Experience with laparoscopic donor nephrectomy at a European transplant centre

Abstract

Renal grafts from live donors represent an important source for transplantation of end stage renal failure patients. Postoperative short- and long-term comfort is essential. Laparoscopic nephrectomy was performed in 22 cases. The left kidney was preferred for optimal length of the vessels. One procedure was converted to open surgery because of venous bleeding. Warm ischemia time varied between 4 and 7.5 min. Urine production started peroperatively in all cases, and the renal function was excellent. Shoulder pain 1-3 days postoperatively was observed in seven patients; the rest were comfortable on peroral non-opioid analgesia. The patients were discharged at postoperative days 3-9, and returned to work 2-4 weeks later as compared to 4-8 weeks after open nephrectomy at our centre. Laparoscopic donor nephrectomy in the hands of experienced laparoscopic and transplant surgeons is a safe operation with less discomfort to the living kidney donor.

Living Donor Nephrectomy: Flank Incision Versus Anterior Vertical Mini-Incision

“…The minimal invasive open approach was well tolerated by our donors leading to reduced total and postoperative hospital stay compared with ODN. The postoperative hospital stay after MIDN is even comparable to that of other European transplant centers performing laparoscopic DN (13)(14)(15)(16). The open procedures allowed us to obtain kidneys with multiple arteries and veins.…”

Laparoscopic donor nephrectomy

“…Twelve studies described case series containing more than 20 laparoscopic donor nephrectomies without a control (level III) ( Table 3 )15, 16, 40–49. Seven case series with fewer than 20 laparoscopic nephrectomies50–56 and eight case reports57–64 were also identified (level III).…”

“…Laparoscopic procedures described in level I–II studies were performed between February 1995 and May 2001. A total of 13 included studies originated from papers with no formal peer‐review process39, 42, 43, 49, 50, 51, 53, 56, 65–69.…”

Laparoscopy for living donor nephrectomy - particularities of the currently applied techniques

“…Independent of the surgical technique applied and the side of the kidney to be retrieved the donor is usually placed in a full flank (lateral decubitus) position with the kidney planned to be extracted facing upwards [2,5,21,22]. Tissues are typically dissected using bipolar forceps and a pair of Metzenbaum scissors [2,6,23], while some authors prefer an ultrasonic dissector [3]. Meticulous control of bleeding is essential to avoid loss of overview because of light absorption by blood [2,5,6,15,21,22,24–27].…”

“…From 2001 on the number of living kidney donors in the USA has outscored the number of cadaveric donors. In Europe Scandinavian countries have the highest share of LDKT but a general trend toward an increase in living kidney donation is seen in Europe as well [http://www.optn.org; 2,3].…”