Five Year Experience With Single-Port Donor Nephrectomy as a Standardized Approach.

Abstract

In 2009, our center adopted a single-port transumbilical approach for living kidney donation and accepted this as our standardized approach after initial success. Our first reports demonstrated equivalent donor and recipient outcomes and improved patient satisfaction. Here we update our results with our 5 year experience and provide follow up of over 300 cases. Methods: A retrospective review of all single-port donor nephrectomies was performed under IRB approval. Operative and hospital records were collected and utilized to create a database of these patients. Results: Between 2009 and 2014, 338 cases were initiated via a single port approach. Left nephrectomy was performed in 97% of cases. Thirty-two cases (9.5%) required placement of additional ports due to technical challenges with renal mobilization or visualization due to intraabdominal fat. Multiple vessels were present in 41% of cases. Incisional hernia developed in 8 cases (2.4%). One patient required conversion to an open procedure for bleeding. Two patients required a return to the OR in the perioperative period: 1 for a bowel injury and 1 for an internal hernia. Two patients required post-operative blood transfusion. Operative time decreased between the first 100 cases and the subsequent cohort. Conclusions: Single port donor nephrectomy can be reliably performed with safe outcomes. As our prior report indicated, a low rate of incisional hernia exists, but this rate has has not increased with prolonged follow-up. Our earlier work supporting improved patient satisfaction, combined with this present large series of excellent outcomes, suggest that the single port approach should be the standard surgical approach in centers with appropriate technical expertise.