The introduction of minimally invasive surgery and laparoscopic techniques to urology has had their greatest impact on the unique procedure of laparoscopic donor nephrectomy. This has converted the utilized morbid operation of open nephrectomy, performed through a flank or subcostal approach, to a minimally invasive procedure associated with minimal morbidity and early discharge from the hospital. The scope of this abstract is to review the techniques utilized at our institution with specific emphasis on recent modifications developed to make it safer for the donor and the recipient. Furthermore, we believe that attention to every detail is imperative to ensure proper kidney retrieval via the laparoscopic approach, with consistently good results in the recipient.
Our center exclusively uses the transperitoneal access for kidney retrieval which provides a wider field for operation and easy maneuverability of the instruments especially during retrieval. Only pure laparoscopy (not hand assisted) is used since we believe that incision for removing the kidney from the abdomen is much smaller compared to the incision used for a hand-assisted approach using the hand port. Furthermore, the postoperative pain and morbidity are much less.
We performed a controlled sequential evaluation of open donor nephrectomy versus classical and modified laparoscopic donor Nephrectomy, recruiting 100 consecutive donor-recipient pairs operated upon from 1997 till 2003 [open Nx (n=30), performed 1997-2000 and lap Nx (n=70), performed 2000-2003] with prospective recording of operative data, anatomic details of graft, hospital stay and donor recovery.
The donor characteristics and renal function were similar for open Nx and lap Nx. Operative parameters were similar except for longer warm ischemia time in lap Nx vs. open Nx (3.14±2.10 vs. 1.5±0.5 min, p<0.001). Donor complications were equivalent but differed in spectrum (trend towards more intra-operative complications with lap Nx versus more postoperative complications for open Nx). Donor recovery, hospital stay, and return to work were improved in lap Nx vs. open Nx (p<0.001). Renal function in lap Nx vs. open Nx were similar (2-year serum creatinine1.26±0.21 vs.1.31±0.40, respectively), and graft survival were similar. In conclusion, Lap Nx offers major advantages to the donor compared to open Nx, and yields similarly favorable results in graft outcomes, but is more surgically demanding. Consequently, lap Nx should be adopted as the procedure of choice of live kidney retrieval. A detailed technical description of right and left donor nephrectomy including the technical modifications introduced at our center will be presented. A short video clip depicting the techniques will be shown.