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

Abstract

Background and objective The field of kidney transplantation in sub-Saharan Africa is still in the rudimentary stages. The majority of patients with chronic kidney disease have no access to renal replacement therapy, leading to very high mortality rates. Donor nephrectomy (DN) is an important aspect of kidney transplantation. Over the last two decades, open DN (ODN) has given way to minimally invasive techniques like laparoscopic DN (LDN) and robotic-assisted DN. In this study, we aimed to describe our experience with mini-flank incision donor nephrectomy (MIDN) at a Nigerian renal transplant center. Materials and methods We conducted a retrospective review of all DN cases performed at a single Nigerian kidney transplantation center over a three-year period. Information obtained from these patients was classified into pre-, intra-, and postoperative. The data included sociodemographic characteristics, preoperative preparation, details of intraoperative techniques, and postoperative findings. These were entered into a proforma and analyzed using SPSS Statistics version 21 (IBM Corp., Armonk, NY). Results A total of 230 patients underwent ODN during the study period. The majority of the donors were males (92.8%) with a mean age of 30.83 ±8.43 years. The body mass index (BMI) of most (76.1%) of the donors was within the normal range (18.5-24.9 kg/m 2 ). The duration of DNs ranged from 72 to 154 minutes with a mean duration of 130 ±28 minutes. The length of flank incisions ranged from 7.8 to 12 cm with a mean incision length of 10.8 ±1.0 cm. Donors who had MIDN attained satisfactory postoperative pain control with about 90% of them having a BMI of <30 kg/m 2 . Oral intake and ambulation were commenced on the first postoperative day, and the cosmetic outcomes were deemed acceptable in over 90% of kidney donors. Conclusion Mini-incision for DN through the flank approach is a suitable alternative to LDN in the developing world where facilities and skills for LDN or robotic nephrectomies are largely unavailable. It offers a short recovery time, early ambulation, and excellent allograft outcomes.

Kidney Transplantation in Nigeria: A Single Centre’s Early Surgical Experience and Outcomes

“…All kidney donors were evaluated for compatibility and had high-quality CT angiography to assess and determine the vascular anatomy of the kidneys and decide on which was most suitable for donor nephrectomy [15,22]. Donor nephrectomies were performed in an open fashion in this study for all patients, in contrast to the developed world where laparoscopic hand-assisted and robotic nephrectomies are the standard of practice [16,19,21,22]. Left open donor nephrectomy was more commonly performed in this series in a ratio 4:1, similar in literature [23,24] due to the longer left renal vein and its convenience during anastomosis.…”

“…An extraperitoneal flank approach was used for donor nephrectomy with the operation table in an in inverted-V position for all patient (Figure 1). A mini-skin incision measuring between 8 and 12 cm was used via an 11 th rib trans-costal approach [16]. The 11 th rib was excised to gain better access to the renal hilum especially in right donor nephrectomies.…”

Diagnostic dilemma and surgical management of circumcaval ureter: A case report

“…He was subsequently scheduled for an open ureteric exploration via a flank extraperitoneal approach as described in a previous publication. [ 11 ] Intraoperatively, a right circumcaval ureter was noted [ Figure 4 ] with significant stenosis of the postcaval ureter segment mimicking a pelvi-ureteric junction obstruction (PUJO) [ Figure 5 ] with prestenotic dilatation. Meticulous dissection and mobilisation were done from the renal pelvis down the pelvic brim to ensure a tension-free anastomosis [ Fiure 6 ].…”

Successful Third Kidney Transplantation in a Nigerian Kidney Transplant Center: A Case Report

“…On the day of the surgery, both the donor and the recipient were taken to the twin operating rooms of the hospital. The renal allograft was surgically removed from the donor through a mini-flank incision, as previously described [ 9 ]. During the donor workup, computed tomography angiography revealed a solitary renal artery and renal vein on the kidneys on both sides.…”