Transperitoneal Hand-Assisted Laparoscopic Donor Nephrectomy of the Right Kidney: Is There An Issue with the Renal Vessels?

Abstract

Objective: Short right renal vessels might complicate kidney transplantation causing traction and difficulties during anastomosis. Single-center prospective comparison of right- and left-sided transperitoneal hand-assisted laparoscopic donor nephrectomy is presented. Patients and methods: Eighty-two living kidney donors underwent hand-assisted laparoscopic donor nephrectomy (HALDN) between 2003 and 2008. Right-sided HALDN was performed in 73 living kidney donors. The operative technique of right-sided HALDN was modified in order to obtain the maximum length of right renal vessels. Outcome data in donors including quality of life as well as graft outcome in recipients were collected prospectively. Results: All procedures were completed laparoscopically with no conversion. Mean operative time was 127 min (vs. 138 min in left HALDN, p=0.08). The mean warm ischemia time was 41 sec (vs. 39 sec in left HALDN, p=0.23). There was no renal artery or vein thrombosis in any of the grafts. Mean blood loss was 81 mL (vs. 92 mL in left HALDN, p=0.09). Hospital discharge was on an average of 3.6 days postoperative. Delayed graft function occurred in two recipients: one in the left group and the other in the right group. One-year graft survival rate was 95% in the left group versus 96.9% in the right group (p=0.08). Further, no statistically significant difference in serum levels of creatinine was seen between the groups 1 year after the transplantation. Conclusions: Right HALDN is technically safe and feasible and results in convenient extension of right renal vessels to full length with no increased incidence of vascular thrombosis.