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Background: Nephrectomy is the cardinal treatment option for patients with non-functioning kidneys due to malignant and benign causes. Both laparoscopic and open nephrectomy is preferred but the laparoscopy has less complication and improved surgical outcome when compared over open procedure. In this backdrop, the present study was conducted to compare the surgical outcomes and complications of open and laparoscopic nephrectomy procedures. Materials and methods: This was a retrospective study conducted on 50 patients admitted with non-functioning kidneys. They were divided into two groups--laparoscopic nephrectomy (n = 25) and open simple nephrectomy (n = 25). The duration of hospital stay, surgery, postoperative catheter drain removal and surgical complications were analyzed and compared between laparoscopic and open methods. Results: Laparoscopic nephrectomy showed less operative time (90.60 ± 15.99 vs 133.64 ± 10.57 minutes; p = 0.001), shorter hospital stay (3.40 ± 0.12 vs 5.48 ± 0.16 days; p = 0.001) and early postoperative catheter removal (3.20 ± 1.08 vs 2.56 ± 1.04; p = 0.03) when compared with open nephrectomy and it was significant. The complication rate was lower in laparoscopic nephrectomy when compared with simple open nephrectomy (12 vs 36%). Conclusion: Laparoscopic nephrectomy for non-functioning is an effective alternative to open nephrectomy, leading to reduced operative time, quicker recovery and fewer complications as indicated by our findings. [ABSTRACT FROM AUTHOR]

Background & objective: Pain during nephrectomy has been reported to be extremely intense and may trigger complex biochemical and physiological stress response if managed inadequately. Erector spinae plane block (ESPB) and thoracic epidural analgesia (TEA) both have been advocated for pain management in adult patients undergoing open nephrectomy under general anesthesia. We compared the efficacy and the dynamics of both of these procedures. Methodology: This was a randomized, double-blinded, controlled trial involving 54 patients were undergoing open nephrectomy for malignant kidney tumors. All patients were ASA class II, had a BMI 20-40 kg/m², and were between the ages of 18-65 y. Through random assignment, people were divided into two identical, equivalent groups: Group A (n = 27) received TEA, whereas Group B (n = 27) received US-guided continuous ESPB. Mean arterial pressure (MAP) and intraoperative heart rate (HR) were recorded before and after incision, and at 30 min, 1 h, and 1.5 h. Postoperative HR, MAP were recorded at 6 h and 12 h, both at rest and when moving. Numerical rating scale (NRS) score was used to compare the intensity of postoperative pain. Results: Postoperative HR, MAP, at 6 h and 12 h, at rest and when moving, were substantially reduced in the TEA group than those in the ESPB group. The NRS score of the ESPB group was substantially greater than that of the TEA group. In contrast to the TEA group, much more total amount of morphine was consumed in the ESPB group. The time to first rescue analgesia was substantially shorter in ESPB group than that of the TEA group. Conclusions: The results of our study prove that US guided erector spinae plane block is effective in providing postoperative analgesia, decreasing use of intraoperative and postoperative opioids in patients having open nephrectomy. However, it is still inferior to thoracic epidural analgesia in terms of pain control after 6 h postoperatively. Otherwise, erector spinae plane block has fewer side effects compared to thoracic epidural analgesia. So, it may be used as an alternative to thoracic epidural analgesia. [ABSTRACT FROM AUTHOR]

ABSTRACTBackground Pain control after surgery is of highest priority. Erector spinae plane block [ESPB] was reported to be a successful method to reduce pain scores and consumption of postoperative opioids. However, hardly any investigation has looked at the ideal volume of bupivacaine for ESPB. So, this work tried to fill this gap of literature in patients undergoing simple nephrectomy.Methods In this randomized double blinded control study, 100 cases undergoing simple nephrectomy were randomized into 4 groups with 25 patients per group. Group E1, 2, and 3 received ESPB with 2.5, 3.4, and 6.6 ml/segment of 0.25% bupivacaine, respectively, whereas there was no block given to the control group. Intraoperative fentanyl consumption, heart rate [HR] and the blood pressure [BP], Postoperative morphine consumption, time passed to first analgesic request, numerical rating score [NRS] of pain, the complications, HR and BP were documented for 24 hours after the operation.Results The reduction in intraoperative fentanyl consumption, postoperative morphine consumption and NRS were a significantly different between the block groups and control. Group E3 had significant difference from other groups with the longest time to first analgesia request. A lower HR was shown in block groups but within normal range. BP showed insignificant difference between groups. There were no reported complications in all study groups.Conclusions The volume of 6.6 ml/level was associated with the best pain control, without significant hemodynamic changes or adverse events as compared to other groups. This suggests that this volume may be the optimal for ESPB in patients undergoing simple nephrectomy.

Background: Pain control after surgery is of highest priority. Erector spinae plane block [ESPB] was reported to be a successful method to reduce pain scores and consumption of postoperative opioids. However, hardly any investigation has looked at the ideal volume of bupivacaine for ESPB. So, this work tried to fill this gap of literature in patients undergoing simple nephrectomy. Methods: In this randomized double blinded control study, 100 cases undergoing simple nephrectomy were randomized into 4 groups with 25 patients per group. Group E1, 2, and 3 received ESPB with 2.5, 3.4, and 6.6 ml/segment of 0.25% bupivacaine, respectively, whereas there was no block given to the control group. Intraoperative fentanyl consumption, heart rate [HR] and the blood pressure [BP], Postoperative morphine consumption, time passed to first analgesic request, numerical rating score [NRS] of pain, the complications, HR and BP were documented for 24 hours after the operation. Results: The reduction in intraoperative fentanyl consumption, postoperative morphine consumption and NRS were a significantly different between the block groups and control. Group E3 had significant difference from other groups with the longest time to first analgesia request. A lower HR was shown in block groups but within normal range. BP showed insignificant difference between groups. There were no reported complications in all study groups. Conclusions: The volume of 6.6 ml/level was associated with the best pain control, without significant hemodynamic changes or adverse events as compared to other groups. This suggests that this volume may be the optimal for ESPB in patients undergoing simple nephrectomy. [ABSTRACT FROM AUTHOR]

