Abstract
There are two approaches to laparoscopic donor nephrectomy: standard laparoscopic donor nephrectomy (LDN) and hand-assisted laparoscopic donor nephrectomy (HALDN). In this study we report the operative statistics and donor complications associated with LDN and HALDN from large-center peer-reviewed publications. Methods. We conducted PubMed and Ovid searches to identify LDN and HALDN outcome studies that were published after 2004. Results. There were 37 peer-reviewed studies, each with more than 150 patients. Cumulatively, over 9000 patients were included in this study. LDN donors experienced a higher rate of intraoperative complications than HALDN donors (5.2% versus. 2.0%, P < .001). Investigators did not report a significant difference in the rate of major postoperative complications between the two groups (LDN 0.5% versus HALDN 0.7%, P = .111). However, conversion to open procedures from vascular injury was reported more frequently in LDN procedures (0.8% versus 0.4%, P = .047). Conclusion. At present there is no evidence to support the use of one laparoscopic approach in preference to the other. There are trends in the data suggesting that intraoperative injuries are more common in LDN while minor postoperative complications are more common in HALDN.
Highlights
There has been a rapid increase in living organ donation in order to bridge the shortfall between the demand and supply of donor organs
In this study we report the operative statistics and donor complications associated with laparoscopic donor nephrectomy (LDN) and handassisted laparoscopic donor nephrectomy (HALDN) from large-center peer-reviewed publications
Published reports suggest that LDN is more technically challenging than open donor nephrectomy (ODN) in patients who are greater than their ideal body weight [2]
Summary
There has been a rapid increase in living organ donation in order to bridge the shortfall between the demand and supply of donor organs. Kidney transplant recipients have benefited considerably by the expansion in living donation. The 2007 annual report from the Scientific Registry of Transplant Recipients (SRTR) shows that 45% of all transplanted kidneys were obtained from living donors [1]. Laparoscopic donor nephrectomy (LDN) became the surgical approach of choice [2]. Evidence shows that LDN does not adversely affect donor graft function or survival compared to kidney recovery through an open approach [3]. Published reports suggest that LDN is more technically challenging than open donor nephrectomy (ODN) in patients who are greater than their ideal body weight [2]
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