Vascular Surgery Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Nephrology and Transplantation Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Ann Vasc Surg. 2024 Sep;106:108-114. doi: 10.1016/j.avsg.2023.12.077. Epub 2024 Feb 20.
In a kidney transplant tertiary referral center; we compared 3 operating team configurations of different surgical specialties to highlight the effect of the operating surgeon's specialty on various operative details and procedural outcome.
A total of 50 cases of living donor transplantations were divided into 3 main groups according to the operating surgeons' specialty, the first group (A) includes 12 patients exclusively operated on by urologists with advanced training in transplantation, the second group (B) includes 35 patients operated by combined surgical specialties; a urologist and a vascular surgeon both with advanced transplantation training, and a third group (C) includes 3 cases where the transplant operation commenced with operating urologists as in group (A) but required intraoperative urgent notification of a vascular surgeon to manage unexpected intraoperative technical difficulties or major complications. Cases were studied according to operative details, anastomosis techniques, ischemia times, total procedure time, recovery of urinary output, intensive care unit (ICU) stay, postoperative surgical complications and serum creatinine level for up to 3 years of follow-up.
Study of operative details revealed that total duration of graft ischemia was significantly shorter in group (B) and significantly longer in group (C) (P value 0.001), Total procedural duration also varied significantly between the 3 groups, group (B) being the shortest while group (C) was the longest (P value less than 0.001). Technically; group (A) used only end to end arterial anastomosis as a standard technique, while group (B) used both end-to-end and end-to-side anastomoses as required per each case. End to side anastomosis in group (B) yielded better immediate graft response in the form of change in color, texture, earlier and more profuse postoperative urine volumes (P value 0.025). Furthermore, anastomosis to common and external iliac arteries (group B) yielded earlier and higher urine volumes than the internal iliac artery (P values 0.024 and 0.031 respectively). Group (B) recorded significantly less postoperative perigraft hematomas and lymphoceles compared to the other 2 groups. Equal rates of urine leaks, ICU stay, creatinine levels, patient and grafts survival rates among groups (A) and (B), while postoperative recovery and ICU stay duration were more lengthy in the complicated group (C).
A vascular surgeon operating in a transplantation team would deal comfortably and efficiently with various vascular related challenges and complications, thus avoiding unnecessary time waste, complications and costs.
在一家肾脏移植三级转诊中心，我们比较了不同外科专业的 3 种手术团队配置，以突出手术医生专业对各种手术细节和程序结果的影响。
总共 50 例活体供肾移植患者根据手术医生的专业分为 3 个主要组，第一组（A）包括 12 例仅由接受过高级移植培训的泌尿科医生手术，第二组（B）包括 35 例由联合外科专业的医生手术；泌尿科医生和血管外科医生均接受过高级移植培训，第三组（C）包括 3 例，手术开始时由泌尿科医生按照组（A）进行操作，但需要术中紧急通知血管外科医生处理意外的术中技术困难或主要并发症。根据手术细节、吻合技术、缺血时间、总手术时间、尿输出恢复、重症监护病房（ICU）停留时间、术后手术并发症和血清肌酐水平，对术后 3 年的随访情况进行研究。
对手术细节的研究表明，组（B）的移植物总缺血时间明显缩短，组（C）明显延长（P 值 0.001），3 组的总手术时间也有显著差异，组（B）最短，组（C）最长（P 值小于 0.001）。技术上，组（A）仅使用端端动脉吻合作为标准技术，而组（B）则根据每个病例的需要使用端端吻合和端侧吻合。组（B）中的端侧吻合在颜色、质地、更早和更丰富的术后尿量方面产生了更好的即时移植物反应（P 值 0.025）。此外，与髂内动脉相比，吻合至髂总动脉和髂外动脉（组 B）产生了更早和更高的尿量（P 值分别为 0.024 和 0.031）。组（B）记录到的术后吻合口周围血肿和淋巴囊肿明显少于其他 2 组。组（A）和（B）的尿漏、ICU 停留时间、肌酐水平、患者和移植物存活率相等，而复杂组（C）的术后恢复和 ICU 停留时间更长。
血管外科医生在移植团队中操作，可以舒适、有效地处理各种血管相关的挑战和并发症，从而避免不必要的时间浪费、并发症和成本。
