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Tambunan, Nicholas

Perbandingan hasil luaran antara pneumoperitoneum tekanan rendah dengan tekanan standar pada laparoscopic living donor nephrectomy = Comparison of outcome between low pressure and standard pressure pneumoperitoneum in laparoscopic living donor nephrectomy

"ABSTRAK

Nama : Nicholas TambunanProgram Studi : UrologiJudul : Perbandingan Hasil Luaran antara Pneumoperitoneum TekananRendah dengan Tekanan Standar pada Laparoscopic Living Donor Nephrectomy Saat ini, transplantasi ginjal dilakukan melalui prosedur Laparoscopic Living Donor Nephrectomy LLDN dengan cara memasukkan gas CO2 ke dalam ruang intraperitoneum menggunakan tekanan standar 12-15 mmHg . Namun, dikatakan juga bahwa dengan tekanan rendah 8-10 mmHg dapat berkaitan dengan nyeri pasca operasi dan efek samping yang lebih rendah. Ini merupakan studi perbandingan prospektif yang dilakukan di Departemen Urologi, Rumah Sakit Umum Cipto Mangunkusumo mulai bulan November 2015 sampai Agustus 2016. Seluruh subjek menjalani prosedur LLDN. Pada periode ini, subjek menerima prosedur pneumoperitoneum tekanan rendah. Kelompok ini kemudian dibandingkan secara acak dengan kelompok prosedur pneumoperitoneum tekanan standar yang menjalani prosedur LLDN sebelumnya. Dari 85 subjek yang menjalani LLDN dengan tekanan rendah dan standar masing-masing adalah 41 dan 44. Meskipun tidak ada perbedaan signifikan dari nyeri pasca operasi, efek samping pada tekanan rendah lebih rendah daripada tekanan standar p = 0,033 untuk nyeri epigastrik, p = 0,024 untuk mual, dan p = 0,018 untuk muntah . Namun, durante operasi, 22 subjek dengan tekanan rendah perlu mendapatkan konversi gas menjadi tekanan standar. Berdasarkan analisis, penyebab konversi adalah Indeks Massa Tubuh IMT pasien donor yang tinggi p

ABSTRACT

Name Nicholas TambunanStudy Program UrologyTitle Comparison of Outcome between Low Pressure and StandardPressure Pneumoperitoneum in Laparoscopic Living DonorNephrectomy Nowadays, kidney transplantation is done through laparoscopic living donor nephrectomy performed by insufflating CO2 gas into intraperitoneum space using standard pressure 12 15mmHg . However, it is also hypothesized that with lower pressure 8 10 mmHg could be used for laparoscopic living donor nephrectomy related with lower postoperative pain and side effects. This was a prospective comparative study done in Department of Urology, Cipto Mangunkusumo General Hospital from November 2015 to August 2016. All subjects underwent laparoscopic living donor nephrectomy LLDN . In this period, the subjects received a low pressure pneumoperitoneum procedure. This group was later compared randomly to a standard pressure pneumoperitoneum procedure group who underwent previous LLDN procedure. Out of 85, subjects underwent LLDN with low and standard pressure were 41 and 44, respectively. Despite nonsignificant difference of post op pain and duration of operation, the side effect in low pressure was lower than standard p 0.033 for epigastric pain, p 0.024 for nausea, and p 0.018 for vomiting . However, 22 subjects with low pressure need to be converted to standard pressure. Based on stratified analysis, the cause of conversion was higher BMI p"

2017

T-Pdf

UI - Tesis Membership Universitas Indonesia Library

Peri Eriad Yunir

Perbandingan Laparoscopic Living Donor Nephrectomy (LLDN) tanpa menggunakan drain dan dengan menggunakan drain = Comparison of Laparoscopic Living Donor Nephrectomy (LLDN) without using and using drain a randomized controlled trial study

"ABSTRAK

Laparoscopic Living Donor Nephrectomy LLDN menjadi prosedur standar donor ginjal hidup di beberapa negara, termasuk Indonesia, khususnya di RSUPN Cipto Mangunkusumo Jakarta. Pada LLDN digunakan drain sebagai alat monitoring pasca operasi. Penelitian Randomized Controlled Trial ini dilaksanakan pada 40 pasien donor ginjal di Rumah Sakit Cipto Mangunkusumo Jakarta yang dibagi ke dalam dua grup; grup tanpa drain dan yang menggunakan drain grup kontrol , untuk membandingkan lama rawatan, skala nyeri, kondisi luka operasi, dan keluhan saluran cerna pasca operasi pada kedua grup. Tidak didapatkan perbedaan pada semua parameter antara LLDN menggunakan drain dan tanpa menggunakan drain.