Objective: To perform a systematic review and network meta‐analysis (NMA) to determine the advantages and disadvantages of open (OPN), laparoscopic (LPN), and robot‐assisted partial nephrectomy (RAPN) with particular attention to intraoperative, immediate postoperative, as well as longer‐term functional and oncological outcomes. Methods: A systematic review was performed as per the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses‐NMA guidelines. Binary data were compared using odds ratios (ORs). Mean differences (MDs) were used for continuous variables. ORs and MDs were extracted from the articles to compare the efficacy of the various surgical approaches. Statistical validity is guaranteed when the 95% credible interval does not include 1. Results: In total, there were 31 studies included in the NMA with a combined 7869 patients. Of these, 33.7% (2651/7869) underwent OPN, 20.8% (1636/7869) LPN, and 45.5% (3582/7689) RAPN. There was no difference for either LPN or RAPN as compared to OPN in ischaemia time, intraoperative complications, positive surgical margins, operative time or trifecta rate. The estimated blood loss (EBL), postoperative complications and length of stay were all significantly reduced in RAPN when compared with OPN. The outcomes of RAPN and LPN were largely similar except the significantly reduced EBL in RAPN. Conclusion: This systematic review and NMA suggests that RAPN is the preferable operative approach for patients undergoing surgery for lower‐staged RCC. [ABSTRACT FROM AUTHOR]

Background: Role of continuous infusion of local anesthetic drug in the transverse abdominal plane using a catheter inserted during the surgical closure of the wound has not been evaluated as a “sole technique” in patients undergoing open nephrectomy. Thus we designed this prospective, randomized comparative study to evaluate this aspect. Aim and Objectives: To compare the efficacy of continuous surgical transverse abdominal plane block with intravenous fentanyl infusion in open nephrectomies. The primary outcomes were post-operative tramadol consumption, pain at rest and pain while coughing. The secondary outcomes were the level of sedation, time to mobilize, and the incidence of wound infection. Material and Methods: Fifty patients undergoing elective open nephrectomy were randomly divided into two equal groups to either receive intravenous fentanyl infusion (Group A), or continuous infusion of bupivacaine in the transversus abdominis plane through a surgically inserted catheter (Group B). The independent sample t-test was applied for numerical variables, while one way Analysis of Variance (ANOVA) repeated measure was used for analyzing the continuous variables. Chi-square and Fisher's exact tests were the tools used for analyzing the dichotomical variables. Results: Tramadol consumption, pain while resting, and pain during coughing were significantly lower in Group B (p

Background: Role of continuous infusion of local anesthetic drug in the transverse abdominal plane using a catheter inserted during the surgical closure of the wound has not been evaluated as a "sole technique" in patients undergoing open nephrectomy. Thus we designed this prospective, randomized comparative study to evaluate this aspect. Aim and Objectives: To compare the efficacy of continuous surgical transverse abdominal plane block with intravenous fentanyl infusion in open nephrectomies. The primary outcomes were post-operative tramadol consumption, pain at rest and pain while coughing. The secondary outcomes were the level of sedation, time to mobilize, and the incidence of wound infection. Material and Methods: Fifty patients undergoing elective open nephrectomy were randomly divided into two equal groups to either receive intravenous fentanyl infusion (Group A), or continuous infusion of bupivacaine in the transversus abdominis plane through a surgically inserted catheter (Group B). The independent sample t-test was applied for numerical variables, while one way Analysis of Variance (ANOVA) repeated measure was used for analyzing the continuous variables. Chi-square and Fisher's exact tests were the tools used for analyzing the dichotomical variables. Results: Tramadol consumption, pain while resting, and pain during coughing were significantly lower in Group B (p<0.001, p=0.003, p=0.001 respectively). Level of sedation and time to mobilize were also significantly lower in patients of Group B. Adverse effects were not differing significantly between groups. No wound infection was noted in either group. Conclusion: Continuous surgical wound infusion of 0.25% bupivacaine through a catheter placed by the surgeon in the transverse abdominal plane in open nephrectomy patients can be considered as an effective and safe alternative of providing postoperative pain relief than intravenous fentanyl infusion. [ABSTRACT FROM AUTHOR]

A solitary functioning kidney (SFK) with renal cell carcinoma (RCC) is an imperative indication for nephron-sparing surgery (NSS). Nevertheless, a giant pT3 RCC mass (maximum diameter >20 cm) on the functioning side of a patient with SFK is extremely rare. However, whether NSS is more beneficial than radical nephrectomy (RN) in such patients is controversial. Here, we present the case of a 71-year-old female patient with a 20 cm*16 cm RCC mass in the SFK, who initially presented with hematuria and acute urinary tract obstructive anuria caused by renal calculi. The patient underwent NSS treatment after our evaluation, and the 26-month follow-up revealed that her renal function recovered to the state before the tumor formation. In addition, no relapse or metastasis was detected.

Introduction: Removal of a kidney is a common surgical procedure for a long time. The procedure was traditionally done by open surgery. Since the advent of laparoscopic surgery, nephrectomy is being done increasingly laparoscopically. The laparoscopic approach has obvious advantages. Better cosmetics, less operative time, lesser need for blood transfusions, fewer analgesia requirements, early mobility, and oral feed, early return to work, and fewer intraoperative and post-operative major complications all contribute to the superiority of laparoscopic nephrectomy. Objective: To compare surgical outcomes of open versus laparoscopic nephrectomy. Materials and Methods: This Retrospectives study was conducted in the Department of Urology, Institute of kidney disease, Hayatabad, Peshawar over a period of 2 years from January 2018 to January 2020. Results: Our study included a total of 78 cases, 48.7% males and 51.3% females. The patient means the age of 42.69 years. 39.7% had hypertension and 19.2% had diabetes mellitus. Open nephrectomy was done in 40 patients and laparoscopic nephrectomy in 38 patients. The average operating time for open nephrectomy was 160.5 minutes and 130.9 minutes for laparoscopic nephrectomy. The average blood loss during open and laparoscopic nephrectomy was 361.25ml and 59.86ml. Blood transfusion rate in open and laparoscopic nephrectomy was 55% and 10.5% (p=0.001). Overall, the post-operative complication rate was 52.5% and 21.5% for an open and laparoscopic approach. Post-operative pain was noted in 7.9% of patients in laparoscopic and 97.5% for an open approach. Fever was noted postoperatively in 26.3% and 62.5% of patients in laparoscopic and open approaches (p=0.001). The average hospital stay in the laparoscopic approach was 2.8days and 4.5days in the open approach. The mean tumor size was 5.65cm in laparoscopic while 8.1cm in the open approach. Catheter and drain removal was on average 1.18 days and 1.32days post-op day in the laparoscopic group while it was 2.35days and 2.3days post-op day in an open group, respectively. There were no per-op complications in the laparoscopic approach as compared to 2 Cases of minor IVC injury in open. Conclusion: In our study, we conclude that the laparoscopic approach for nephrectomy is far superior as compared to the open approach and it is recommended that Laparoscopic simple and radical nephrectomy should be considered a gold standard treatment. [ABSTRACT FROM AUTHOR]

