cases just after opening the clamp. It was successfully managed by PTFE interposition graft with subsequent end to side anastomosis of donor renal artery to the vascular graft. Results: No patient had bleeding or infective complications related to the graft and three patients had immediate diuresis. Normal immediate graft function was present in three patients while the other two had delayed graft function. Conclusion: Polytetrafluoroethylene interposition graft is a successful procedure to salvage the kidney and lower limb in case of progressive intimal dissection of external iliac artery during renal transplant surgery.

Live donor kidney transplantation in India: effects of donor and recipient age on graft survival

Abstract Introduction: The increasing gap between demand and supply of human kidneys has resulted in the use of more expanded criteria donor organs are used. The influence of age on short- and long-term survival of renal allograft has not been well studied in Indian population. Materials and methods: Two hundred and seventy-eight patients were evaluated retrospectively who underwent kidney transplantation from Jan 2008 to June 2011. Patients were divided into 6 groups: group A (donor age 20–40 years, recipient age <50 years), group B (donor age 20–40 years, recipient age >50 years), group C (donor age 40–60 years, recipient age <50 years), group D (donor age 40–60 years, recipient age >50 years), group E (donor age >60 years, recipient age <50 years) and group F (donor age >60 years, recipient age >50 years). Uni-variate analysis was used to assess the effect of donor and recipient age as predictive factors for graft outcome, using the Kaplan–Meier method (log-rank) with p < 0.05 considered significant. Results: Graft survival was found to be lowest in elderly recipients and in patients with donor age >60 years. Renal function was superior using younger donors both in short and long term. The incidence of acute rejection was found to be lower in elderly donor group than in younger, although the difference was not statistically significant. Conclusion: Donor’s higher age did not show significant impact on allograft survival although, kidney allografts demonstrated decreased short and long term renal function.