Introduction of Laparoscopic Donor Nephrectomy: Challenges, Outcomes and Success Strategies

Abstract

Background: Laparoscopic live donor nephrectomy (LLDN) has become the standard of care and is popular among most of the transplant centers across the globe. Despite proven advantages of LLDN, some transplantation centers hesitate to start the program because of issues concerning donor safety and allograft function.

Objective: To discusses the main barriers for creating a successful LLDN program, strategies that allowed us to start a successful LLDN program along with the study results.

Methods: The donors undergoing LLDN from December 2016 to February 2018 were enrolled in the study and prospectively evaluated. LLDN were performed by two senior surgeons alternately with assistance by the laparoscopic urologist in all cases. Also, in the present study, two technical alterations were done in the standard surgical technique of transperitoneal LDN. The first important modification made was the use of two additional ports for use by laparoscopic urologists. The second modification involved dissection on both poles of the kidney before hilar dissection.

Results: A total of 112 transperitoneal LLDN were performed during the study period. The mean (range) of operation time was 117.5 (81–158) min; the ischemia time was 194 (171–553) sec. Only one patient needed conversion to open surgery. No other major peri-operative or posto-perative complications occurred. All kidney grafts were functioning well.

Conclusion: With proper planning, team approach, and few technical modifications, introduction of LLDN is safe and effective.