ABSTRACT

Laparoscopic Living Donor Nephrectomy LLDN has become the standard procedure for living kidney donor in several countries, including Indonesia, especially in Cipto Mangunkusumo General Hospital Jakarta. Drainage tube in LLDN is intended as a tool of postoperative monitoring. This randomized controlled trial was performed in 40 LLDN patients in Cipto Mangunkusumo Hospital Jakarta, divided into two groups without drainage tube and using drainage tube control group , in order to compare postoperative length of stay, pain scale, surgical wound condition and gastrointestinal tract complaints. There were no differences found in all evaluated parameters within the two groups."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2016

T58715

UI - Tesis Membership Universitas Indonesia Library

Senohadi Boentoro

Transfusi Darah pada Laparoscopic Living Donor Nephrectomy: Pengalaman Satu Pusat dari 500 Kasus = Blood Transfusions in Laparoscopic Living Donor Nephrectomy: Single Center Experience from 500 Cases

"Pendahuluan dan tujuan: Pembedahan laparoskopi telah diakui dapat mengurangi tingkat morbiditas sehingga meningkatkan keselamatan pasien. Saat tindakan LLDN, komplikasi yang paling sering adalah cedera pembuluh darah ginjal, yang sering membutuhkan transfusi darah. Selain perlunya transfusi darah, pendarahan berat yang disebabkan oleh cedera pembuluh ginjal membutuhkan konversi dan perbaikan terbuka. Dengan demikian, penelitian ini ingin mendeskripsikan dan menganalisis kebutuhan transfusi darah dalam operasi laparoscopic living donor nephrectomy di pusat kami.

Bahan dan metode: Studi kohort retrospektif ini dilakukan di Departemen Urologi di Rumah Sakit Nasional Cipto Mangunkusumo. Rekam medis semua pasien donor ginjal yang menjalani prosedur LLDN di institusi kami dari November 2011 hingga Oktober 2017 ditinjau. Data termasuk usia donor, kadar hemoglobin sebelum operasi, kadar hemoglobin pasca operasi, jumlah pendarahan intraoperatif, jumlah arteri renalis, jumlah vena renalis, sisi donor, konversi ke operasi terbuka, durasi operasi, dan BMI donor dikumpulkan dan dianalisis. Data-data ini selanjutnya dikorelasikan dengan tingkat transfusi.

Hasil: Terdapat 500 pasien yang menjalani tindakan laparoscopic living donor nephrectomy di institusi kami. Semua pasien menjalani prosedur LLDN dengan pendekatan transperitoneal. Perbedaan proporsi tingkat transfusi darah antara pasien pria 0,9% dibandingkan dengan 0,6% pada pasien wanita tidaklah signifikan (p=0,782). Tidak ada perbedaan yang signifikan dalam proporsi tingkat transfusi darah dengan sisi ginjal (p=0,494), jumlah arteri (p=0,362), usia (p=0,978), BMI (p=0,569), dan kadar hemoglobin sebelum operasi (p=0,766). Median perkiraan jumlah pendarahan pada pasien yang menerima transfusi darah intraoperatif secara signifikan lebih besar daripada pasien yang tidak menerima transfusi darah (p <0,001).

Kesimpulan: Berdasarkan penelitian ini, kami menyarankan bahwa di institusi kami, penggunaan produk darah pra operasi tidak selalu diperlukan. Kurva pembelajaran dan teknik ahli bedah memiliki peran penting dalam mencegah komplikasi intraoperatif dan kehilangan darah.

Introduction and objectives: Laparoscopic surgery has been acknowledged to reduce the morbidity rate thus improving patient safety. During the LLDN, the most frequent complication is renal vessels injuries, which often requires a blood transfusion. Besides the need for a blood transfusion, major bleeding caused by renal vessels injuries require open conversion and repair. Thus, this study would like to descript and analyze the need for blood transfusion in laparoscopic living donor nephrectomy surgery in our center.

Materials and methods: We performed a retrospective cohort study in the Department of Urology at Cipto Mangunkusumo National Hospital. The records of all kidney transplantation donor patients who underwent LLDN procedures carried out at our institution from November 2011 to October 2017 were reviewed. Data including donor age, preoperative hemoglobin level, postoperative hemoglobin level, intraoperative bleeding, number of artery(ies), number of vein(s), donor side, conversion to open surgery, surgery duration, and donor BMI were collected and analyzed. These data were further correlated with transfusion rate.

Results: There were 500 patients underwent laparoscopic living donor nephrectomy procedure at our institution. All of the patients had LLDN with a transperitoneal approach. The difference in blood transfusion rate proportion between male patients with 0.9% compared to 0.6% in female patients was not significant (p=0.782). There are no significant difference in blood transfusion rate proportion regarding to renal side (p=0.494), number of artery (p=0.362), age (p=0.978), BMI (p=0.569), and preoperative hemoglobin (p=0.766). Median estimated blood loss in patients who received intraoperative blood transfusion was significantly much greater than in patients who did not receive a blood transfusion (p<0.001).

Conclusion: Based on this study, we suggest that in our institution, preoperative blood products are not necessarily needed. The surgeon's learning curve and technique play a significant role in preventing intraoperative complications and blood loss."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020

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UI - Tesis Membership Universitas Indonesia Library

Bagus Baskoro

Learning curve pada prosedur laparoscopic living donor nephrectomy: dampak dari pendekatan berbasis mentor-initiated = Learning curve in laparoscopic living donor nephrectomy: impact of a mentor-initiated approach / Bagus Baskoro

"ABSTRAK

Tujuan:

Penelitian ini bertujuan untuk menganalisis variabel yang berhubungan

dengan kondisi intra-operatif dan pasca-operasi selama proses pembelajaran dan

melakukan evaluasi hasil dari metode berbasis

mentor-initiated pada LDN di Rumah Sakit Cipto Mangunkusumo (RSCM), Jakarta, Indonesia.

