HAND-ASSISTED RETROPERITONEOSCOPIC DONOR NEPHRECTOMY - SINGLE CENTER EXPERIENCE FROM 450 CONSECUTIVE DONORS

Abstract

Introduction: Living donor nephrectomies has been performed since 1964 at our hospital. Since 2005 the handassisted retroperitoneoscopic donor nephrectomy has been used. It is considered safe and is associated with good results and outcome. Materials and Methods: All living donor nephrectomies in the year 2005-2018 at our institution has been included, in total 457 donors. 88 % (402/457) was left-sided donations. All donors had 3-month follow-up at our institution. All peroperative and postoperative complications has been recorded. No death. The most common peroperative complication was vascular (arterial) injury 1,7% (8/457) to the donor kidney, followed by bleeding 0,8% (4/457). Reoperation rate was low, 0,6% (3/457). Urinary tract infection 4,5% (21/457), followed by wound infection 3,2% (15/457) was the most common postoperative complications. Pulmonary embolism was diagnosed in 0,8%(4/457) of the donors.Results: Peroperative and early postoperative complications in 457 consecutive donors are presented. There were no deaths in this time-period. The most common peroperative complication was injury to vessel to the donor kidney and postoperative urinary- and wound infections.Discussion: In this consecutive series of donor nephrectomies some small changes has occurred over time. The anti-coagulation has been increased from Dalteparin 2500 ie to 5000 ie x1 starting the night before surgery. The antibiotic prophylaxis has remained the same. The Pfannenstiel incision was originally horizontally but has been vertically since 2014. Pain medication was changed from patient-controlled morphine pumps to automatic local anesthetic wound infiltration (Ropivacaine) in 2012. Conclusion: The handassisted retroperitoneoscopic donor nephrectomy method is safe and can be used for living donor nephrectomies with acceptable complication rates.