Standard vs Modified Technique of Laparoscopic Donor Nephrectomy

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Abstract

Introduction

Laparoscopic donor nephrectomy (LDN) has now become a standard procedure to retrieve the kidney. We present a modified technique of laparoscopic trans-peritoneal donor nephrectomy, which reduces total surgery time, chances of vascular spasm and post-operative lymphatic leak.

Materials and Methods

We started doing LDN in standard fashion from the year 1998. Donor was placed in kidney position. Standard port placement was done and colon was mobilised medially. Ureter-gonadal vein complex was identified and followed cranially till renal vein. Dissection of lymphatic vessels was carried out around the renal pedicle and renal fat was dissected free with baring of the kidney. Graft was retrieved through preplaced Pfannensteil incision. There were a number of cases with renal artery spasm and occasional acute tubular necrosis (ATN), lymphorrhoea and prolonged drainage from drain in situ. We modified this technique from 2010 with minimal dissection around renal vessels and mobilization of kidney along with renal fat. Lymphatic vessels were clipped and cut after clipping and cutting renal vessels. Removal of perinephric fat and lymphatics was done on the bench. (Video of the techniques to be demonstrated during oral presentation).

Results

We performed around 1200 LDN with standard technique vs. 800 cases with modified technique. Mean operative time in modified technique was 104 min vs. 136 min in standard technique. Mean duration of drain in situ was 4.2 days for standard technique vs. 2.3 days in modified technique. Renal artery spasm requiring papaverine instillation was in 112 cases of standard technique vs. nil in modified technique. Post operative ATN was seen in 24 cases of standard technique vs. 6 cases of modified technique. Minor renal trauma was seen in 86 cases of standard technique vs. in 12 cases of modified technique.

Conclusions

Our modified technique of LDN reduces chances of arterial spasm and subsequent ATN, total surgery time and incidence of post-operative lymphatic leak. Chances of renal injury (hematoma/tear) are also minimized.

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