LAPAROSCOPIC LIVE DONOR NEPHRECTOMY: IS IT SAFE? ANALYSIS OF 69 CONSECUTIVE CASES AND COMPARISON TO OPEN NEPHRECTOMY

Abstract

44 Introduction: Laparoscopic live donor nephrectomy (LDN) is a less invasive alternative to open nephrectomy (ODN) for living kidney transplant donation. Although a more rapid and less painful post-operative recovery has been reported for LDN, concerns have been raised regarding the safety of LDN, the short and long term function of kidneys removed by LDN, and a potential higher incidence of urologic complications in transplant recipients secondary to ureteral trauma during LDN. Objective: To assess the results of LDN as compared to ODN, the feasibility and safety of LDN, and the incidence of delayed graft function and urologic complications in LDN kidneys post-transplant. Methods: Between 10/97 and 1/99, 69 LDN's were performed at our center. All patients were followed longitudinally with office visits and telephone interviews. These patients were compared to 50 ODN performed from 1/96 to 10/97.(Table)TableLDN procedures took significantly longer than ODN. However, LDN was associated with significant reduction in i.v. narcotic use, a rapid return to diet, and shorter hospital stay. No patients undergoing successful LDN required epidural or PCA analgesia, while all ODN pts did. Of the 69 LDN procedures, a total of 64 (93%) were completed laparoscopically. Five patients were converted to laparotomy: three for hemorrhage and two for questionable vascular anatomy. 7 LDN pts had minor complications and 4 had major complications. All major complications consisted of vascular injuries (2 lumbar vein injuries, 1 renal artery and 1 aortic injury). Open conversion was associated with large donor body habitus and/or obesity (4 of 5 pts > 90 kg). All patients made complete recoveries. All LDN kidneys functioned immediately post-transplant. We have observed 100% graft and patient survival in LDN transplant recipients. There have been no short or long-term urologic complications in this series. Conclusion: With increasing experience and standardization of technique, LDN is a safe and effective procedure. LDN patients have a rapid postoperative recovery and short hospital stay. Excellent initial graft function and long-term graft survival have been observed. With careful surgical technique, urologic complications can be avoided. LDN has become the preferred surgical approach performed by transplant surgeons for living kidney donation at our center.