Laparoscopic live donor nephrectomy: The preliminary experience

Background: Recent improvements in video technology and surgical instrument ation have resulted in the application of minimally invasive techniques to many surgical procedures including splenectomy and adrenalectomy.(1,2) Neph rectomy requires a long flank incision with division of abdominal musculatu re and possible subcostal nerve damage. Severe postoperative pain and a pro longed recuperative period may result, and the cosmetic outcome may not be satisfactory. A new surgical approach utilizing laparoscopic dissection and delivery of the kidney through a small incision was performed to circumven t these problems. The aim of this paper is to describe the technique of lap aroscopic live donor nephrectomy (LLDN) and present the preliminary outcome . Methods: Over the 12-month period between May 1997 and April 1998, 16 donor s underwent donor nephrectomy by a laparoscopic approach. The procedure was assessed with regard to its safety, feasibility and advantages over the op en method. Results: All the nephrectomies were completed without conversion to an open procedure. The average postoperative pain score on a visual analogue scale of 1-10 was 2 in LLDN. The donors required 36 mg morphine on average over 36 h postoperatively. Postoperative stay averaged 3 days. One donor develop ed an infective complication along the wound drain tract which settled with adequate drainage and antibiotics. All the removed donor kidneys were tran splanted with immediate good function. There were no surgical complications or graft losses. The recipients' serum creatinine was in the range of 96-1 81 mmol/L 3 months after transplantation. Conclusions: Significant potential advantages of LLDN include less postoper ative pain, shorter hospitalization and decreased recuperative time. This p reliminary experience indicates LLDN to be effective in terms of safety and feasibility.