Material dan Metode: Penelitian retrospektif ini menggambarkan pengalaman pada 140 prosedur LDN yang dilakukan di RSCM sejak November 2011 sampai Agustus 2014. Sebanyak 66 kasus LDN pertama, dilakukan oleh seorang ahli bedah laparoskopi sebagai operator utama (mentor) dan secara bersamaan, membimbing operator kedua (trainee). Setelah itu, operasi dilakukan secara bergantian oleh kedua ahli bedah. Dilakukan analisis pada variabel yang berhubungan dengan kondisi intra-operatif dan pasca operasi pada 66 kasus LDN pertama, serta analisa perbandingan antara prosedur operasi yang dikerjakan oleh masing-masing ahli bedah.

Hasil: Rerata usia pendonor adalah 32.97 tahun dengan rasio jenis kelamin 6:4 (laki-laki:perempuan). Sebanyak 64% pendonor tidak memiliki hubungan keluarga dengan resipien. Donor ginjal kiri dilakukan pada 82.1% (n=112) prosedur, dan kanan sebanyak 17.9% (n=28). Tidak ada perbedaan signifikan pada waktu operasi (p=0.36), Warm Ischemia Time (WIT) 1 (p=0.66), jumlah perdarahan intra-operatif (p=0.46) antara kedua operator. Hanya satu variable (time to clip) yang ditemukan secara statistik bermakna, p = 0.024. Perbandingan antara grup pertama (1-50 LDN) dan grup terakhir (100-140 LDN) hanya variable WIT 1 dan time to clip; p = 0.029, p = 0.029 yang ditemukan signifikan secara statistik.

Kesimpulan: LDN merupakan suatu prosedur yang cukup menjanjikan dan aman untuk meningkatkan jumlah pendonor ginjal. Kesulitan untuk mencapai suatu learning curve menjadi permasalahan utama yang harus dihadapi oleh setiap ahli bedah laparoskopik, terutama karena dampak yang potensial terhadap keberhasilan suatu transplantasi ginjal. Pengalaman yang cukup pada operasi laparoskopi saluran kemih bagian atas sangat diperlukan sebelum melakukan LDN. Pendekatan berbasis mentor-initiated akan membantu peserta latihan untuk mengenali dan melakukan keseluruhan operasi dengan baik tanpa membahayakan patient safety.

ABSTRACT

Objective: variables related to both surgical and postoperative outcome during the learning curve and evaluate the result of mentor-initiated approach of laparoscopic donor nephrectomies at Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

Materials and Methods: This retrospective study describes our experiences on 140 laparoscopic nephrectomies in living donors performed in Cipto Mangunkusumo Hospital from November 2011 to August 2014. First sixty-six LDN was performed by one experienced laparoscopic surgeon as the main operator while mentoring the second operator. Afterward the surgery was performed alternately between the two surgeons. Variables related to both the surgical and postoperative outcome during the initial phase and comparisons of the procedures performed by each surgeon were analyzed.

Results: Donors’ average age was 32.97 years with male female ratio 6 : 4. About 64% patients were not family related. The left kidney procedures was performed 112 times (82.1%), whereas the right kidney 28 procedures (17.9%). No significant difference in operating time done by both operators (p= 0.36), WIT 1 (p=0.66), and intraoperative blood loss (p=0.46) with only time to clip as single statistically significant variable with p=0.024. Comparison between 1-50 LDN group and the 100-140 LDN group on WIT 1 and time to clip were found statistically significant with p = 0.029, p = 0.029. Conclusion: Laparoscopic donor nephrectomy (LDN) is a fairly safe and a promising procedure to increase the kidney donation pool. A steep learning curve is still the main problem that every surgeon had to deal with, mainly due to the concern of its potential impact on graft survival. Experience in laparoscopic upper urinary tract surgery is recommended to start with LDN. A mentor-initiated approach allows the introduction of this procedure to trainees with good results on

the overall surgery without compromising patient safety.

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014

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Andry Giovanny

Penggunaan antibiotik profilaksis dosis tunggal pada laparoscopic living donor nephrectomy: sebuah uji klinis tersamar acak ganda = Single dose prophylaxis antibiotic in laparoscopic living donor nephrectomy: a double blind randomized controlled trial study

"Penggunaan antibiotik secara benar telah menjadi perhatian dunia medis dikarenakan meningkatnya kejadian resistensi antibiotik. Prosedur standar penggunaan antibiotik profilaksis telah banyak diterapkan dalam prosedur bedah urologi, namun penggunaan obat antibiotik secara berkepanjangan setelah prosedur bedah urologi belum banyak dipelajari, terutama pada tindakan bedah urologi dengan kriteria bedah tercemar sepertilaparoscopy living donor nephrectomy(LLDN). Penelitian ini bertujuan untuk mengevaluasi aspek efisiensi dan keaman dari penggunaan antibiotik profilaksis dosis tunggal pada tindakan pembedahan LLDN di Rumah Sakit Cipto Mangunkusumo, Jakarta. Penelitian in merupakan studi klinis acak tersamar ganda yang dilakukan pada April 2015 hingga Agustus 2015 di Rumah Sakit Cipto Mangunkusumo. Lima puluh pasien pada penelitian ini dibagi menjadi 2 kelompok, dimana kelompok penelitian pertama dibagi mendapatkan 1 g cefoperazone dosis tunggal sebagai antibiotik profilaksis, sedangkan pada kelompok kedua diberikan 1g cefoperazone dosis tunggal yang kemudian dilanjutkan dengan dosis 2 kali sehari selama 3 hari. Angka kejadian infeksi pasca operasi dan faktor yang mempengaruhinya dibandingkan antara kedua kelompok percobaan. Hasil penelitian ini mendapatkan bahwa tidak ada perbedaan yang bermakna pada variabel umur, jenis kelamin, body mass index, jumlah leukosit dan hemoglobin pre operatif, durasi operasi, jumlah perdarahan intraoperatif maupun durasi perawatan pasien di rumah sakit antara kedua kelompok percobaan ini. Pada pengamatan hari pertama pasca operasi, pada kedua kelompok percobaan terdapat peningkatan jumlah leukosit: 15.540/ml (9.660/mL – 22.450/mL) pada kelompok dosis tunggal, dan 16.110/mL (9.440 /mL - 21.770/mL) pada kelompok dengan pemberian antibiotik selama 3 hari (P=0,466, 95% CI -2.453 to 1.141). Pada kelompok pasien dengan pemberian antibiotik profilaksis saja, didapatkan 1 pasien (4%) dengan gejala infeksi sistemik, sedangkan pada kelompok penelitian lainnya tidak didapatkan kejadian ini (P= 0,312). Dari penelitian ini kami menyimpulkan bahwa penggunaan antiobiotik dosis tunggal sebagai terapi profilaksis pada LLDN merupakan terapi yang aman dan efektif.