Study objective: Patients undergoing open nephrectomy surgery experience severe perioperative pain, which is primarily due to incision of several muscles. Abdominal wall blocks are known to reduce pain without causing epidural-associated hypotension. We conducted this study to compare unilateral ultrasound-guided transmuscular quadratus lumborum block and posterior transversus abdominis block in combination with general anesthesia alone in terms of intraoperative and postoperative analgesics and hemodynamics and postoperative complications. Methods: This was a randomized, double-blinded, controlled trial conducted in the operating room. This study included 48 patients aged 20–60 years, with ASA I and II, and a body mass index ≤ 30 kg.m-2 who were scheduled for open nephrectomy procedure.The 48 patients scheduled for nephrectomy were randomly allocated into one of the following three groups after induction of general anesthesia: Group A (n = 16) received USG transmuscular QLB; Group B (n = 16) received unilateral USG posterior transversus abdominis plane (TAP) block; and Group C (n = 16; control group) did not receive any blocks. Introperative fentanyl consumption, and hemodynamics (heart rate and mean arterial pressure (MAP)) were recorded after anesthesia induction, at surgical incision, and every 15 min till the end of surgery. Visual Analogue Scale (VAS) was evaluated immediately at 30 min and 1,2,4,6, and 12 hours postoperatively. The time of first analgesic request was also recorded. Results: Intraoperative fentanyl consumption (μg) was significantly lower in Groups A and B (164.69 ± 27.35 and 190.31 ± 44.48, respectively) than in Group C (347.50 ± 63.64) (p

Intraoperative efforts have been made to reduce the risk of tumor thrombus in renal cell carcinoma during nephrectomy and inferior vena cava (IVC) thrombectomy to decrease mortality. We present a patient diagnosed with renal malignancy and IVC thrombus. The patient underwent a nephrectomy combined with IVC thrombectomy, utilizing a novel approach with the Inari Protrieve™ (Inari Medical, Inc., Irvine, CA) to prevent embolization of tumor thrombus. With the integration of Protrieve™, we propose an approach to facilitate future surgical techniques for nephrectomy with IVC extension., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Cooper et al.)

Giant hydronephrosis (GH) is very rare in adults. We report a case of a 46-year-old man who presented with progressively increasing abdominal swelling. A contrast-enhanced CT scan of the abdomen and pelvis was used for the diagnosis. Left side open nephrectomy was performed and 22 L fluid was evacuated. UPJ obstruction was noted intraoperatively. No recurrence of abdominal swelling was noted on follow up examination.

Introduction Laparoscopic nephrectomies are safe, with low complication rates in skilled hands. However, traditional approaches may be unsuitable for conditions such as post-renal abscesses, long-standing urinomas, non-functioning kidneys post-pyeloplasty, pyelolithotomies, post-partial nephrectomy recurrences, tuberculous kidneys, pyelonephritis, and redo-renal surgeries. This study describes a modified retrograde nephrectomy technique and its outcomes in 40 cases. Methods We reviewed 40 cases where the retrograde nephrectomy technique was used. Surgeons opted for this method based on intraoperative findings and initial difficulties in accessing the lower pole area. Results Traditional dissection was challenging due to adhesions in the lower pole. The retrograde technique, starting from the renal hilum, allowed early ligation of renal arteries and veins, reducing bleeding risks and facilitating safer caudal dissection. Conclusions The retrograde nephrectomy technique offers a safer and more efficient alternative for complex nephrectomies. Early vascular control minimizes hemorrhage risk, making it a valuable method in challenging renal surgeries., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee issued approval AMH-C-S-072/09-23. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kannan et al.)

Ana Mimic,1 Carsten Bantel,2,3 Jelena Jovicic,1 Branko Mimic,4 Darija Kisic-Tepavcevic,5 Otas Durutovic,6,7 Nebojsa Ladjevic1,7 1Department of Anaesthesia, Urology Clinic, Clinical Centre of Serbia, Belgrade, Serbia; 2Department of Anaesthetics, Klinikum Oldenburg AöR, Oldenburg, Germany; 3Section of Anaesthetics, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; 4East Midlands Congenital Heart Centre, University Hospital Leicester, Leicester, UK; 5Institute of Epidemiology, School of Medicine, University of Belgrade, Belgrade, Serbia; 6Department of Urology, Urology Clinic, Clinical Centre of Serbia, Belgrade, Serbia; 7Department of Surgery and Anaesthesiology, School of Medicine, University of Belgrade, Belgrade, Serbia Purpose: There is an increasing interest in the identification of predictors for individual responses to analgesics and surgical pain. In this study, we aimed to determine psychological factors that might contribute to this response. We hence investigated patients undergoing a standardized surgical intervention (open nephrectomy). Patients and methods: Between May 2014 and April 2015, we conducted a prospective observational cohort study. The following psychological tests were administered preoperatively: Mini-Mental State Examination, Amsterdam Preoperative Anxiety and Information Scale (APAIS), Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, and Pain Catastrophizing Scale. The primary outcome, postoperative pain intensity (11-point numerical rating scale, [NRS]), was assessed in the “immediate early” (first 8 hours), “early” (12 and 24 hours), and “late early” periods (48 and 72 hours).Results: A total of 196 patients were assessed, and 150 were finally included in the study. NRS scores improved from 4.9 (95% confidence interval [CI]: 4.7–5.1) in the “immediate early” to 3.1 (95% CI: 2.9–3.3) in the “early” and 2.3 (95% CI: 2.1–2.5) in the “late early” postoperative period. Most (87%) patients received intravenous opioids, while 13% received analgesics epidurally. Repeated measures analysis of variance indicated better pain management with epidural analgesia in the first two postoperative periods (F=15.01, p

