Retroperitoneal laparoscopic live donor nephrectomy: a cost-effective approach

Area of Science:

• Urology
• Minimally Invasive Surgery
• Transplantation Surgery

Background:

• Live donor nephrectomy is crucial for kidney transplantation.
• Traditional methods can be invasive, leading to donor morbidity.
• Developing cost-effective and safe surgical techniques is essential, especially in resource-limited settings.

Purpose of the Study:

• To establish a modified, cost-effective, and safe retroperitoneal laparoscopic live donor nephrectomy (RPLLDN) approach.
• To evaluate the safety and efficacy of this modified technique in a series of living renal donors.

Main Methods:

• A consecutive series of 109 living related renal donors underwent a three-port retroperitoneal laparoscopic live donor nephrectomy (RPLLDN).
• A novel method was used to create the retroperitoneal space, and harmonic scalpels/scissors were employed for vessel and ureter division.
• Graft retrieval involved a longitudinal 6-8 cm incision, with main renal vessels secured by Hem-o-lok clips.

Main Results:

• All 109 procedures were successful with a mean operation time of 129.7 minutes and mean warm ischemic time of 3.6 minutes.
• Mean blood loss was minimal (73.6 mL), with no requirement for blood transfusion or conversion to open surgery.
• Donor complications were low (5% minor), and recipient complications were also limited (3% major, 4% minor).

Conclusions:

• The modified retroperitoneal laparoscopic live donor nephrectomy (RPLLDN) approach is a safe and effective alternative.
• This technique offers a cost-effective solution for kidney donation, particularly beneficial for developing countries.
• The study demonstrates successful outcomes with low morbidity for both donors and recipients.