Proper antibiotic use has been on the world concern due to the increase ofantibiotic resistant. Standardized techniques and prophylactic antibiotics are widely used in urologic surgeries, but the prolonged administration of antibiotic after an operation has not been fully studied, especially clean contaminated surgery such as laparoscopy living donor nephrectomy (LLDN). This study was aimed to evaluate efficacy and safety of single dose prophilaxis antibiotic in laparoscopic live donor nephrectomy operation in Cipto Mangunkusumo Hospital, Jakarta. This study was a double blind randomized controlled trial conductedfrom April 2015 to August 2015 in Cipto Mangunkusumo Hospital. The single dose group were given 1 g cefoperazone as prophylactic antibiotics while the 3 days group were also given cefoperazone before surgery and continued twice daily for three days. The incidence of post-operative infection and contributing factor were compared between the two groups. Fifty patients participated in our study divided equally into two groups. There was no participant failed to comprehend to the study, counted as drop out. There were no significant differences in age, gender, body mass index, pre-operative leucocyte and hemoglobin value, duration of surgery, intraoperative bleeding and length of stay between the two groups. At the follow up 1^stday after surgery both groups showed elevated level of leucocyte, 15.540/ml (9.660/mL – 22.450/mL) in the single dose group and 16.110/mL (9.440 /mL – 21.770/mL) in the 3 days group. (P=0,466, 95% CI -2.453 to 1.141). There was only 1 patient in the single dose prophylaxis group (4%) with systemic infection sign, compared to no patient in the other group (P= 0,312). Single-dose prophylactic antibiotic is safe and as effective in the management oflaparoscopic living donor nephrectomy. "

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2018

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UI - Tesis Membership Universitas Indonesia Library

Sidabutar, Karina Evelyn

Keamanan pengunaan klip polimer pada nefrektomi donor hidup per laparoskopi: pengalaman di Indonesia = Safety of polymer clips in laparoscopic living donor nephrectomy: Indonesian experience / Karina Evelyn Sidabutar

"ABSTRAK

Penelitian ini dilakukan untuk menilai keamanan penggunaan klip polimer untuk kontrol vaskular pada nefrektomi donor hidup per laparoskopi. Kami mengumpulkan data secara retrospektif dari semua donor nefrektomi ginjal hidup per laparoskopi yang dilakukan di Rumah Sakit Cipto Mangunkusumo, Jakarta, Indonesia. Klip polimer digunakan untuk ligasi kedua arteri dan vena ginjal. Insidensi kegagalan klip polimer didokumentasikan untuk pendataan. Antara November 2011 dan Agustus 2015, kami mengevaluasi 260 pasien donor hidup dengan nefrektomi per laparoskopi. Ginjal kiri diambil dari 219 84,5 pasien. Arteri ginjal multipel ditemukan pada 25 9,6 pasien. Untuk semua kasus, kami menggunakan klip polimer untuk mengendalikan arteri ginjal XL dan L dan vena ginjal XL . Kami menempatkan 2 klip seproksimal mungkin ke aorta atau vena kava. Median estimasi perdarahan adalah 100 20 - 2000 ml. Perdarahan sebesar 2000 ml terjadi pada satu kasus, yaitu kasus klip terlepas. Rata-rata time to clip yaitu lamanya waktu dari sayatan pertama sampai ligasi arteri ginjal adalah 155 68 - 318 menit. Median warm ischemic time yaitu lamanya waktu dari ligasi arteri hingga cold ischemic time adalah 3,01 1,22 - 30,43 menit. Ada 10 kasus dengan warm ischemic time yang lebih dari 10 menit. Selain itu, terdapat 3 kasus 1,2 dengan kegagalan klip. Satu pasien membutuhkan konversi menjadi operasi terbuka untuk kontrol vaskular yang memadai. Dua pasien mengalami penguncian klip polimer yang tidak tepat, yang memerlukan pemasangan ulang klip. Penggunaan klip polimer untuk pengendalian vaskular pada nefrektomi donor hidup per laparoskopi relatif aman bila diterapkan dengan benar. Namun evaluasi tunggul vaskular ginjal setelah pengambilan ginjal donor merupakan langkah yang penting untuk memastikan penempatan dan keamanan klip polimer yang tepat.

