Comparing Surgical Complications of Donors and Recipients in Retroperitoneoscopic versus Mini-Incision Donor Nephrectomy: A Single-Center Experience

Abstract

Anterior vertical mini-incision donor nephrectomy (MIDN) has been used as the standard retrieval procedure in our center. Though the MIDN approach was tolerated very well with low complication rates, there were especially cosmetic reasons, to consider a change of procedure. Hence we switched to a total retroperitoneoscopic donor nephrectomy (RPDN) in 2011. We compared the outcome and surgical complications of donors and recipients of the first 30 RPDNs performed with 30 consecutive MIDN procedures. In both techniques, right and left nephrectomies were carried out. After a very short learning curve, the mean RPDN operation times were shorter compared to the MIDN (109 versus 171 min, < 0.01) and donors were discharged earlier. No major complications occurred in the RPDN group and complications were less frequent compared to MIDN (17% versus 40%). The renal function in the recipients was equivalent in both groups at the time of discharge and after one year. We conclude that RPDN is easy to learn for a surgical team experienced in open retroperitoneal donor nephrectomy. The change of the retrieval technique is safe for the donor and the recipient regarding surgical complications and recipients' renal function. Donors benefit from RPDN due to earlier hospital discharge and faster recovery.

Prediction, prevention, and management of delayed graft function: where are we now?

“…Left vs right laparoscopic living‐donor nephrectomy does not appear to influence rates of DGF . Retroperitoneoscopic donor nephrectomy, a less invasive surgical approach, does not adversely affect risk for DGF, nor hand‐assisted laparoscopic retrieval . The pathogenesis of DGF after living donation is different from DGF after deceased donation.…”

Donor Nephrectomy Through Mini-Flank Incision: A Single-Centre Experience Among Nigerian Patients

“…The majority of our study population were young males in their third and fourth decades of life, which contrasts with several other studies where more female donors were encountered with a mean age of over 50 years [ 16 , 17 ]. This is likely due to the fact that most Africans believe that men are stronger than their female counterparts, and hence able to withstand the rigors of surgery [ 18 ].…”

Anterior vertical mini‐incision vs. retroperitoneoscopic nephrectomy in living kidney donation: a prospective study on donors' quality of life and clinical outcome

“…Ruszat et al also found a comparable major complication rate in ODN, LDN, hand‐assisted LDN, and RPDN, but they conclude that learning laparoscopic nephrectomy might be associated with a higher complication rate. As we describe elsewhere, the RPDN technique is relatively easy to perform and has a short learning curve .…”

“…At our center, donor nephrectomies were routinely performed in a retroperitoneal approach to avoid possible intra‐abdominal complications. In March 2011, we changed our surgical technique from anterior vertical MIDN to a retroperitoneoscopic approach to further reduce the surgical burden for our patients. Here, we report the results of a single‐center experience in the first consecutive sample of n = 45 RPDN donors compared to a consecutive sample of n = 38 MIDN donors assessed immediately before the technique was changed.…”

“…Another retroperitoneal technique is RPDN, first described by Yang et al (11). Like LDN, it has the benefit of small incisions for the donor but combined with easier access to the blood vessels, a shorter learning curve, and the lack of complications of the transabdominal approach of LDN (9,10,(12)(13)(14)(15)(16). Data regarding the outcome of RPDN, however, are still comparatively scarce (4,14).…”