Abstract
Background:
Laparoscopic donor nephrectomy (LDN) has become the gold standard approach for kidney donation. The procedure has evolved with time and technological advancements. Contemporary LDN underwent multiple technical refinements to decrease operative time, warm ischemia times (WITs), morbidity, and improve safety of the procedure.
Objective:
To illustrate contemporary surgical techniques for LDN and provide a step-by-step guide for the procedure.
Design, Setting, and Participants:
Our Prospectively maintained donor database was reviewed for donors who underwent left LDN between January 2013 and December 2016.
Surgical Procedure:
Pure laparoscopic left donor nephrectomy was performed using contemporary standardized technique, all patients were enrolled in enhanced recovery program for donor nephrectomy.
Outcome Measurements and Statistical Analysis:
Clinical data were collected in a prospectively maintained database. Perioperative donor and recipient outcomes were evaluated.
Results and Limitations:
A total of 246 donors were included in the study. Mean operative time was 145.2 ± 31.6 minutes. Mean estimated blood loss was 165.6 ± 45.2 mL. Mean WIT was 2.9 ± 1.0 minutes. Complications were reported in 27 patients (10.9%), patients with Clavien grade 1 in 15 patients (6.9%), grade 2 in 11 patients (4.4%), and Clavien grade 3 in 1 patient (0.4%) (inferior epigastric artery-related hematoma and subsequent evacuation). Vascular control in this series was achieved by double Hem-O-Lok application after a policy change in our institute because of a stapler malfunction. The main limitation of this study is the retrospective nature despite prospective maintenance of our database.
Conclusion:
With cumulative refinement of the technique, the described approach for laparoscopic left donor nephrectomy may improve the efficiency of the procedure and offer functional advantage of the graft with low complication rates.
Authors have received and archived patient consent for video recording/publication in advance of video recording of the procedure
No competing financial interests exist.
Runtime of video: 8 mins 55 secs
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