Techniques in laparoscopic donor nephrectomy

Abstract

What's known on the subject? and What does the study add? Innovations in laparoscopic surgery have provided transplant surgeons with a range of techniques as well as a vast array of minimally invasive instruments. Whilst randomized control trials have compared open and laparoscopic donor nephrectomy, there is a paucity of high quality data comparing different laparoscopic approaches. This article summarizes the main techniques of laparoscopic donor nephrectomy currently in use and reviews the evidence available for each. In addition, controversial aspects of donor nephrectomy are examined, including the technological advances applicable to this operation. Increasing numbers of living donor kidney transplants are being performed worldwide, and the majority of donor operations are now laparoscopic. Transperitoneal ‘pure’ and hand‐assisted laparoscopic donor nephrectomy are the two most commonly performed procedures, although retroperitoneal approaches are advocated by some centres. Controversy persists with respect to the technical aspects of donor nephrectomy, including both the approach and the method of ligation of the hilar vessels. More recently, robot‐assisted, laparo‐endoscopic single site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES) ‐assisted donor nephrectomy have also been performed, further increasing the number of options available, but creating uncertainty as to the ideal approach.

Utility of inguinal incision in retroperitoneoscopic live donor nephrectomy

“…The laparoscopic technique has been widely used for living donor nephrectomy (LDN) . Compared with open donor nephrectomy, LDN has advantages of less trauma, less intra‐operative blood loss, less post‐operative complications, and shorter hospital stay, without differences in renal allograft function .…”

Laparoscopic Living Donor Nephrectomy

“…Other advantages of HALDN over LDN include shorter operative and warm ischemia times. Potential disadvantages of HALDN are the higher cost caused by the disposable hand port and a higher rate of incisional hernia (1).…”

“…Transperitoneal 'pure' and hand-assisted laparoscopic donor nephrectomy (HALDN) are the two most commonly performed procedures, although retroperitoneal approaches are advocated by some centers (1).…”

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

“…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).…”