ABSTRACT

This study was conducted to assess the reliability and safety of polymer clips for vascular control in laparoscopic living donor nephrectomy. We collected data retrospectively from all laparoscopic living donor nephrectomy performed in Ciptomangunkusumo Hospital, Jakarta, Indonesia. Polymer clips was applied for both renal artery and renal vein ligation. The incidence of polymer clip failure was recorded accordingly. Between November 2011 and August 2015, we evaluated 260 patients of laparoscopic living donor nephrectomy. The left kidney was harvested from 219 84.5 patients. Multiple renal arteries was discovered in 25 9.6 patients. For all cases we used polymer clips to control the renal artery XL and L and renal vein XL . We placed 2 clips as proximal as possible to the aorta or caval vein. The median estimated blood loss was 100 20 ndash 2000 ml. A blood loss of 2000 ml occurred in one case of clip dislodgement. The median time to clip the length of time from first incision to renal artery clamping was 155 68 ndash 318 minutes. The median warm ischemic time the length of time from clamping to cold ischemic time was 3.01 1.22 ndash 30.43 minutes. There were 10 cases with warm ischemic time of more than 10 minutes. Three cases 1.2 of clip failures occurred. One patient needed conversion to open surgery to achieve adequate vascular control. Two patients experienced improper locking of the polymer clips, necessitating clips reapplication. The use of polymer clips for vascular control in laparoscopic living donor nephrectomy is reliable and safe when properly applied. However the evaluation of renal vascular stump after harvesting donor kidney is an important step to ensure the right placement and safety of polymer clips."

2017

T55535

UI - Tesis Membership Universitas Indonesia Library

Albertus Marcelino

Donor ginjal obesitas pada era nefrektomi donor hidup per laparoskopi: seberapa aman? = Obese kidney donors in laparoscopic living nephrectomy era: how safe?

"Obesitas adalah masalah kesehatan di seluruh dunia, menyebabkan 3,4 juta kematian per tahun. Obesitas dinilai merupakan kontraindikasi relatif untuk operasi laparoskopi. Nefrektomi donor hidup per laparoskopi merupakan prosedur baku emas untuk pengangkatan ginjal pada beberapa pusat transplantasi. Namun pemilihan donor obesitas untuk menjalani laparoskopi nefrektomi masih menjadi perdebatan. Tujuan penulisan ini adalah untuk membandingkan hasil jangka pendek donor obesitas dan non-obesitas yang menjalani nefrektomi donor hidup per laparoskopi. Pada penelitian ini dilakukan analisa retrospektif pada 259 donor hidup antara November 2011 dan Agustus 2015. Indeks massa tubuh lebih dari 30 kg/m2 dikategorikan obesitas. Dua puluh subjek termasuk dalam kategori donor obesitas. Kami melakukan pengambilan sampel acak untuk 30 donor non- obesitas sebagai kelompok kontrol. Data intraoperatif dan pascaoperatif dibandingan antara kedua kelompok. Nilai p ≤0,05 menunjukkan perbedaan bermakna. Karakteristik yang sama terdapat pada kedua kelompok donor. Tidak terdapat perbedaan bermakna pada waktu iskemik pertama, perkiraan kehilangan darah intraoperatif, dan nyeri pascaoperatif pada kedua kelompok. Waktu operasi pada donor obesitas lebih lama daripada kelompok kontrol (270 vs 245 menit, p≤0,05). Waktu lama rawat lebih panjang pada kelompok obesitas (4 vs 3 hari, p≤0,05). Pada rumah sakit kami, donor obesitas menunjukkan hasil jangka pendek yang sebanding dengan donor non-obesitas pada nefrektomi donor hidup per laparoskopi. Meskipun ditemukan waktu operasi yang lebih lama dan lama rawat yang lebih panjang, tidak terdapat komplikasi yang bermakna pada donor obesitas. Masih diperlukan evaluasi hasil jangka panjang untuk rasionalisasi donor obesitas.

Obesity is a major worldwide health problem, causing up to 3.4 million deaths per year. it was considered as a relative contraindication for laparoscopic surgery. Nowadays, Laparoscopic living donor nephrectomy is the gold standard procedure for kidney procurement in many transplant centers. However, the selection of the obese donors undergoes laparoscopic nephrectomies is still debatable. The objective of this study is to compare short-term results of obese donors and non- obese donors undergoing laparoscopic living donor nephrectomies. A retrospective analysis of 259 live donors between November 2011 and August 2015 was performed. Body mass index equal or more than 30 kg/m2 was categorized as obese. Twenty subjects were categorized as obese donors. We randomly assigned for 30 non-obese donors for the control group. Intra-operative and post-operative data were compared between these two groups. A p-value ≤0.05 was considered significant. There were same donors’ characteristics between two groups. No significant differences were found in the first warm ischemic time, estimated blood loss, and postoperative pain. The operative time in the obese group was significantly longer than in the control group (270 vs 245 minutes, p≤0.05). The hospital stay was also significantly longer in the obese group (4 vs 3 days, p≤0.05). At our hospital, obese donors show comparable short-term results to non-obese donors in laparoscopic living nephrectomy. While longer operative time and length of stay were found, there was no significant complication observed. Long-term outcomes should be evaluated for the rationalization of these obese donors. "

