Left or Right Kidney in Hand-Assisted Donor Nephrectomy? A Randomized Controlled Trial

Abstract

Operating time of HALDN of the right kidney is significantly shorter than HALDN of the left kidney. No differences were detected in complication rates and graft survival between left and right-sided donor nephrectomy.

The Evolution of Laparoscopic Right Donor Nephrectomy: Progression to Single Site Surgery

“…Moreover, the intraoperative complication rates were similar between left and right donors, and the 3 right procurementtechniques. Our intraoperative complication rates are similar [5] if not better than others have reported [10,19]. We have not seen an increase in intraoperative complications despite the evolution of more technically challenging methods of procurement.…”

“…On the other hand, intraoperative complications related to splenic lacerations during mobilization of the splenic flexure of the colon or injuries to the supraadrenal branches of the left renal vein are more common in left sided donors [10]. In our study the overall intraoperative complication rate was 4.1%.…”

“…Furthermore, R-LAP-DN has been well-established and offers the donor all of the advantages associated with laparoscopic donor nephrectomy. Prior studies have shown that R-LAP-DN is faster than L-LAP-DN, with equivalent complication rates; however in our experience, laterality does not affect operative time [5,[8][9][10]. Left kidneys have been the preferred kidney at the majority of transplant centers because of the early documented increased incidence of venous thrombosis and early graft loss in right kidneys [4,15].…”

“…Technical modifications in the surgical technique, such as extending the renal vein length and reducing stretch on the renal artery, improved operative and post-operative outcomes by decreasing vascular complications [4][5][6][7]. In addition, several studies have shown that right kidneys procured via traditional hand-assisted or standard laparoscopic methods have shown equivalent function compared to a matched group of left sided allografts [5,[8][9][10][11]. Nevertheless, many centers remain reluctant to procure the right kidney, even if multiple vessels are present on the left kidney [3].…”

Surgical Advances in Laparoscopic Donor Nephrectomy

“…For example, in right sided donors, liver lacerations and injuries to the retro-aortic renal arteries are more common. On the other hand, intraoperative complications related to splenic lacerations during mobilization of the splenic flexure of the colon or injuries to the supra-adrenal branches of the left renal vein are more common in left sided donors [29].…”