Retroperitoneal Donor Nephrectomy: An Experience of 490 Patients in Mexico

Laparoscopic nephrectomy is the standard for kidney donors, offering the advantages of minimally invasive surgery without increasing risks to the patient or the graft. There are several transperitoneal and retroperitoneal approaches, but there is no consensus on the optimal one.

To present our centre's experience with retroperitoneal lumboscopic nephrectomy and to report the outcomes achieved in terms of safety, donor morbidity, and graft performance.

A retrospective observational cohort analysis of patients undergoing retroperitoneal lumboscopic nephrectomy between October 2016 and December 2023 was performed. Descriptive statistical analysis was performed with median and interquartile ranges, as well as frequencies and percentages as appropriate.

Between October 2016 and December 2023, we operated on 490 patients, of whom 203 were men. Left nephrectomy was performed in 486 of the surgeries. There was no mortality associated with the procedure, and morbidity was minimal. The mean surgical time was 96 minutes with a standard deviation (SD) of ± 13 minutes. Three patients (0.6%) required reoperation: two for residual hematoma and one for a chylous collection. Four patients (0.8%) required conversion to open surgery. All procured kidneys were transplanted, and the average warm ischemia time was 4.5 minutes (SD ± 1.2 min). Two of the recipients of these grafts experienced delayed graft function, which subsequently resolved, and the patient now has a functioning kidney. Postoperative outcomes were favorable, and hospital stays were less than 72 hours, except for the two patients who underwent early reoperation. Patients returned to their normal daily activities in approximately three weeks.

Laparoscopic retroperitoneal nephrectomy proved to be a safe and effective surgical technique with excellent results for both the patient and the graft.