Introduction and Objectives: In recent years, there has been a shift to minimally invasive partial nephrectomy (MIPN) with the dissemination of robot-assisted technology. However, contemporary data on the comparative morbidity of open partial nephrectomy (OPN) and MIPN are lacking. We, therefore, evaluated the perioperative morbidity of OPN and MIPN using a contemporary national cohort. Methods: We identified 13,658 patients aged 18 to 89 who underwent PN from 2010 to 2015 in the National Surgical Quality Improvement Program (NSQIP) database, of whom 9018 (66.0%) underwent MIPN. The associations of MIPN with 30-day morbidity were evaluated using logistic regression, adjusted for patient features. Results: Median age at surgery was 60 (interquartile range [IQR] 51, 68) years. Overall, 30-day complications occurred in 6.7% of patients. Compared with OPN, MIPN was associated with lower rates of 30-day complications (4.9% vs 10.1%, p < 0.0001), perioperative blood transfusion (3.8% vs 12.5%, p < 0.0001), prolonged hospitalization (5.6% vs 23.4%, p < 0.0001), readmission (4.4% vs 7.8%, p < 0.0001), reoperation (1.8% vs 3.2%, p < 0.0001), and 30-day mortality (0.3% vs 0.6%, p = 0.001). On multivariable analysis, MIPN was independently associated with a reduced risk of 30-day complications (odds ratio [OR] 0.46, p < 0.0001), perioperative blood transfusion (OR 0.27, p < 0.0001), prolonged hospitalization (OR 0.19, p < 0.0001), readmission (OR 0.59, p < 0.0001), and reoperation (OR 0.57, p < 0.0001). Postoperative complications occurred predominantly early after surgery, whereas hospital readmissions and reoperation occurred at a consistent rate. Conclusions: In this contemporary national cohort, MIPN was independently associated with reduced rates of 30-day complications, perioperative blood transfusion, prolonged hospitalization, hospital readmission, and reoperation, compared with OPN. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Renal cell carcinoma represents an important surgical disease. In the present times, in case of an imagistic suspicion of a renal cell carcinoma, a total nephrectomy or a radical nephrectomy should be performed when the tumor formation is not suitable for partial nephrectomy. Renal cell carcinoma is the third most common type of cancer after prostate and bladder cancer in the field of uro-oncology. Its incidence has known a rapid increase in the last years, thanks to the well spread use of the new imagining techniques, that also improved the mortality and morbidity rate caused by this malignancy. We performed a comparison between open versus laparoscopic nephrectomy, regarding the treatment of renal cell carcinoma, in order to assess if the laparoscopic nephrectomy for renal tumors is by any means superior to the "old-school" open approach, and if it can, indeed, replace the open surgical intervention. Materials and Methods. 63 cases of patients with renal cell carcinoma who underwent nephrectomy were studied in a retrospective manner. The surgeries were performed in the Urology Clinic of "Prof. Dr. Theodor Burghele" Clinical Hospital, between January 2011 and September 2013. The subjects were divided into two study groups by means of the surgical approach used, open or laparoscopic nephrectomy and several parameters were analyzed. Results. Of the total 63 patients with RCC, 28 underwent laparoscopic nephrectomy, while the rest of 35 underwent open nephrectomy. The mean age of patients with laparoscopic nephrectomy was 59.39±12 years, compared to 63.31±11 years for the open approach. The male patients were statistically significantly older than the female patients in our population (p=0.017). Clear-cell carcinoma accounted for approximately 70% of all adult epithelial kidney tumors, in the nephrectomy series. Papillary renal cell carcinoma was the second most common type of renal cell carcinoma and it accounted for 10-15% of all types of renal cell carcinomas. Mean length of hospitalization was significantly higher for patients receiving open surgery than for those receiving laparoscopy (8.26 days versus 5.81 days, respectively) (p=0.0001). Blood loss has been lower for the laparoscopically operated patients, compared to the other group of open nephrectomies: average blood loss was 93 ml versus 202 ml in the open nephrectomy group (p=0.002). Complications were more frequent after open surgery compared to laparoscopic surgery (p=0.015). Conclusions. The laparoscopic approach in the surgical treatment of the renal cell carcinoma has the advantage of a reduced rate of complications, decreased postoperative pain, shorter hospital- stay and therefore more rapid socio-professional reintegration. In terms of success rates and oncological results, both techniques presented with similar results, only minor differences were observed, with no statistical significantly difference. [ABSTRACT FROM AUTHOR]

Background: Open surgical procedures are associated with substantial postoperative pain; an alternative method providing adequate pain relief with minimal side effects is very much required. Aim: The aim of this study was a comparative evaluation of the efficacy of continuous thoracic paravertebral block (PVB) and thoracic epidural analgesia (EA) for postoperative pain relief in patients undergoing open nephrectomy. Settings and Design: Prospective, randomized, and single-blind study. Materials and Methods: Sixty adult patients undergoing open nephrectomy under general anesthesia were randomized to receive a continuous thoracic epidural infusion (Group E) or continuous thoracic paravertebral infusion (Group P) with bupivacaine 0.1% with 1 µg/ml fentanyl at 7 ml/h; both infusions were started after induction of anesthesia. The primary outcome measures were postoperative pain during rest (static pain), deep inspiration, coughing, and movement (getting up from supine to sitting position); the secondary outcome measures were postoperative nausea and vomiting, requirement of rescue antiemetic, hypotension, sedation, pruritus, motor block, and respiratory depression. These were assessed till the morning of the third postoperative day. Statistical Analysis: Results were analyzed by the one-way ANOVA, Chi-square test, and Mann-Whitney U-test. P < 0.05 was considered significant. Results: Both the groups were similar with regard to demographic factors (P > 0.05). The visual analog scale scores at rest, deep breathing, coughing and movement, and postoperative fentanyl consumption were similar in the two groups (P > 0.05); the incidence of side effects was also similar in the two groups (P > 0.05). Conclusions: Continuous thoracic PVB is as effective as continuous thoracic EA in providing pain relief in patients undergoing open nephrectomy in the postoperative period. The side effect profile of the two techniques was also similar. [ABSTRACT FROM AUTHOR]

