title: First experience: Open small incision rectus sheath approach renal transplant: A case series.
abstract: BACKGROUND
  Prevention of wound complications is an important goal in surgery, and reduction of modifiable risks factors are an important step towards protecting patients from further complications. Renal transplantation has sought to be more inclusive giving access to transplantation to complex patient populations, many of which have an increased risk of complications specifically obese recipients. Surgical techniques continue to advance and may contribute to reducing complications. We hypothesized that the Anterior Rectus Sheath (ARS) Approach would provide an open transplant with minimal damage and less wound complications, including fluid collections such as lymphoceles, when compared to the conventional technique (CON) with equivalent graft function and survival.
  
  
  METHODS
  The ARS approach was adopted at our center in November of 2012. Medical records for 44 patients that underwent kidney transplantation at our Center between May 1, 2012 and March 31, 2013 were reviewed with data collected up to August 2015. Two were excluded (2 intraperitoneal transplants), leaving 22 in the ARS group and 20 in the CON group.
  
  
  RESULTS
  Demographics, data, and perioperative factors were found to be similar, but operative and post-operative findings indicated significant differences between the groups. Significant reductions of wound complications, including fluid collections, were observed and operative time, incision length, and drain usage were improved with the ARS technique. Secondary outcome assessing overall patient outcomes showed no significant difference.
  
  
  CONCLUSIONS
  This retrospective review case series quantified that this easily adopted modification of the conventional transplant technique is a safe, effective, and swift approach to renal transplantation with favorable graft results and improved surgical outcomes with less post-operative wound complications.
authors.affiliation: Urologic Surgery, Charleston Area Medical Center, Charleston, WV, USA.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Phillips
authors.affiliation: Health Education & Research Institute, Charleston Area Medical Center, Charleston, WV, USA.
authors.forename: Sharon K
authors.initials: SK
authors.lastname: Hill
authors.affiliation: Renal Transplant Center, Charleston Area Medical Center, Charleston, WV, USA.
authors.forename: Lorie D
authors.initials: LD
authors.lastname: Lipscomb
authors.affiliation: Renal Transplant Center, Charleston Area Medical Center, Charleston, WV, USA; Glickman Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: Joseph.africa@camc.org.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Africa
mesh_terms: D000328:Adult; D000368:Aged; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D017568:Rectus Abdominis / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D000072836:Surgical Wound; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
keywords: Kidney transplant; Minimally invasive; Surgical technique; Wound complications