title: Laparoscopic living donor nephrectomy: is there a difference between using a left or a right kidney?
abstract: BACKGROUND
  The goal of this study was to review the results of 279 laparoscopic living donor nephrectomies (LLDN) regarding outcomes of using the left or the right kidney.
  
  
  METHODS
  Among 279 patients who underwent LLDN between August 1998 and April 2009, 260 underwent a left (group L) and 19, a right (group R) nephrectomy. The two groups were compared regarding intra- and postoperative parameters, including pre- and postoperative renal function, length of surgery, conversion to an open approach, delayed graft function, and complications.
  
  
  RESULTS
  There were no significant differences between the two groups regarding preoperative glomerular filtration rate (L = 129.5 ± 32 mL/min versus group R = 127.3 ± 26 mL/min), length of surgery (group L = 228 ± 58 minutes versus group R = 226 ± 62 minutes group), postoperative donor creatinine (group L = 1.36 ± 0.9 mg/dL versus group R = 1.48 ± 0.8 mg/dL), conversion to open (group L = 6.6% versus group R = 5.3%), delayed graft function (group L = 7.2% versus group R = 6.3%) and recipient postoperative creatinine at 1 month (group L = 1.54 ± 1.4 mg/dL versus group R = 1.32 ± 1.1 mg/dL). There were three intraoperative donor complications in group L (bleeding in one donor required transfusion), and none in group R. Similarly, there was a great albeit not a significant difference in the number of major postoperative donor complications among group L (n = 16) versus group R (n = 2). The right kidney was chosen because of the number of vessels (n = 5), presence of cysts (n = 5), size and renal function (n = 6), presence of renal stones (n = 2), and tortuous ureter (n = 1). The reasons for conversion to open included bleeding, anatomic issues, and presence of adhesions. It should be noted that during the last 3 years there were no conversions to open, whereas the only conversion among group R was the first case.
  
  
  CONCLUSIONS
  Intra- and postoperative parameters were comparable between the groups. Considering the limitations of the small sample size of right LLDNs in this study, it appears that it is as safe and effective as a left procedure. The learning curve is extremely important, as can be seen by the lack of conversion in the last 3 years.
authors.affiliation: Department of Surgery, Aristoteleion University of Thessaloniki, Thessaloniki, Greece. tsoulfasg@gmail.com
authors.forename: G
authors.initials: G
authors.lastname: Tsoulfas
authors.forename: P
authors.initials: P
authors.lastname: Agorastou
authors.forename: D
authors.initials: D
authors.lastname: Ko
authors.forename: M
authors.initials: M
authors.lastname: Hertl
authors.forename: N
authors.initials: N
authors.lastname: Elias
authors.forename: A B
authors.initials: AB
authors.lastname: Cosimi
authors.forename: T
authors.initials: T
authors.lastname: Kawai
mesh_terms: D015415:Biomarkers / Q000097:blood; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D002983:Clinical Competence; D003404:Creatinine / Q000097:blood; D051799:Delayed Graft Function / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D005919:Glomerular Filtration Rate; D058733:Hand-Assisted Laparoscopy / Q000009:adverse effects; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D059032:Learning Curve; D019520:Living Donors; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D003404:Creatinine