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

Area of Science:

• Urology
• Transplant Surgery
• Minimally Invasive Surgery

Background:

• Laparoscopic live donor nephrectomy (LLDN) is widely adopted but some centers hesitate due to donor safety and allograft function concerns.
• Addressing these barriers is crucial for expanding LLDN programs globally.

Purpose of the Study:

• To identify barriers to establishing successful LLDN programs.
• To present strategies and technical modifications for successful LLDN program initiation.
• To report outcomes of LLDN procedures.

Main Methods:

• Prospective evaluation of 112 donors undergoing transperitoneal LLDN between December 2016 and February 2018.
• Standard LLDN performed by senior surgeons with laparoscopic urologist assistance.
• Two technical modifications: use of additional ports and pre-hilar dissection.

Main Results:

• 112 transperitoneal LLDN procedures completed with a mean operative time of 117.5 minutes and ischemia time of 194 seconds.
• Only one conversion to open surgery was required; no major peri- or post-operative complications.
• All kidney allografts demonstrated good initial function.

Conclusions:

• LLDN can be safely and effectively introduced with meticulous planning and a collaborative team approach.
• Specific technical modifications enhance the safety and efficacy of LLDN.
• Successful LLDN programs are achievable, improving donor and recipient outcomes.