11 February 2020 : Original article
Evolution of Laparoscopic Donor Nephrectomy Techniques and Outcomes: A Single-Center Experience with More than 1000 Cases
Shin Jay Cho1CDEF*, Hyong Woo Moon1CDE, Sung-Min Kang2CDE, Sae Woong Choi1BC, Kang Sup Kim2BC, Yong-Sun Choi2BC, Sung-Hoo Hong1BC, U-Syn Ha1BC, Ji Youl Lee1DE, Sae Woong Kim1DE, Joon Chul Kim3BE, Hyuk Jin Cho1ABCDEFDOI: 10.12659/AOT.918189
Ann Transplant 2020; 25:e918189
Abstract
BACKGROUND: Laparoscopic donor nephrectomy (LDN) has evolved and has been established as a surgical standard of care for kidney transplantation.
MATERIAL AND METHODS: This study retrospectively reviews 1132 patients who underwent 4 different laparoscopic living-donor nephrectomies: hand-assisted laparoscopic nephrectomy (HALDN), pure laparoscopic donor nephrectomy (PLDN), laparoendoscopic single-site plus 1-port donor nephrectomy (LESSOP-DN), and mini laparoscopic donor nephrectomy (MLDN).
RESULTS: The mean estimated blood loss (EBL) for the HALDN group was meaningfully higher than those of LESSOP-DN and MLDN (57.5±52.2 mL versus 21.0±30.0 mL versus 18.2±28.7 mL) (P<0.001). The EBL for PLDN (53.3±35.3 mL) was also significantly higher than those of LESSOP-DN and MLDN (P<0.001). Length of stay (LOS) for HALDN was longer than that for LESSOP-DN (4.2±1.2 day versus 4.0±1.4 days, P=0.002). There was 1 intraoperative open conversion in the HALDN group and 2 HALDN surgeries that required postoperative exploratory laparotomy. LESSOP-DN had 3 (0.8%) postoperative incisional hernias. For recipients, the results revealed no significant differences between all 4 groups in terms of estimated glomerular filtration rate (eGFR) and the 1-year graft failure rate.
CONCLUSIONS: The LESSOP-DN group was associated with a shorter incision length than those of HALDN and PLDN and shorter LOS than that of HALDN. Recipient results showed no meaningful difference regarding laparoscopic donor nephrectomy technique.
Keywords: Kidney Transplantation, Laparoscopy, Living Donors, Blood Loss, Surgical, Hand-Assisted Laparoscopy, Kidney, Length of Stay, Nephrectomy
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