Aim: To evaluate and compare the extent of surgical stress following laparoscopic nephrectomy (LN) and open nephrectomy (ON) in children. Materials and Methods: Twenty consecutive children undergoing nephrectomy were randomized to LN or ON groups. Acid-base balance, blood glucose, acute phase proteins (C-reactive protein [CRP]) and inflammatory markers (interleukin-6 [IL-6]) were measured pre-operatively, as well as 4 and 24 h after surgery. The differences between the two groups were analyzed statistically (significance value for P < 0.05). Results: The overall acid base status was more stable in LN. The fall in pH 4 h after surgery was more in ON (P = 0.440) and the difference in pH in ON 4 h and 24 h post-operatively was statistically significant (P = 0.002). In LN, significant difference was found in the base excess mean pre-surgery (mean -3.280 mEq/L) and 4 h post-surgery (mean -7.480 mEq/L) (P =

Context: Current literature suggests that laparoscopic nephrectomy (LN) in patients with xanthogranulomatous pyelonephritis (XGP) is associated with high conversion and complication rate. Aims: To report contemporary outcome of patients with XGP, managed with either open nephrectomy (ON) or LN. Settings and Design: In this retrospective study, medical records of 37 patients with histopathologically confirmed XGP from January 2001 to October 2009 were reviewed. Materials and Methods: The clinical presentation, preoperative course, intraoperative findings, postoperative recovery and complications in ON and LN were analyzed. Statistical Analysis: Student′s t test was used to perform statistical comparison between the LN and ON groups. Values are expressed as mean ΁ standard deviation. Results: In 37 patients, 20 underwent ON and 17 underwent LN. One patient in the LN group required conversion. He had ectopic pelvic kidney, and the vascular pedicle could not be identified because of dense adhesions. There were no intraoperative complications. The mean blood loss was 257.5 ΁ 156.67 ml and 141.18 ΁ 92.26 ml in ON and LN groups, respectively. Mean hospital stay was 15.45 ΁ 7.35 days and 9.71 ΁ 4.55 days in ON and LN groups, respectively. Postoperative complications were classified according to Clavien grading for surgical complications. Grade 2 complications were seen in 40% and 29.4% of patients in ON and LN groups, respectively. One patient in LN required secondary suturing of specimen retrieval site. Conclusions: LN in patients with XGP is often challenging and requires considerable experience in laparoscopy. In properly selected patients, all benefits of minimally invasive surgery can be availed with LN.

Aims: Spontaneous nephrocutaneous fistula (NCF) is a rare and severe condition. The aim of this study was to update the data of the literature about this disease and, reporting and considering also our experience in 1 case of NCF, to make a new clinical algorithm. Methods: This study was done with a review of all the literature and a comparison with our experience. Results: The characteristic sign of spontaneous NCF is a flank sinus discharging material. Physical examination and computed tomography usually lead to the diagnosis. The main predisposing factors are renal stones/staghorn calculi, xanthogranulomatous pyelonephritis and renal tuberculosis. In the vast majority of the cases kidneys are poorly functioning or nonfunctioning. Surgical approach is the common management and usually consists of open nephrectomy. We create a clinical management algorithm obtained by a review of the literature and our experience with spontaneous NCF. Conclusions: Spontaneous NCF represents a very serious renal disease leading to loss of the kidney in the vast majority of cases. We propose a revised and user-friendly clinical diagnostic-therapeutic algorithm for spontaneous NCF based on the worldwide literature. [ABSTRACT FROM AUTHOR]

Introduction: We evaluated perioperative and mortality outcomes of robotic-assisted radical nephrectomy (RRN) vs. open radical nephrectomy (ORN) for very large renal cell carcinomas (RCC).Materials and Methods: Adult patients with non-metastatic RCC >10 cm in size (pT2b) were identified from the National Cancer Database (2010-2017). Mixed-effects multivariable logistic regression adjusting for patient, tumor, and facility characteristics were used to evaluate rates of positive margin, prolonged length of stay (LOS) (>75th percentile), 30-day readmission, and 30-day and 90-day mortality for RRN vs. ORN. Overall survival (OS) was evaluated using the Kaplan-Meier method and adjusted Cox proportional hazard modeling.Results: Of the 2,977 patients who underwent radical nephrectomy, 492 (16.5%) underwent RRN. Factors associated with RRN included male gender, metro or urban locations, academic facilities, Charlson-Deyo score >2, private or Medicaid insurance, and surgery in a later year (all P < 0.05). Tumors ≥15.1cm in size were associated with a higher rate of conversion to open surgery (P < 0.001). ORN was associated with increased median postoperative LOS (4d [interquartile range; IQR 3-6] vs. 3d, [IQR 2-4]; P < 0.01). RRN demonstrated no significant difference in the risk of positive margin, 30-day readmission, 30-day mortality, or 90-day mortality. RRN was associated with a decreased risk of prolonged LOS (OR 0.38; 95%CI [0.28-0.53]). There was no difference in long-term OS observed in patients treated with ORN vs. RRN.Conclusions: Very large, non-metastatic RCC can be safely and effectively treated with RRN. Rates of conversion to open were higher for tumors ≥15.1 cm. RRN has comparable long-term OS and improved LOS compared to ORN. [ABSTRACT FROM AUTHOR]

