Evolution of the Technique of Laparoscopic Live Donor Nephrectomy at a Single Center: Experience with More than 350 Cases

Abstract

Aim: To present our experience with laparoscopic live donor nephrectomy (LLDN), evolution of the technique and analysis with respect to the cost-effective modifications. Materials and Methods: This is a retrospective review of all the LLDNs performed at our institute from January 2001 to November 2006. Few of the cost-effective modifications to the procedure include use of metallic autoclavable ports and instruments, Hem-o-lock clips for ureter, renal artery and vein, and extraction of the graft manually without use of a specimen retrieval bag. Results: From January 2001 to December 2001, 42 laparoscopy-assisted LLDNs, and since December 2001 380 LLDNs were performed, which includes 342 cases of transperitoneal and 38 cases of retroperitoneal LLDN. The mean operative time was 180 ± 45 and 192 ± 35 min, mean blood loss was 85 ± 50 and 115 ± 50 ml, warm ischemia time was 4.5 ± 2 and 3.5 ± 1.5 min in transperitoneal and retroperitoneal LLDNs, respectively. The total number of conversions was 14, with 12 in the transperitoneal group and 2 in the retroperitoneal group. Mean hospital stay was 3.14 ± 1.5 days. Recipient mean serum creatinine at days 1, 3 and 7 was 2.56 ± 0.91, 1.63 ± 0.46 and 1.72 ± 0.25, respectively. The total cost incurred by the patient at our institute for LLDN including stay in the hospital was USD 500 ± 150. Conclusion: LLDN provides all the benefits of minimally invasive therapy to the donors while preserving allograft function in the recipients. Few technical modifications can make the procedure more cost-effective for routine use.