title: Laparoscopic donor nephrectomy with transvaginal extraction: initial experience of 30 cases.
abstract: OBJECTIVE
  To assess the safety and feasibility of laparoscopic donor nephrectomy with transvaginal extraction and impact of body mass index (BMI), menopausal status, previous surgery, and uterine fibroids.
  
  
  METHODS
  Five-port conventional laparoscopic donor nephrectomy with successful transvaginal extraction of the kidney was performed in 30 donors. The parameters assessed included age, BMI, operative time, estimated blood loss, warm ischemia time, postoperative pain score, preoperative and postoperative sexual function, wound complications, hospital stay, return to normal activities, recipient creatinine level, and other recipient-related complications. The data were compared with 30 female donors who had laparoscopic donor nephrectomy and transabdominal extraction.
  
  
  RESULTS
  The total number of patients who consented for the study was 38. In seven patients, an intraoperative decision to abort the transvaginal extraction was made because of obesity, pelvic adhesions, large uterine fibroids, and uterine artery injury. When compared with transabdominal extraction, there was no significant difference in warm ischemia time, mean operative time, estimated blood loss, hospital stay, recipient creatinine level, and complications. The mean pain score was significantly less on postoperative day 3 and day 4. There was also an earlier return to normal activities in the transvaginal group. There was no increase in infectious complication in both donors and recipient.
  
  
  CONCLUSIONS
  Based on our initial experience with laparoscopic donor nephrectomy with transvaginal extraction, we recommend this procedure for a premenopausal donor, with a BMI <30. Our initial cases demonstrate that transvaginal extraction is feasible and safe for the donors.
authors.affiliation: 1 Department of Urology and Nephrology, Medical Trust Hospital , Cochin, Kerala, India .
authors.forename: T A
authors.initials: TA
authors.lastname: Kishore
authors.forename: Abijit
authors.initials: A
authors.lastname: Shetty
authors.forename: Tarun
authors.initials: T
authors.lastname: Balan
authors.forename: Mammen M
authors.initials: MM
authors.lastname: John
authors.forename: Mohammed
authors.initials: M
authors.lastname: Iqbal
authors.forename: Joshy
authors.initials: J
authors.lastname: Jose
authors.forename: K
authors.initials: K
authors.lastname: Vinodan
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D019520:Living Donors; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009392:Nephrectomy / Q000379:methods*; D020858:Tissue and Organ Harvesting / Q000379:methods*