Background: Kidney transplantation (KTx) is considered to be the treatment of choice for end stage renal disease. One of the most challenging dilemmas in KTx is the shortage of suitable organs. The live donor nephrectomy is considered a unique operation performed on healthy donors, which provides a superior outcome in the recipients. Several surgical techniques have been developed so far to minimize donor postoperative complications as much as possible without compromising the quality of the kidney. The development of a minimally invasive surgery, laparoscopic live donor nephrectomy (LDN), was based on this concept. Materials and Methods: By searching the pubmed, we reviewed the most evidence based clinical studies specifically randomized clinical trials and meta-analyses to give an overview of the efficacy and safety of LDN versus ODN. Results: The advantages of a LDN vs. a conventional open donor nephrectomy (ODN) are a smaller incision, better wound cosmetics, a lower rate of incisional hernia and adhesion, less postoperative pain, shorter hospitalization, and earlier return to work. Some concerns are longer operative and warm ischemic times, long-term learning curve for surgeons, and the risk of more serious complications than during an ODN. Conclusion: Overall, the review of literature shows that a LDN provides less postoperative pain, a shorter hospital stay, a shorter period of rehabilitation, and earlier return to normal work and physical activities in comparison to the conventional open flank nephrectomy but is comparable to the mini muscle splitting approach. The complication rate is generally lower in centers accustomed to performing LDNs; however, complications can be life threatening and could impose significant costs to the health system. Weighing the longer operation and warm ischemic time, as well as the risk of more serious complications against the advantages of a LDN mandates a precise indication. The risk-benefit assessment for choosing one procedure should be done meticulously. Even though the short-term graft function in both techniques is comparable, there is a lack of enough long-term outcome analyses. Finally, in any transplant center, the cost of the laparoscopic procedure should be considered. [ABSTRACT FROM AUTHOR]

Objectives To examine the trends of open and laparoscopic partial nephrectomy and radical nephrectomy according to sociodemographic and tumor characteristics. Methods Using the Surveillance, Epidemiology, and End Results Medicare-linked database, 6024 patients diagnosed with T1a renal cell carcinoma were abstracted. Multivariable logistic regression analyses were used for prediction of open radical nephrectomy, open partial nephrectomy, laparoscopic radical nephrectomy and laparoscopic partial nephrectomy. Covariates comprised of patient age, baseline comorbidity status, sex, race, marital status, socioeconomic status, population density, Surveillance, Epidemiology and End Results registry, tumor size, and year of diagnosis. Results Open radical nephrectomy decreased from 89% in 1988 to 66% in 2005 ( P < 0.001), whereas open partial nephrectomy increased from 7% to 29% ( P < 0.001). Meanwhile, utilization of either laparoscopic radical nephrectomy or laparoscopic partial nephrectomy remained low. Treatment utilization differed according to Surveillance, Epidemiology, and End Results registries ( P < 0.001). Increasing patient age, female sex, low socioeconomic status and unmarried status (all P ≤ 0.003) were predictors of open radical nephrectomy. The utilization rates of laparoscopic radical nephrectomy or laparoscopic partial nephrectomy varied minimally according to the examined characteristics. Older patients or women were significantly more likely to undergo laparoscopic radical nephrectomy, even after adjustment for all covariates (both P ≤ 0.02). Conclusions The rising utilization rates of radical nephrectomy are encouraging. Nevertheless, disparities of treatment type still exist. It is of concern that older and female patients are less likely to undergo nephron-sparing surgery, and to have a radical nephrectomy by the laparoscopic approach instead. [ABSTRACT FROM AUTHOR]

Objective: Compare costs between open and laparoscopic nephrectomy at our hospital. Materials and methods: We performed a retrospective, observational, descriptive, and comparative cross study. The data were obtained from the records of patients undergoing laparoscopic and open nephrectomy between January 2005 and June 2012. All cases were elective and patients with diagnoses not comparable, were excluded. The economic cost calculation was performed using the Diagnosis Related Groups calculated by the IMSS. Normality tests were applied in numerical variables with U Mann-Whitney finding a freely distribution. For dichotomous variables, we used Χ². We considered a value of p < 0.05 as significant. Results: In the period between January 2005 and June 2012 were performed 182 elective nephrectomies, only 58 were included to meet the selection criteria, 39 open and 19 laparoscopic, the median ages were 58 and 57 years and the surgical time was 160 and 200 minutes respectively, the median hospital stay was 5 days for both groups and procedure costs calculated using DRG were $ 77,545.35 and $ 62,036.28 pesos respectively. Conclusions: According to this analysis, the economic advantage offered by the laparoscopic technique supports continues performing such surgery in our institution. [ABSTRACT FROM AUTHOR]

Aim: To evaluate and compare the extent of surgical stress following laparoscopic nephrectomy (LN) and open nephrectomy (ON) in children. Materials and Methods: Twenty consecutive children undergoing nephrectomy were randomized to LN or ON groups. Acid‑base balance, blood glucose, acute phase proteins (C‑reactive protein [CRP]) and inflammatory markers (interleukin‑6 [IL‑6]) were measured pre‑operatively, as well as 4 and 24 h after surgery. The differences between the two groups were analyzed statistically (significance value for P < 0.05). Results: The overall acid base status was more stable in LN. The fall in pH 4 h after surgery was more in ON (P = 0.440) and the difference in pH in ON 4 h and 24 h post‑operatively was statistically significant (P = 0.002). In LN, significant difference was found in the base excess mean pre‑surgery (mean –3.280 mEq/L) and 4 h post‑surgery (mean –7.480 mEq/L) (P = <0.05), as well as between 4 h and 24 h after surgery (mean –2.660 mEq/L) (P = 0.011).The acute rise in CRP 24 h post‑operatively in the ON (88.972 mg/L) was significantly higher when compared to both the pre‑operative and 4 h post‑operative values (P < 0.05). This rise was however, not statistically significant when compared to the 24 h post‑operative value in LN (46.399 mg/L) (P = 0.062). The rise in IL‑6, 24 h post‑procedure in LN (mean 44.444 pg/ml) was statistically lower than that in the open group (mean 343.333 pg/ml) (P = 0.041). Conclusions: The stable acid‑base status and lesser rise of CRP and IL‑6 in LN lead to the conclusion that surgical stress caused by LN is less than ON. [ABSTRACT FROM AUTHOR]

Although the safety of living kidney donation has been well established, prospective studies examining the physical and psychosocial aspects of the donor's quality of life are still scarce. Thus, the purpose of this prospective work was to assess the quality of life of 50 consecutive donors before and after kidney transplantation. All donors were asked to respond to both a donor questionnaire and the short-form 36-item health survey ( SF-36). Interviews were individually conducted before, three months after, and over one yr after transplantation. Donation was considered a positive experience by all patients and had no impact on any physical or psychosocial aspect of the donor's life. Improved self-esteem and better quality of life after donation were reported in 52% of the cases. All donors would donate again and encouraged donation. SF-36 data indicated improvement in post-donation mental and physical scores among living donors closely related to recipient. Overall, most donors had a positive experience, felt no changes in quality of life, experienced enhanced self-esteem, would donate again, and recommended donation. [ABSTRACT FROM AUTHOR]