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2017

T-Pdf

UI - Tesis Membership Universitas Indonesia Library

Elita Wibisono

Laparoskopi donor nefrektomi hidup di Rumah Sakit Cipto Mangunkusumo : nyeri pascaoperasi dan analisis pemulihan = Laparoscopic living donor nephrectomy in Cipto Mangunkusumo Hospital : postoperative pain and recovery analysis

"ABSTRAK

Laparoskopi donor nefrektomi hidup (LDNH) merupakan prosedur unik karena memengaruhi individu sehat. Dengan laparoskopi, nyeri masih dirasakan oleh pasien meskipun telah banyak berkurang. Studi ini bertujuan mengevaluasi nyeri pascaoperasi LDNH, serta pemulihan, dan faktor-faktor yang memengaruhinya. Penelitian ini adalah studi retrospektif noneksperimental dengan analisis deskriptif. Sampel diambil secara konsekutif di Rumah Sakit Cipto Mangunkusumo (RSCM). Kriteria eksklusi mencakup data tidak lengkap, riwayat nyeri kronik, dan konsumsi analgesik jangka panjang. Parameter yang dinilai meliputi data demografik dan data pascaoperasi. Dari bulan November 2011 hingga November 2015, terkumpul 277 pasien dengan median usia 30 (18-62) tahun dan rasio laki-laki:perempuan 9:4. Nyeri dinilai dengan Visual Analogue Scale (VAS) dan dikelompokkan menjadi nyeri ringan (0-2), sedang (3-4), dan berat (5-10). Didapatkan skor VAS pasca-LDNH hari-1 2(1-6), hari ke-2 2(0-4), dan hari ke-3 1(0-3). Perbaikan skor dari hari ke-1 hingga hari ke-3 signifikan (p<0,001). Nyeri berat hanya ditemukan pada hari ke-1 (2,2%). Metode anestesi yang digunakan, yaitu analgesik epidural (82,3%) dan kombinasi epidural-intravena (17,7%). Durasi analgesik epidural 2(1-7) hari, durasi kateterisasi 7(3-30) hari, durasi rawat inap 3(2-9) hari, kembali ke aktivitas normal 7(3-30) hari, dan kembali bekerja 14(6-90) hari. Terdapat hubungan yang signifikan antara VAS hari 1 dan 3 dengan relasi donor-resipien (p<0,001 dan p=0,029). VAS lebih tinggi ditemukan pada donor yang memiliki relasi dengan resipien. Kesimpulan penelitian ini adalah penanganan nyeri dan pemulihan pasien pasca-LDNH di RSCM sudah baik, dibuktikan dengan rendahnya skor VAS pascaoperasi dan baiknya parameter pascaoperasi. Nilai VAS berkorelasi dengan donor yang memiliki relasi, tetapi hal ini perlu diteliti lebih lanjut.

ABSTRACT

Laparoscopic living donor nephrectomy (LLDN) is a unique procedure as it can give impact to a healthy individual. Although postoperative pain in donor nephrectomy has been far reduced by laparoscopic technique, patients still can experience considerable pain. The aim of this study was to evaluate the LLDN postoperative pain and patients recovery as well as related factors. This study was non-experimental using descriptive analytic method with retrospective study design. Data of patients who underwent consecutive LLDN in Cipto Mangunkusumo Hospital were collected. Exclusion criteria were patients with incomplete data, history of chronic pain and long-term analgesic consumption. The parameters evaluated were demographic data (age, sex, body mass index, donor site, related or unrelated donor) and postoperative data (postoperative pain, types of analgesia, duration of catheterization, hospital length of stay, return to normal activities and return to work). Statistical analysis was carried out using SPSS version 20.0 with p-value less than 0.05 was considered statistically significant. From November 2011 to November 2015, there were 277 patients included with median age of 30 (18-62) years old and male-to-female ratio 9:4. LLDN postoperative pain was evaluated using Visual Analogue Scale (VAS) and classified to mild (0-2), moderate (3-4) and severe (5-10) pain. The VAS scores on day 1 were 2 (1-6), 2 (0-4) on the day 2, and 1 (0-3) on day 3 post LLDN. This value improved statistically significant from day 1 to day 3 (p<0.001). Severe pain was only found on the first day (2.2%). The most common analgesia technique used was epidural analgesia (82.3%), followed by combination of epidural and intravenous analgesia (17.7%). The postoperative data evaluated were duration of epidural analgesia (2 (1-7) days), duration of urethral catheterization (2 (1-5) days), length of hospital stay (3 (2-9) days), return to normal activities (7 (3-30) days), and return to work (14 (6-90) days). There were no significant relations between VAS scores in the day 1 and 3 with demographic and postoperative data (p>0.05), except in VAS for day 1 and 3 with donor-recipient relation (p<0.001 and p = 0.029); higher VAS was found in kidney donors who were related rather than the unrelated ones. The postoperative pain of LLDN patients in Cipto Mangunkusumo Hospital is adequately managed by analgesia provided as shown by the low postoperative VAS scores. The recovery parameters for LLDN patients also show promising result based on short length of hospital stay, return to normal activities and return to work. Higher VAS score correlated with kidney donors who are related but further studies are still needed to support this finding."

