title: Laparoscopic donor nephrectomy at a low volume living donor transplant center: successful outcomes can be expected.
abstract: OBJECTIVE
  Concern has been raised about possible increased morbidity associated with laparoscopic donor nephrectomy (LDN) during the learning curve of the procedure and at centers with a low volume of living donors. We evaluated the safety and success of LDN at a low volume living donor transplant center with a skilled laparoscopic urologist and experienced renal transplant team.
  
  
  METHODS
  We reviewed the records of all patients who underwent LDN at our institution. A single surgeon skilled in laparoscopy (JAC) performed all LDNs. Patient demographics, operative reports, complications and recipient outcomes were evaluated.
  
  
  RESULTS
  A total of 17 LDNs were performed between January 2000 and September 2002. There was 1 elective conversion to an open procedure for kidney harvest due to complex hilar anatomy. Only 1 minor complication occurred (wound seroma) and 1 donor had creatinine persistently elevated to 1.9 mg/dl (normal 0.6 to 1.2). Mean operating room time, estimated blood loss and hospital stay were 250 minutes, 188 ml and 2.5 days, respectively. Recipient creatinine had a nadir mean of 1.2 mg/dl and a 90-day postoperative mean of 1.6 mg/dl. One recipient eventually lost the graft due to recurrent disease.
  
  
  CONCLUSIONS
  LDN can be performed safely and efficiently at low volume transplant centers with a skilled laparoscopist and experienced renal transplant team. Laparoscopic skills developed during similar procedures, such as laparoscopic radical and partial nephrectomy, minimize the learning curve and morbidity of LDN to produce results consistent with those in the published literature.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9110, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Duchene
authors.forename: D Brooke
authors.initials: DB
authors.lastname: Johnson
authors.forename: Shujun
authors.initials: S
authors.lastname: Li
authors.forename: Jay S
authors.initials: JS
authors.lastname: Roden
authors.forename: Arthur I
authors.initials: AI
authors.lastname: Sagalowsky
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Cadeddu
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome