Laparoscopic donor nephrectomy-Technique and peri-operative outcomes in an Australian transplant center

INTRODUCTION

Demand for donor kidneys far exceeds the availability of organs from deceased donors. Living donor kidneys are an important part of addressing this shortfall, and laparoscopic nephrectomy is an important strategy to reduce donor morbidity and increase the acceptability of living donation.

AIM

To retrospectively review the intraoperative and postoperative safety, technique, and outcomes of patients undergoing donor nephrectomy at a single tertiary hospital in Sydney, Australia.

METHOD

Retrospective capture and analysis of clinical, demographic, and operative data for all living donor nephrectomies performed between 2007 and 2022 at a single University Hospital in Sydney, Australia.

RESULTS

Four hundred and seventy-two donor nephrectomies were performed: 471 were laparoscopic, two of which were converted from laparoscopic to open and hand-assisted nephrectomy, respectively, and one (.2%) underwent primary open nephrectomy. The mean warm ischemia time was 2.8 min (±1.3 SD, median 3 min, range 2-8 min) and the mean length of stay (LOS) was 4.1 days (±1.0 SD). The mean renal function on discharge was 103 μmol/L (±23.0 SD). Seventy-seven (16%) patients had a complication with no Clavien Dindo IV or V complications seen. Outcomes demonstrated no impact of donor age, gender, kidney side, relationship to the recipient, vascular complexity; or surgeon experience, on complication rate or LOS.

CONCLUSION

Laparoscopic donor nephrectomy is a safe and effective procedure with minimal morbidity and no mortality in this series.

Living Kidney Donor Knowledge of Provided Information and Informed Consent: The PRINCE Study

Background: Informed consent for living kidney donation is paramount, as donors are healthy individuals undergoing surgery for the benefit of others. The informed consent process for living kidney donors is heterogenous, and the question concerns how well they are actually informed. Knowledge assessments, before and after donor education, can form the basis for a standardized informed consent procedure for live kidney donation. Methods: In this prospective, a multicenter national cohort study conducted in all eight kidney transplant centers in The Netherlands, we assessed the current status of the informed consent practice for live donor nephrectomy. All of the potential living kidney donors in the participating centers were invited to participate. They completed a pop quiz during their first outpatient appointment (Cohort A). Living kidney donors completed the same pop quiz upon admission for donor nephrectomy (Cohort B). Results: In total, 656 pop quizzes were completed (417 in Cohort A, and 239 in Cohort B). The average donor knowledge score was 7.0/25.0 (±3.9, range 0–18) in Cohort A, and 10.5/25.0 (±2.8, range 0–17.5) in Cohort B. Cohort B scored significantly higher on overall knowledge, preparedness, and the individual item scores (p < 0.0001), except for the long-term complications (p = 0.91). Conclusions: Donor knowledge generally improves during the live donor workup, but it is still quite disappointing. Long-term complications, especially, deserve more attention during living kidney donor education.

Single-port live donor nephrectomy using a novel Curved Radius r2 Surgical System in an in vivo model

OBJECTIVE

Single-port laparoscopic donor nephrectomy provides low morbidity and satisfactory cosmetic results for patients. The aim of this animal study was to establish a surgical technique of single-site (LESS) living donor nephrectomy using novel curved r2 CURVE manipulators specially designed for single-port access.

MATERIAL AND METHODS

A total of six LESS nephrectomies were performed in three female pigs. r2 CURVE-instruments (Tuebingen Scientific Medical GmbH) were used providing a curved rotatable shaft, endless tip rotation, as well as 90° tip deflection. A 10 mm 30° extra long laparoscope, r2-curved Grasper, Maryland dissector and bipolar scissors were used for mobilization and dissection.

RESULTS

All LESS nephrectomies were performed successfully. Average operative time was 80 min (range, 42-149 min). No technical problems were observed. Insertion and extraction of the instruments through the single-port were easy to conduct. The diameter of the used single-port was sufficient for safe manual organ harvesting. Potential conflict between the laparoscope and the instrument handles was avoided by using an extra long laparoscope.

CONCLUSIONS

The new curved and deflectable instruments showed that single-port nephrectomy using the R2 manipulators is feasible. Single-port laparoscopic nephrectomy might be more patient-friendly and improve the willingness of potential donors to donate live organs.

Utility of inguinal incision in retroperitoneoscopic live donor nephrectomy

BACKGROUND

Retroperitoneoscopic live donor nephrectomy has been performed in many countries. The purpose of this study was to evaluate the inguinal incision as a route for hand-assisted manipulation and allograft retrieval.

METHODS

From April 2011 to June 2012, a prospective clinical study of 21 cases of retroperitoneal live donor nephrectomy was performed at our hospital. All donors were grouped in a test group (n = 11, inguinal incision) or a control group (n = 10, lumbar incision). The operative time, warm ischaemia time, blood loss, hospital stay, cosmetic satisfaction, incision complications, and recipient's serum creatinines were compared between groups.

RESULTS

All 21 cases of retroperitoneal live donor nephrectomy were accomplished successfully without serious complications. There was no difference in blood loss and operative time between groups. The mean warm ischaemic time and hospital stay was shorter (P < 0.01), and satisfaction with cosmesis was greater (P < 0.05) in the test group. The abdominal asymmetry (4/10) and wound dehiscence occurred only in the control group. The recipient's serum creatinine was lower in the test group at 1 day (P < 0.01) and 3 days (P < 0.05) after transplantation.

CONCLUSION

The inguinal incision offers an ideal route for hand-assisted manipulation and allograft retrieval during retroperitoneoscopic live donor nephrectomy, and has a potential to be generally applied in the future.