118.5: Laparoscopic donor nephrectomy: Introduction, success strategies and outcomes.

Abstract

Background: Laparoscopic donor nephrectomy (LDN) has become the standard of care and popular among most of the transplant centers across the globe. However, for novices, it remains a challenge because of safety concerns during learning curve and many small volume centers are still hesitant to start laparoscopic donor program. At our institution, we adopted an approach that allowed us implementation of laparoscopic live donor nephrectomy without increased donor morbidity or graft failure, even during the early portion of a learning curve. Methods: From December 2016 to May 2019, 231 Laparoscopic donor nephrectomy were performed by transperitoneal approach. All donors and recipients underwent extensive preoperative evaluation and testing by a multidisciplinary team before the decision was made to proceed with the donation. To reduce beginner’s fear, we made some technical modification in surgical technique. One important modification was use of additional ports and involvement of 2nd consultant or chief surgical resident as assistant in some cases, depending on internal anatomy and the donor’s body habitus. Second important modification was in sequence of hilar dissection. In our approach we completed dissection on both poles of kidney first and did the difficult lumbar vein and hilar dissection in the last. Information that was collected and analyzed included epidemiological data, pre-, intra- and post-operative parameters including operative time, warm ischemia time, delayed graft function, length of stay and complications. Results: The first laparoscopic left donor nephrectomy at our institute was performed in December 2016 and till May 2019, 231 LDN were performed. Mean operation time was 108.4 (72-158) minutes, and Mean warm ischemia time 188(168-553)seconds. 26 donors (11.6%) suffered a total of 29 postoperative complications. All complications were Class I and Class II only. No major (Grade III and Grade IV) perioperative or postoperative complications occurred. So our initial data of 231 patients seems much better. We attribute this to various reasons. First reason for our success is proper planning and team approach. Involvement of experienced assistant and use of additional ports played a vital role. This strategy, facilitated maximum exposure of the renal hilum by simultaneous retraction and suction by assistant, leading to faster dissection, smooth progression and operative time reduction. Second reason in our opinion for our success is the sequence of hilar dissection in the last after dissection of both poles of kidney. It made intrahilar dissection easier and safer because of opportunity of dissection in a relatively stretched hilum with a possible vision from both poles. Conclusions: We propose that with proper planning, team approach and few technical modifications, introduction of laparoscopic live donor nephrectomy is safe and effective.