Background and purpose: Laparoscopic donor nephrectomy is an appropriate alternative for open donor nephrectomy in kidney transplant. The latter has been applied in most health centers for 50 years and it has been proven that unilateral nephrechtomy (laparotomy) is safe for the doner and so the remaining kidney can handle its function well. Since the former method for the kidney doner has been recently used as well, it seems necessary to compare the long-term function of the transplanted kidney in the two methods for the first time in Hashemi Nejad Hospital. Materials and methods: In description study, 133 kidney transplation evaluated, 75 case were laparatomic donor nephrectomy & 58 case were laparascopic. Kidney function evaluated with creatinin one years Post transplantion. Results: After one year of transplantation, no significant differences were observed in the creatinine level of the two groups. This research showed that the nephrectomy method, either laparoscopy or laparotomy, has no influence on the kidney function after one year. This research is showed creatinin value will equal one year after transplantation in two groups, so donor nephectomy by laparatomic laparascopic approach has no significant effect in kidney Function. Conclusion: Laparoscopic nephrectomy is recommended because it has few side effects for the kidney donor and it can be used in clinical settings. [ABSTRACT FROM AUTHOR]

Context: Current literature suggests that laparoscopic nephrectomy (LN) in patients with xanthogranulomatous pyelonephritis (XGP) is associated with high conversion and complication rate. Aims: To report contemporary outcome of patients with XGP, managed with either open nephrectomy (ON) or LN. Settings and Design: In this retrospective study, medical records of 37 patients with histopathologically confirmed XGP from January 2001 to October 2009 were reviewed. Materials and Methods: The clinical presentation, preoperative course, intraoperative findings, postoperative recovery and complications in ON and LN were analyzed. Statistical Analysis: Student's t test was used to perform statistical comparison between the LN and ON groups. Values are expressed as mean ± standard deviation. Results: In 37 patients, 20 underwent ON and 17 underwent LN. One patient in the LN group required conversion. He had ectopic pelvic kidney, and the vascular pedicle could not be identified because of dense adhesions. There were no intraoperative complications. The mean blood loss was 257.5 ± 156.67 ml and 141.18 ± 92.26 ml in ON and LN groups, respectively. Mean hospital stay was 15.45 ± 7.35 days and 9.71 ± 4.55 days in ON and LN groups, respectively. Postoperative complications were classified according to Clavien grading for surgical complications. Grade 2 complications were seen in 40% and 29.4% of patients in ON and LN groups, respectively. One patient in LN required secondary suturing of specimen retrieval site. Conclusions: LN in patients with XGP is often challenging and requires considerable experience in laparoscopy. In properly selected patients, all benefits of minimally invasive surgery can be availed with LN. [ABSTRACT FROM AUTHOR]

Background: Hand-assisted laparoscopic donor nephrectomy is equal effective as open nephrectomy with several advantages in terms of postsurgical pain, cosmetic results and recovery times. Laparoscopic transplant nephrectomy experience is limited in Mexico. Our aim was to compare intraoperative and postoperative outcomes with both techniques. Methods: Medical recordings were obtained from 100 kidney donors who underwent hand-assisted laparoscopic nephrectomy and 200 to open nephrectomy between june 2007 to october 2009. Intraoperative, postoperative and anatomical aspects were registered. The data were analyzed with t Student and U Mann Whitney test. Results: Hand-assisted laparoscopic donor nephrectomy and open nephrectomy patients were comparable for sex and renovascular anatomy. Hand-assisted laparoscopic patients were younger (33.1 ± 10.35 vs. 36.43 ± 9.51 years, p = 0.006). Operating time (88.76 ± 40.6 vs. 100.02 ± 50.36 min, p = 0.009), warm ischemia time (186.51 ± 50 vs. 218.39 ± 66.6 seg, p < 0.001), postoperative length of stay (35.52 + 12.05 vs. 73.57 + 14.11 h, p < 0.001), resumption of oral intake (4.1 + 0.6 vs. 8.61 + 5.15 h, p < 0.001) were shorter in hand assisted laparoscopic patientes, with lower estimated blood loss (87 ± 40 vs. 176.52 ± 228.83 mL, p < 0.001). Similar complication ratio was observed. Conclusions: Hand-assisted laparoscopic donor nephrectomy improves the postoperative outcome when compared to open nephrectomy. It is posible in short term that hand-assisted laparsocopic donor nephrectomy becomes the first choice for kidney donors. [ABSTRACT FROM AUTHOR]

Very few studies have prospectively followed living kidney donors the first year after donor surgery. In 2003, we in-depth interviewed living kidney donors one wk after donation to explore their immediate experiences of going through nephrectomy. The aim of the current investigation was to explore experiences regarding physical and psychosocial health during the first year after donor surgery. Twelve donors going through open donor nephrectomy were interviewed by telephone at one yr after donation. The analysis was carried out with an empirical phenomenological method. All participants expressed an overall positive experience about being a donor a year after transplantation. However, several participants experienced physical disincentives longer than expected post-donation. Emotional distress, such as mild depression and a feeling of loss, was also part of the donor experiences. Donors experiencing unsuccessful recipient outcome reported severe physical and mental reactions. This study provides insights on the physical and mental cost to living kidney donation. Awareness of how donors may experience their situations can help transplantation professionals in their efforts to understand and provide support. [ABSTRACT FROM AUTHOR]

Andersen MH, Mathisen L,Øyen O, Wahl AK, Hanestad BR, Fosse E. Living donors’ experiences 1 wk after donating a kidney.Clin Transplant 2004 DOI: 10.1111/j.1399-0012.2004.00304.x© Blackwell Munksgaard, 2004In Norway living kidney donors account for approximately 40% of all renal transplants. There is a shortage of information about how living kidney donors experience the donation process during the initial recovery from surgery. The aim of this study was to explore physical and psychosocial issues related to the experiences of living kidney donors 1 wk after open donor nephrectomy. A total of 12 living kidney donors participated in the study. Data were collected by individual in-depth interviews and analysed using empirical phenomenological method. Being a living kidney donor is a complex experience. The informants expressed strong feelings of responsibility and obligation concerning the recipients and had a positive attitude towards the donation. On the other hand, the donors experienced it strange to be a fit individual and go through a major operation. Several of the donors reported that it was painful to go through donor surgery and regarded the recovery period as troublesome. Some donors also reported the double role of being both a patient and a relative to be a stressful experience. This study reveals the importance of being aware of the complex situation of living kidney donors. Health professionals need to understand the nature of the donation process and the donors’ needs. It is essential to focus on physical, mental and interpersonal factors when counselling potential living kidney donors. [ABSTRACT FROM AUTHOR]

