Transition from laparoscopic to retroperitoneoscopic approach for live donor nephrectomy

Area of Science:

• Urology
• Transplant Surgery
• Minimally Invasive Surgery

Background:

• Laparoscopic donor nephrectomy is the standard of care.
• Transperitoneal (TLDN) and retroperitoneoscopic (RLDN) are common approaches.
• RLDN offers anatomical benefits by avoiding intraperitoneal organ manipulation.

Purpose of the Study:

• Compare the merits of RLDN versus TLDN.
• Assess the learning curve for transitioning from TLDN to RLDN.

Main Methods:

• 106 live donor nephrectomies (56 TLDN, 50 RLDN) performed between January 2010 and February 2017.
• Collected data included demographics, perioperative parameters, pain scores, and graft function.
• Statistical analysis included Student's t test, Mann-Whitney test, and CUSUM analysis for learning curve.

Main Results:

• All procedures were successful without conversion to open surgery, blood transfusion, readmission, or mortality.
• No postoperative complications exceeded Clavien grade II.
• Kidney graft function was comparable between TLDN and RLDN groups.
• Follow-up ranged from 3 to 78 months.

Conclusions:

• Retroperitoneoscopic donor nephrectomy (RLDN) is a safe approach with outcomes comparable to TLDN.
• RLDN's anatomical advantage of avoiding intraperitoneal organ manipulation may lower perioperative complication risk.