Laparoscopic Live Related Renal Transplantation: Preliminary Experience

Abstract

Introduction: Laparoscopic donor nephrectomy has gained popularity because of its excellent morbidity profile and appreciable outcome. However, laparoscopic approach for renal transplantation has been scarcely practiced till date.1,2 We present a video demonstration of laparoscopic renal transplantation and discuss the merits and demerits of this procedure. Methods: Patients were selected after detailed evaluation as per standard criteria for renal transplantation. Related donors with single renal artery and single renal vein were selected. The left side was selected for renal harvest. Renal recipients underwent ultrasonography and voiding cystourethrogram. Renal allograft was harvested through laparoscopic approach, and graft was prepared in bench and perfused with cold perfusant. Orientation stitches were made on the apex of the allograft artery, allograft vein, ureter, and upper pole of the graft. Recipients were placed in supine position with 20° right up tilt. Five ports were utilized. Peritoneal flap was created for placement of allograft. Allograft was inserted through a 5-cm Pfannenstiel incision. Allograft vein was anastomosed to recipient external iliac vein using 5-0 polypropelene suture in a continuous fashion and allograft artery was anastomosed to recipient renal artery using 5-0 polypropelene suture in a continuous fashion. A 11-centimeter-long suture was selected for arterial and venous anastomosis. Ureteroneocystostomy was created obeying Lich Gregoir principle, and a 4F ureteral stent was inserted retrograde across the ureterovesical anastomosis. Cold ischemia time, operative time, operative and postoperative events, and time to normalization of creatinine were noted. Ultrasound-doppler evaluation of the graft was performed at 5 days postprocedure. Results and Discussion: Three cases of laparoscopic live related renal transplantation were performed. Mean age of the donors was 39.67 years and mean age of the recipients was 33.3 years. Two recipients were female and one was male. Mean body mass index was 21.2 kg/m2. All procedures were completed via laparoscopic approach. Mean cold ischemia time was 61 minutes. Mean operation duration was 158.33 minutes and mean blood loss was 79.16 mL. Mean time to oral tolerance was 21.3 hours. Mean urine output on the first day was 9333.33 mL. Mean time to creatinine normalization was 5.33 days. Mean time to drain removal was 6.33 days and mean duration of hospital stay was 7.67 days. No significant intraoperative or postoperative happenings were recorded. On postoperative Doppler satisfactory vascular flow to the kidney was observed. The peak systolic velocity and RI values were within normal range. Laparoscopic renal transplantation ranks among the most advanced laparoscopic exercises practiced till date. The operator needs to be proficient in laparoscopic exercises. Satisfactory vascular reconstruction without undue delay and ureteric reimplantation remain the major challenges with this technique. Despite a longer cold ischemia sustained by the graft in comparison to incisional approach, no delay was experienced in graft function. The morbidity profile is excellent and the graft outcome is comparable to that achieved by conventional incisional approach. No competing financial interests exist. Runtime of video: 5 mins 46 secs