Background: Although the advent of hand-assisted laparoscopic donor nephrectomy (HLDN) has had a positive impact on the donor pool, there is still some concern about its safety. The aim of this study was to assess the impact of a change in surgical access to live-donor nephrectomy on donor-related complication rates, the renal function of the donor, and the graft function of the recipient. Methods: At our hospital, HLDN was introduced in 1998. Thereafter, we compared 49 consecutive donors undergoing open donor nephrectomy (ODN) between 1987 and 2002 with 57 consecutive donors undergoing HLDN between 1998 and 2002. Donor renal and recipient graft functions were assessed by measuring creatinine levels and urine output, with the addition of warm and cold ischemia time and dialysis requirements in the latter group. Data are presented as means (± SD) and analyzed with the Student t-test or Fisher's exact test. Results: The ODN and HLDN donors were comparable for age, gender, body mass index, renovascular anatomy, and preoperative creatinine. Estimated blood loss (370 ± 280 vs 168 ± 160 ml, p < 0.0001), time to resumption of oral intake (1.7 ± 0.5 vs 1.3 ± 0.7 days, p = 0.01), duration of intravenous narcotic requirements (23 = 0.7 vs 1.7 ± 1.0 days, p < 0.0001), and hospital stay (4.2 ± 1.4 vs 2.9 ± 1.3 days, p < 0.0001) were significantly decreased after HLDN. There were no significant differences between ODN and HLDN in operating time (204 ± 46 vs 202 ± 49 mm), donor-related complication rates (12.2% vs 14%), or donor renal and recipient graft functions. Conclusion: The introduction of HLDN to an established renal transplant program led to an improved short-term outcome without any increase in donor-related complication rates or delay in recipient graft function. [ABSTRACT FROM AUTHOR]

Study Objective: Patients undergoing open nephrectomy surgery experience severe perioperative pain, which is primarily due to incision of several muscles. Abdominal wall blocks are known to reduce pain without causing epidural-associated hypotension. We conducted this study to compare unilateral ultrasound-guided transmuscular quadratus lumborum block and posterior transversus abdominis block in combination with general anesthesia alone in terms of intraoperative and postoperative analgesics and hemodynamics and postoperative complications., Methods: This was a randomized, double-blinded, controlled trial conducted in the operating room. This study included 48 patients aged 20-60 years, with ASA I and II, and a body mass index ≤ 30kg.m -2 who were scheduled for open nephrectomy procedure.The 48 patients scheduled for nephrectomy were randomly allocated into one of the following three groups after induction of general anesthesia: Group A (n=16) received USG transmuscular QLB; Group B (n=16) received unilateral USG posterior transversus abdominis plane (TAP) block; and Group C (n=16; control group) did not receive any blocks. Introperative fentanyl consumption, and hemodynamics (heart rate and mean arterial pressure (MAP)) were recorded after anesthesia induction, at surgical incision, and every 15min till the end of surgery. Visual Analogue Scale (VAS) was evaluated immediately at 30min and 1,2,4,6, and 12hours postoperatively. The time of first analgesic request was also recorded., Results: Intraoperative fentanyl consumption (μg) was significantly lower in Groups A and B (164.69±27.35 and 190.31±44.48, respectively) than in Group C (347.50±63.64) (p<0.001). Postoperatively, total pethidine consumption was significantly lower in Groups A and B than in Group C (85.31±6.68, 84.06±4.17mg, and 152.19±43.43mg, respectively) (p<0.001. Time to rescue analgesia was longer in Groups A and B than in Group C (138.75±52.39min, 202.50±72.25min, and 37.50±13.42min, respectively) (p<0.001). VAS score was significantly lower in Groups A and B than in Group C at 30min and 1, 2, 4, and 6hours postoperatively., Conclusion: Transmuscular quadratus lumborum block and posterior transversus abdominis blocks were effective in providing perioperative analgesia in patients undergoing open nephrectomy. However, quadratus lumborum block provided superior analgesia., (Copyright © 2021 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.)

OBJECTIVES To address donor attitudes and reasons for selecting either laparoscopic or open donor nephrectomy (LDN, ODN), as despite the increased interest in laparoscopic procedures, organ donation continues to lag behind the demand for organs, and many new initiatives have failed to reduce the gap. PATIENTS AND METHODS This case series comprised a 10-year review of medical records and a transplant database on donor demographics, analgesic requirements, postoperative complications and length of hospital stay. A structured telephone interview was conducted for all live donors to evaluate donor awareness, reasons for selecting LDN and the psychosocial impact of DN on donors’ rehabilitation. RESULTS Between 1995 and 2004, 38 LDN and 38 ODN were carried out; 70% were women in both groups, with a respective mean age of 44.4 and 47.1 years. Three LDNs were converted to ODN due to technical difficulties. The mean operative duration for LDN (194.8 min) was 78 min longer than for ODN (116.8 min). As expected, the mean analgesia requirement and length of hospital stay was less for LDN than ODN, by 55.4 mg of morphine equivalent and 2.3 days. Although all renal donors were aware of the option of LDN, one patient chose ODN due to safety concerns. The primary source of donor information was derived predominantly from the donor assessment process. The main reason for choosing LDN was the earlier return to work (54%), followed by less postoperative pain (33%). In general, there was minimal psychosocial impact after renal transplantation and the overall donor experience was very positive (85%). CONCLUSION LDN has remained a safe, less-invasive but effective technique for allograft procurement, with minimal morbidity. Overall, there is less postoperative pain and fewer surgical complications, and an earlier return to normal functioning. The level of satisfaction with the whole renal donation process was very positive, with minimal psychosocial impact. [ABSTRACT FROM AUTHOR]