Laparoendoscopic Single-Site Donor Nephrectomy

Abstract

Living donor kidney transplantation is the best available treatment for end-stage renal disease. Unfortunately, donor burden, especially the threat of poor cosmesis, is a major impediment to living organ donation. Due to its decreased morbidity for the donor and equivalent outcomes for the recipient, laparoscopic donor nephrectomy is now accepted as a standard of care for living donor kidney procurement. The laparoendoscopic single-site (LESS) technique is the next step in further optimizing donor nephrectomy to expedite recovery and maximize cosmesis. Herein, we provide a detailed review and step-by-step surgical guide to LESS donor nephrectomy. The high degree of technical difficulty required for LESS donor nephrectomy limits its application; therefore, we also discuss current and future advances in the LESS technique, especially related to robotic technology. Owing to the improved range of motion and ergonomics afforded by robotic surgical systems, new developments in robotic technology may permit the widespread use of LESS in the future.