Evolution of laparoscopic live donor nephrectomy: a single-center experience with 1510 cases over 14 years.
OBJECTIVE
This study evaluated the outcomes of laparoscopic donor nephrectomy (LDN) and proposed modifications for kidney donation surgery. From February 1997 to February 2011, 1510 LDNs were performed.


METHODS
Surgical modifications included a modified open access technique for entry into the abdominal cavity, using vascular clips for safe and cost-effective control of the renal pedicle, control of the lumbar veins, and adrenal vein using bipolar cautery instead of clips, and leaving the gonadal vein intact with the ureter. Kidneys were extracted by hand through a Pfannenstiel incision. Heparin was not used after the first 300 cases to prevent potential hemorrhagic complications.


RESULTS
Although three major vascular injuries occurred using the closed access method that were managed successfully, no access-related complications occurred using the modified open access technique. Clip failure did not happen in any cases. Patient and graft survival at 1 year post-transplantation were 96.5% and 95.5%, respectively, and at 5 years post-transplantation were 95.3% and 89.5%, respectively.


CONCLUSIONS
The proposed surgical modifications are based on 14 years of experience and 1510 cases, and make LDN simple, safe, and cost-effective. The excellent recipient and graft outcomes with minimal morbidity obtained further confirm that LDN can be considered as the gold standard for kidney donation surgery.
Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences (SBMU) , Tehran, Islamic Republic of Iran .
Nasser
N
Simforoosh
Mohammad Hossein
MH
Soltani
Abbas
A
Basiri
Ali
A
Tabibi
Shahram
S
Gooran
Seyed Hossein Hosseini
SH
Sharifi
Mohammad Hadi
MH
Shakibi
D000328:Adult; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods; D010535:Laparoscopy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*