Abstract
Anterior vertical mini-incision donor nephrectomy (MIDN) has been used as the standard retrieval procedure in our center. Though the MIDN approach was tolerated very well with low complication rates, there were especially cosmetic reasons, to consider a change of procedure. Hence we switched to a total retroperitoneoscopic donor nephrectomy (RPDN) in 2011. We compared the outcome and surgical complications of donors and recipients of the first 30 RPDNs performed with 30 consecutive MIDN procedures. In both techniques, right and left nephrectomies were carried out. After a very short learning curve, the mean RPDN operation times were shorter compared to the MIDN (109 versus 171 min, P<0.01) and donors were discharged earlier. No major complications occurred in the RPDN group and complications were less frequent compared to MIDN (17% versus 40%). The renal function in the recipients was equivalent in both groups at the time of discharge and after one year. We conclude that RPDN is easy to learn for a surgical team experienced in open retroperitoneal donor nephrectomy. The change of the retrieval technique is safe for the donor and the recipient regarding surgical complications and recipients’ renal function. Donors benefit from RPDN due to earlier hospital discharge and faster recovery.
Highlights
Living kidney donation is one of the most elective procedures in surgery requiring optimal care and technique
We report the results of a single-center experience in the first consecutive 30 retroperitoneoscopic donor nephrectomy (RPDN) compared to 30 mini-incision donor nephrectomy (MIDN) with special emphasis on complications in the donor and the recipient possibly related to the different retrieval techniques
More right-sided nephrectomies were performed in the MIDN group, an effect we would attribute to the small number of patients, since the selection algorithm of the donor side was not changed
Summary
Living kidney donation is one of the most elective procedures in surgery requiring optimal care and technique. Since the introduction of laparoscopic techniques into the donation procedure, various efforts were made to minimize the surgical burden to the donor. Laparoscopic donation became more popular due to less postoperative pain and faster recovery of the donor compared to flank incision. Despite these benefits, there are concerns regarding intraabdominal alterations, such as adhesions of the intestine or injury of the diaphragm. There are concerns regarding intraabdominal alterations, such as adhesions of the intestine or injury of the diaphragm These can result from mobilization of the colon flexure which is needed to provide access to the kidneys. For laparoscopic access with or without hand assistance long operation times (>3 h), the need for an experienced surgeon (long learning curve) and the potential life-threatening complications like splenic injuries have been described [3,4,5]
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