Laparoscopic donor nephrectomy: technique and outcome, a single-center experience

Background

Laparoscopic donor nephrectomy (LDN) has been established as a surgical standard for living kidney donation. The aim of this work is to report our own experience with LDN regarding outcome and technique.

Methods

We prospectively identified 110 LDN cases between May 2017 and April 2020. Donor case files and operative notes were analyzed for age, sex, laterality, body mass index, warm ischemia time (WIT), intraoperative and postoperative complications, operative time, and length of hospital stay (LOS). Data were analyzed using SPSS version 10 (SPSS: An IBM Company, IBM Corporation, Armonk, NY, the USA).

Results

The mean age was 38 years, and 77% were males. Three cases (2.72%) required conversion to conventional open donor nephrectomy (ODN). Nevertheless, none of cases required intraoperative blood transfusion. The mean WIT was 2.6 min. Two cases (1.8%) developed major vascular injury (Clavien grade IIIb) and required conversion to ODN. Postoperatively, one patient (0.9%) needed transfusion of one unit of packed RBCs (Clavien grade II). The mean LOS was 2 days. Most common early postoperative complication was ileus (Clavien grade II) that developed in 4 (3.6%) cases. Incisional hernia (Clavien grade IIIb) was encountered in two (1.8%) cases. Two (1.8%) cases developed wound infection at the incision site and treated conservatively (Clavien grade I).

Conclusions

LDN is a safe technique with accepted intraoperative and postoperative morbidity. It offers short hospital stay, better cosmesis and early convalescence. In experienced hands, it can effectively deal with various vascular and ureteral anomalies without compromising early graft function.

Single Stapler Technique for Vascular Control in Laparoscopic Donor Nephrectomy

BACKGROUND

Recent advancements in surgical instruments, energy sources, vascular staplers, and increased experience altogether led to several modifications in the laparoscopic donor nephrectomy (LDN) technique. In the conventional approach, the renal artery and vein are divided separately by vascular stapling. This study aimed to evaluate the safety and feasibility of using single vascular stapling technique for dividing the renal artery and vein simultaneously.

MATERIALS AND METHODS

Patients who underwent LDN performed by the same surgeon between January 2018 and January 2020 were included. Demographic data, body mass index, number of arteries and veins, vascular division technique, estimated blood loss, surgical time, warm ischemia time, surgical complications, and length of hospital stay were recorded. Descriptive statistics were used to describe the characteristics of the dataset.

RESULTS

A total of 196 donors were included in the cohort. The mean age was 44.5 years (19-80 years, standard deviation: 13.2). A total of 132 donors (82.65%) underwent left-sided LDN, and 34 (17.35%) underwent right-sided LDN. The mean surgical time and warm ischemia time were 68.4 ± 24.7 (32-116) and 2.8 ± 1.2 (1.6-4.0) minutes, respectively. Two cases were converted to open donor nephrectomy (1.02%). The single stapling technique was successfully performed in 168 (85.7%) donors with a single renal artery and vein.

CONCLUSION

Single stapling for the concurrent division of the renal artery and vein in the setting of LDN seems to be a safe and feasible approach. It also has the potential to shorten warm ischemia time and reduce the cost of LDN.

Laparoscopic Live Donor Nephrectomy: Single-Center Experience of 200 Consecutive Cases

Background: Renal transplantation is the ideal treatment method for end-stage renal disease. Since deceased organ donation rates cannot meet the demand, live donor kidney transplantation (LDKT) is commonly performed worldwide. Laparoscopic donor nephrectomy (LDN) is currently the most commonly preferred minimally invasive donor nephrectomy technique. However, experienced surgeons should perform this procedure since the safety of the live donor is the priority in transplant practice. In this study, we aimed to investigate this procedure's safety at the hands of a surgeon during the transition period from open donor nephrectomy (ODN) to LDN. Methods: Data of the donors and recipients who underwent LDN and LDKT in Ankara Medicana Hospital between 2016 and 2019 were included in this study. Demographic, surgical, and immunological data of the donors and recipients were collected retrospectively. Donor data, including duration of surgery, warm ischemia time (WIT), complication rates, duration of hospital stay, and recipient data such as patient and graft survival rates, were compared with the published literature. Results: Two hundred donors and 200 recipients were included. The complication rate, surgical time, WIT at the donor site, and 1- and 3-year patient and graft survival rates were all comparable with the literature. Survival rates were irrespective of the relationship status of the donors with recipients. Conclusions: The LDN procedure can be safely performed by a surgeon with extensive laparoscopic surgery experience in general surgery cases and ODN.