Initial experience with laparoscopic donor nephrectomies

Laparoscopic donor nephrectomy (LDN) is being adopted rapidly by transplant centres around the world as it offers less postoperative pain, quicker convalescence, and better cosmetic result when compared with the open approach. There may, however, be a steep learning curve with this technique.

A retrospective review was performed to evaluate the donor morbidity and graft outcome of 21 consecutive LDN performed at one centre between May 2002 and August 2003.

Eighteen LDN were performed on the left and three on the right side. All left and one right LDN were done transperitoneally while the remaining two right side kidneys were removed by a retroperitoneal approach. The mean (+/-SD) operating time and warm ischemic time were, respectively, 236 minutes (+/- 46) and 4 minutes (+/- 1). The mean time for resuming oral intake was 23 hours (SD +/- 22.7). The median length of hospital stay was 5 days (range 3 to 18). One patient was reoperated for bleeding and required four units of packed cell transfusion. One recipient displayed delayed graft function requiring dialysis for 14 days. There were no graft losses. The mean creatinine of the recipients at the time of discharge was 1.15 mg/dL (+/- 0.21).

There is undoubtedly a learning curve with LDN. Nevertheless, with prior skills in similar procedures such as laparoscopic radical nephrectomies, it is feasible to diminish the learning curve and morbidity of LDN to yield results consistent with those in the published literature.