Depok: Fakultas Kedokteran Universitas Indonesia, 2019

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Hasan Basri, 1967-

Perbaikan pola sirkadian tekanan darah donor ginjal dengan ambulatory blood pressure monitoring pada 12 minggu pasca nefrektomi = Normalization of blood pressure circadian rhythm in kidney donors within 12 weeks post nephrectomy

"[ABSTRAK

Latar Belakang : Isu yang berkembang pada donor ginjal hidup adalah penurunan fungsi ginjal dan terjadinya hipertensi setelah dilakukan nefrektomi. Satu minggu setelah nefrektomi pola tekanan darah sirkadian berubah menjadi non dipper. Selanjutnya terjadi kompensasi sehingga fungsi ginjal akan stabil dalam 12 minggu. Namun belum diketahui apakah perbaikan fungsi ginjal akan diikuti oleh pola tekanan darah sirkadian kembali menjadi dipper.

Tujuan : Untuk mengetahui perubahan pola sirkadian tekanan darah donor ginjal hidup setelah 12 minggu nefrektomi unilateral.

Metode Penelitian : Studi Pre-experimental dengan before and after design. Subyek sebanyak 18 orang donor ginjal hidup sehat yang berusia 18-50 tahun . Peneltian dilakukan di RSCM pada bulan Januari 2015 sampai dengan Mei 2015. Tekanan darah diukur dengan 24 jam ABPM . Pemeriksaan kreatinin darah, eLFG epi dan uACR dilakukan sebelum nefrektomi, pada 1 minggu dan 12 minggu setelah nefrektomi.

Hasil :Terdapat 18 subyek yang memiliki pola dipper sebelum dilakukan nefrektomi unilateral. Tujuh belas subyek mengalami pola non dipper setelah 1 minggu nefrektomi. Pada 12 minggu setelah nefrektomi 16 diantaranya kembali menjadi pola dipper yang bermakna secara statistik (p<0.001).

Simpulan : Terdapat perubahan pola sirkadian tekanan darah non dipper kembali menjadi pola dipper pada donor ginjal hidup 12 minggu setelah nefrektomi unilateral.ABSTRACT Background : The issue of post nephrectomy in living kidney donor is kidney function decrease and hypertension. One week after nephrectomy circadian pattern of blood pressure becomes non dipper. Then there will be a compensatory of renal function that becomes stable within 12 weeks after nephrectomy. However, whether the improvement of renal function is followed by the circadian pattern of blood pressure becomes dipper is still unknown.
Aims : To know the changes circadian pattern of blood pressure among living kidney donors 12 weeks after unilateral nephrectomy.
Methods : A pre-experimental study with before and after design. The subjects were 18 healthy living kidney donors aged 18 to 50 years old , conducted in RSCM hospital between January 2015 to May 2015. Blood pressure was measured by 24 hours ABPM. Serum creatinine, e-GFR epi and uACR were taken before nephrectomy, 1 week and 12 weeks after nephrectomy.
Results : There were 18 subjects had dipper pattern before unilateral nephrectomy. Seventeen of them exhibited a pattern became non dipper on one week after nephrectomy. Sixteen subjects showed the pattern returned to dipper after 12 weeks nephrectomy that statistically significant (p<0.01)
Conclusions : The circadian pattern of blood pressure returned to dipper from non dipper on living kidney donors after 12 weeks unilateral nephrectomy., Background : The issue of post nephrectomy in living kidney donor is kidney function decrease and hypertension. One week after nephrectomy circadian pattern of blood pressure becomes non dipper. Then there will be a compensatory of renal function that becomes stable within 12 weeks after nephrectomy. However, whether the improvement of renal function is followed by the circadian pattern of blood pressure becomes dipper is still unknown.
Aims : To know the changes circadian pattern of blood pressure among living kidney donors 12 weeks after unilateral nephrectomy.
Methods : A pre-experimental study with before and after design. The subjects were 18 healthy living kidney donors aged 18 to 50 years old , conducted in RSCM hospital between January 2015 to May 2015. Blood pressure was measured by 24 hours ABPM. Serum creatinine, e-GFR epi and uACR were taken before nephrectomy, 1 week and 12 weeks after nephrectomy.
Results : There were 18 subjects had dipper pattern before unilateral nephrectomy. Seventeen of them exhibited a pattern became non dipper on one week after nephrectomy. Sixteen subjects showed the pattern returned to dipper after 12 weeks nephrectomy that statistically significant (p<0.01)
Conclusions : The circadian pattern of blood pressure returned to dipper from non dipper on living kidney donors after 12 weeks unilateral nephrectomy.]"

Fakultas Kedokteran Universitas Indonesia, 2015

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Pande Made Wisnu Tirtayasa

Delayed graft function pada laparoskopi donor nefrektomi hidup analisis multivariat = Delayed graft function following laparoscopic live donor nephrectomy a multivariate analysis

