Are concerns over right laparoscopic donor nephrectomy unwarranted?

Abstract

Objective: To examine the ability of several large, experienced transplantation centers to perform right-sided laparoscopic donor nephrectomy safely with equivalent long-term renal allograft function.

Summary background data: Early reports noted a higher incidence of renal vein thrombosis and eventual graft loss. However, exclusion of right-sided donors would deprive a significant proportion of donors a laparoscopically harvested graft.

Methods: A retrospective review was performed among 97 patients from seven centers performing right-sided laparoscopic donor nephrectomy. Surgical and postoperative demographic factors were evaluated. Complications were identified and long-term renal allograft function was compared with historical left-sided laparoscopic donor nephrectomy cohorts.

Results: Right laparoscopic donor nephrectomy was performed for varying reasons, including multiple left renal arteries or veins, smaller right kidney, or cystic right renal mass. Mean surgical time was 235.0 +/- 66.7 minutes, with a mean blood loss of 139 +/- 165.8 mL. Conversion was required in three patients secondary to bleeding or anatomical anomalies. Mean warm ischemic time was limited at 238 +/- 112 seconds. Return to diet was achieved on average after 7.5 +/- 2.3 hours, with mean discharge at 54.6 +/- 22.8 hours. Two grafts were lost during the early experience of these centers to renal vein thrombosis. Both surgical and postoperative complications were limited, with few long-term adverse effects. Mean serum creatinine levels were higher than open and left laparoscopic donor nephrectomy on postoperative day 1, but at all remaining intervals the right laparoscopic donors had equivalent creatinine values.

Conclusions: These results confirm that right laparoscopic donor nephrectomy provides similar patient benefits, including early return to diet and discharge. Long-term creatinine values were no higher than in traditional open donor or left laparoscopic donor cohorts. These results establish that early concerns about high thrombosis rates are not supported by a multiinstitutional review of laparoscopic right donor nephrectomies.

Figure 1. Patient positioning in the left lateral decubitus position, with port placements for the camera, working ports and liver retractor.

Figure 2. Placement of the surgical team, monitors, and the port and hand-assist device.

Figure 3. Kidney mobilization with retraction of the liver.

Figure 4. Mobilization of the vena cava with the surgeon’s hand inferiorly exposing the renal artery (A), vena cava (B), and liver (C).

Figure 5. Renal hilum dissection elevating the kidney with harmonic scalpel (A) and preparing to staple the renal artery (B) with an articulating stapler (C).

Figure 6. Vessels after the graft is removed demonstrating the stapled renal artery (A) and vena cava (B).

Figure 7. Comparison of short- and long-term serum creatinine values for right-sided laparoscopic, open, and left-sided laparoscopic donor recipients.