Living donor of the kidney-open-video.
OBJECTIVE
Living donor nephrectomy (LDN) has evolved a variety of different surgical techniques. Minimal invasive strategies were introduced to benefit the healthy donors. This paper attempts to identify the best possible practise in live kidney donation with special respect to donor safety.


METHODS
We present a single-centre experience of 173 live kidney donations and describe the surgical technique of open retroperitoneal donation in detail and by video sequences. Additionally, the evidence for donor safety (mortality and morbidity) and the integrity of the graft function are reviewed, comparing different surgical techniques for LDN.


RESULTS
Focussing on maximal donor safety, a retroperitoneal access seems mandatory. Very detailed informed consent, including the offer for different retrieval techniques, has led to a total of 163 open and 10 hand-assisted retroperitoneal live kidney donations at our institution. Published and own data reveal longer operating and warm ischaemic times for minimal invasive kidney removal when compared with open technique. Adequate perioperative analgesia (peridural catheter) provides comparable patient comfort, duration of hospital stay, complications and graft function although there are some procedure-associated risks for minimal invasive techniques.


CONCLUSIONS
The special ethical situation of live donation necessitates maximal donor safety. Although open antero-lateral incision and retroperitoneal access does provide some inconveniences for the surgeon, we are convinced that this and the hand-assisted retroperitoneal approach are the only two options for LDN.
Brockmann
Jens G
JG
Klinik und Poliklinik für Allgemeine Chirurgie, Universitätsklinikum Münster, Walderyerstrasse 1, 48149 Münster, Germany. jens.brockmann@ukmuenster.de
Senninger
Norbert
N
Wolters
Heiner H
HH
D006801:Humans; D016030:Kidney Transplantation / Q000592:standards*; D010535:Laparoscopy; D007813:Laparotomy; D019520:Living Donors; D009392:Nephrectomy / Q000379:methods* / Q000592:standards; D012187:Retroperitoneal Space / Q000601:surgery; D012196:Review Literature as Topic; D020858:Tissue and Organ Harvesting / Q000379:methods* / Q000592:standards