Retroperitoneal Single Port Versus Transperitoneal Multiport Donor Nephrectomy: A Prospective Randomized Control...

Area of Science:

• Minimally Invasive Surgery
• Nephrology
• Transplant Surgery

Background:

• Transperitoneal laparoscopic donor nephrectomy (LDN) carries risks of visceral injury.
• Retroperitoneal (RP) laparoscopic donor nephrectomy was explored to mitigate these risks but faced challenges with muscle dissection.
• A translumbar incision offers a less invasive retroperitoneal approach.

Purpose of the Study:

• To compare the outcomes of standard multiport transperitoneal LDN (TP-LDN) with translumbar laparoendoscopic single-site donor nephrectomy (LESS-DN).
• To evaluate the efficacy and safety of a novel retroperitoneal approach for donor nephrectomy.

Main Methods:

• A randomized study comparing LESS-DN and TP-LDN in 50 kidney donors (January 2016 - June 2017).
• Exclusion criteria included BMI ≥30 kg/m², multiple renal arteries, and right-sided nephrectomy.
• Key outcomes measured: postoperative pain (VAS), operative time, blood loss, convalescence, and hospital stay.

Main Results:

• The RP group (LESS-DN) experienced significantly less pain (VAS 0.3 vs 1.1) and required less analgesia.
• The LESS-DN group demonstrated faster convalescence (7.0 vs 10.7 days) and shorter cumulative incision length (7.8 vs 12.4 cm).
• Reduced operative time and blood loss were observed in the LESS-DN group; other parameters were comparable.

Conclusions:

• The single-port retroperitoneal (RP) approach (LESS-DN) significantly reduces postoperative pain and accelerates recovery compared to the transperitoneal (TP) approach.
• This retroperitoneal technique offers a valuable alternative for reducing donor nephrectomy morbidity.
• Further adoption of the RP approach can enhance outcomes for kidney donors.