Başkent Üniversitesi Yayınları
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Item Total Laparoscopic Donor Nephrectomy In Situs Inversus Totalis: A Case Report(Başkent Üniversitesi, 2013-04) Berber, Ibrahim; Gurkan, Alihan; Cakir, Ulkem; Alim, Altan; Gurluler, Ercument; Gures, NazimSitus inversus totalis is a rare anomaly characterized by the total inversion of all abdominal and thoracic organs. For the first time, we report a case of a donor nephrectomy in a patient with situs inversus totalis, completed with a full laparoscopic approach. At the time of this writing, the donor and the recipient are doing well after 6 month’s follow-up. Our experience shows that patients with situs inversus totalis may be eligible candidates for laparoscopic donor nephrectomy, provided that detailed preoperative imaging studies as well as precise preoperative planning are performed before the transplant.Item Comparison of 2 Devices in Pigs To Induce Hypothermia in Laparoscopic Orthotopic Kidney Transplant(Başkent Üniversitesi, 2012-12) Han, Xiuwu; Zhang, Yuhai; Gao, Qiang; Zhao, Zhiwei; Yan, Wei; Zhang, BaoObjectives: To laparoscopically compare the effectiveness of 2 cooling devices for renal hypothermia and investigate the feasibility of laparoscopic orthotopic kidney transplant using a pig model. Materials and Methods: Eight pigs were divided into 2 groups of 4 animals each. Laparoscopic nephrectomy and autotransplant were performed first on only the right kidney. One week later, these procedures were performed on the left kidney, while the first transplanted autograft was removed. After 1 more week, the left autograft was removed for observation. In 1 group, the silicon tube cage was used to induce hypothermia during laparoscopic orthotopic kidney transplant (silicon tube cage group), and in the other group, the plastic bag jacket was used to induce hypothermia during laparoscopic orthotopic kidney transplant (plastic bag jacket group). Results: Two pigs in the silicon tube cage group survived for 7 days after the second autotransplant with serum creatinine levels of 210 µmol/L and 1010 µmol/L. One pig in the plastic bag jacket group survived for 5 days. The mean surface temperature of the grafts was maintained at 9°C ± 3°C and 12°C ± 3°C in the silicon tube cage and plastic bag jacket groups (P = .166). Three of 6 plastic bag jacket devices were ruptured by stitches or instruments. The mean venous and arterial anastomotic times in the silicon tube cage group were significantly shorter than were those in the plastic bag jacket group. Conclusions: Our study shows that the silicon tube cage may be a reliable renal cooling device for use in laparoscopic kidney transplant and indicates the feasibility of laparoscopic orthotopic kidney transplant in pigs.Item Acute Appendicitis Post Liver Transplant: A Case Report and Literature Review(Başkent Üniversitesi, 2012-04) Quartey, Benjamin; Cryer, Chad; Dunne, JamesAlthough acute appendicitis is common, reported cases after orthotopic liver transplant are rare. A 29-year-old woman presented to the emergency department with right lower-quadrant pain and mild leukocytosis 2 years after having a liver transplant. A computed tomography scan revealed an inflamed appendix. On operation, an injected appendix was noted, and she underwent an uncomplicated laparoscopic appendectomy. Histology confirmed the diagnosis and her postoperative course was unremarkable. Owing to the rarity of these cases and paucity of knowledge on management, a high index of suspicion and immediate intervention are required to prevent major complications. This case is the first successful laparoscopic appendectomy after liver transplant ever reported.Item Laparoscopic Donor Nephrectomy—An Iranian Model for Developing Countries: A Cost-Effective No-Rush Approach(Başkent Üniversitesi, 2004-12) Simforoosh, Nasser; Basiri, Abbas; Tabibi, Ali; Shakhssalim, NasserObjectives: This study aimed to evaluate donor and graft outcome in kidney transplantations from laparoscopic donor nephrectomies. Materials and Methods: From June 2000 to June 2004, 341 laparoscopic donor nephrectomies were performed. Demographics and hospital records were reviewed. Mean ages of donors and recipients were 27.59 ± 4.80 years (range, 20-56 years) and 35.36 ± 14.85 years (range, 3-75 years). Results: Nephrectomy was left sided in 96.2%. Mean follow-up was 13.32 ± 35.98 months. Mean warm ischemia time was 8.17 minutes (range, 2.5-19 minutes). Mean operative time was 260.34 minutes. Median serum creatinine levels (mg/dL) of the recipients were 1.30, 1.45, and 1.20 at day 7, and at 1 and 12 months. One-year graft survival was 92.7%, 94.6%, and 92.6% in the laparoscopic donor nephrectomy groups with warm ischemia times of less than 6, 6-10, and more than 10 minutes (P = NS). Conversion to open surgery occurred in 2.1% of donors, and reoperation was performed in 3.8% of laparoscopic donor nephrectomies. Blood transfusion was required in 7.1% of donors. Ureteral complications were observed in 2.1% of recipients. Vascular control was performed using medium-large clips instead of endo GIA, and the kidney was extracted via a suprapubic approach using the hand instead of an ENDOCATCH bag; hence, $600 was saved in each nephrectomy. No vascular accident occurred from pedicular vessels. Conclusions: Laparoscopic donor nephrectomy can be performed with a less-expensive setup (to be expanded in developing countries) without jeopardizing results. Because warm ischemic time in our study did not affect graft outcome significantly, there appears to be no need to rush harvesting the kidney to achieve a better quality kidney. Vascular control using nonautomatic clips instead of more costly endo GIA and hand extraction of the kidney is safe, practical, and economical.