Laparoscopic Live Donor Nephrectomy: Techniques and Results

Abstract

Living donation is still needed to overcome organ shortage. All countries seem to increase and encourage such kind of donation according to medical and ethical guidelines. The results of renal transplantation from living donors are better compared to those from cadaveric kidneys. Since the first successful kidney transplantation from a living donor, some 63 years ago, surgery has shifted toward a less invasive approach offering to the donor less pain, better cosmesis, a shorter hospital stay, and a quick return to normal activities. Laparoscopic living-donor nephrectomy (LLDN) is now considered as the gold standard approach for kidney retrieval on live donors and has undoubtedly revolutionized kidney donation. It must offer to the donor safety, low morbidity, and fast recovery and must obtain a graft with adequate vessel length, short warm ischemia time, and well-preserved ureteral blood supply. We describe our technique of LLDN according to safety principles and reproducible steps. Highly qualified and well-trained surgeons are allowed to perform such techniques within a very well-equipped environment and with experienced surgical staff. A living donor program should undertake at least 30 cases per year to maintain adequate experience and offer less complication rate.

Pure laparoscopic donor nephrectomy without routine drainage does not increase postoperative morbidity

“…Approximately 35% of kidneys from living donors in the United States in 2017 were harvested by a pure laparoscopic technique [ 25 ]. Despite some statements about the needless routine insertions of drain after PLDN [ 9 10 ], even experienced surgeons habitually put in a routine drain after PLDN due to a lack of verified evidence [ 11 12 ]. Because PLDN has been reported to be prone to chylous leakage and major complications including significant bleeding compared with open surgery [ 13 14 15 ], the benefits and risks of drain insertion after PLDN have been questioned.…”

“…Pure laparoscopic living donor nephrectomy (PLDN) was first reported in 1995 at Johns Hopkins Hospital by Ratner et al [ 8 ]. There is a consensus that routine insertion of a drain is not usually needed after PLDN [ 9 10 ]. In practice, even experienced surgeons may still insert routine drains after PLDN [ 11 12 ].…”