"[ABSTRAK

Latar
Belakang
Delayed
graft
function
(DGF)
adalah
komplikasi
yang
umum
dijumpai
pada
transplantasi
dari
mayat.
Berdasarkan
studi
terdahulu,
DGF
dan
factor
resikonya
memiliki
hasil
yang
bervariasi
pada
donor
nefrektomi
hidup
Metode
Peneliti
melakukan
analisis
retrospektif
dari
rekam
medic
donor
dan
resipien
transplantasi
ginjal
pada
100
kasus
laparoskopi
donor
nefrektomi
hidup
di
Rumah
Sakit
Cipto
Mangunkusumo
dari
November
2011
hingga
Februari
2014.
Kriteria
DGF
adalah
pasien
didialisis
pada
1
minggu
post
operasi
dan/
atau
kreatinin
lebih
dari
2.5
mg/dl
pada
hari
ke
7
post
operasi.
Pasien
yang
tidak
masuk
dalam
kriteria
tersebut
didefinisikan
memiliki
renal
allograft
yang
berfungsi
normal
Hasil
Prevalensi
DGF
pada
penelitian
ini
adalah
14%.
Indeks
massa
tubuh
resipien,
cold
ischemia
time,
waktu
anastomosis
vaskular,
dan
total
ischemia
time
lebih
tinggi
pada
grup
DGF,
tetapi
tidak
ditemukan
faktor
resiko
DGF
yang
signifikan
secara
statistic
saat
dilakukan
analisis
multivariat
Kesimpulan
Insidensi
DGF
pada
studi
ini
masuk
dalam
rentang
yang
diamati
pada
studi-‐
studi
sebelumnya.
Faktor
resiko
yang
dilaporkan
sebagai
faktor
resiko
DGF
pada
laparoskopi
donor
nefrektomi
hidup
tidak
signifikan
secara
statistik
dengan
DGF
pada
studi
kali
ini.
ABSTRACT
Background
Delayed graft function (DGF) is a common complication affecting deceased
donor renal transplantation. Based on previous studies, DGF and its risk factors in
live donor nephrectomy (LDN) have a various results.
Methods
We retrospectively analyzed the medical records of donor and recipient from our
first 100 cases of laparoscopic LDN in Cipto Mangunkusumo Hospital from
November 2011 to February 2014. The criteria used to define DGF were the
requirement for dialysis in postoperative week 1 and/or serum creatinine greater
than 2.5 mg/dl at postoperative day 7. Patients who did not match any of these
criteria were define as having normal renal allograft function.
Results
The overall prevalence of DGF was 14%. Recipients body mass index, cold
ischemia time, vascular anastomosis time, and total ischemia time were higher
among the delayed graft function group, but no risk factors for DGF were
significantly associated after multivariate analysis.
Conclusions
The incidence of DGF in our study was in the range of that observed in previous
studies. The factors that previously reported and believed as risk factors of DGF
in laparoscopic LDN were not significantly associated with the development of
DGF in our study.;Background
Delayed graft function (DGF) is a common complication affecting deceased
donor renal transplantation. Based on previous studies, DGF and its risk factors in
live donor nephrectomy (LDN) have a various results.
Methods
We retrospectively analyzed the medical records of donor and recipient from our
first 100 cases of laparoscopic LDN in Cipto Mangunkusumo Hospital from
November 2011 to February 2014. The criteria used to define DGF were the
requirement for dialysis in postoperative week 1 and/or serum creatinine greater
than 2.5 mg/dl at postoperative day 7. Patients who did not match any of these
criteria were define as having normal renal allograft function.
Results
The overall prevalence of DGF was 14%. Recipients body mass index, cold
ischemia time, vascular anastomosis time, and total ischemia time were higher
among the delayed graft function group, but no risk factors for DGF were
significantly associated after multivariate analysis.
Conclusions
The incidence of DGF in our study was in the range of that observed in previous
studies. The factors that previously reported and believed as risk factors of DGF
in laparoscopic LDN were not significantly associated with the development of
DGF in our study.;Background
Delayed graft function (DGF) is a common complication affecting deceased
donor renal transplantation. Based on previous studies, DGF and its risk factors in
live donor nephrectomy (LDN) have a various results.
Methods
We retrospectively analyzed the medical records of donor and recipient from our
first 100 cases of laparoscopic LDN in Cipto Mangunkusumo Hospital from
November 2011 to February 2014. The criteria used to define DGF were the
requirement for dialysis in postoperative week 1 and/or serum creatinine greater
than 2.5 mg/dl at postoperative day 7. Patients who did not match any of these
criteria were define as having normal renal allograft function.
Results
The overall prevalence of DGF was 14%. Recipients body mass index, cold
ischemia time, vascular anastomosis time, and total ischemia time were higher
among the delayed graft function group, but no risk factors for DGF were
significantly associated after multivariate analysis.
Conclusions
The incidence of DGF in our study was in the range of that observed in previous
studies. The factors that previously reported and believed as risk factors of DGF
in laparoscopic LDN were not significantly associated with the development of
DGF in our study., Background
Delayed graft function (DGF) is a common complication affecting deceased
donor renal transplantation. Based on previous studies, DGF and its risk factors in
live donor nephrectomy (LDN) have a various results.
Methods
We retrospectively analyzed the medical records of donor and recipient from our
first 100 cases of laparoscopic LDN in Cipto Mangunkusumo Hospital from
November 2011 to February 2014. The criteria used to define DGF were the
requirement for dialysis in postoperative week 1 and/or serum creatinine greater
than 2.5 mg/dl at postoperative day 7. Patients who did not match any of these
criteria were define as having normal renal allograft function.
Results
The overall prevalence of DGF was 14%. Recipients body mass index, cold
ischemia time, vascular anastomosis time, and total ischemia time were higher
among the delayed graft function group, but no risk factors for DGF were
significantly associated after multivariate analysis.
Conclusions
The incidence of DGF in our study was in the range of that observed in previous
studies. The factors that previously reported and believed as risk factors of DGF
in laparoscopic LDN were not significantly associated with the development of
DGF in our study.]"

2015

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