Laparoscopic live donor nephrectoriy - Is it safe? Analysis of 80 consecutive cases and comparison with open nephrectomy

Background, Laparoscopic live donor nephrectomy (LDN) is a less invasive al ternative to open nephrectomy (ODN) for living kidney donation. Concerns ha ve been raised regarding the safety of LDN, the short and long term functio n of kidneys removed by LDN, and a potential higher incidence of urologic c omplications in LDN transplant recipients. Methods, Between October 1997 and May 1999, 80 LDNs were performed at our c enter. All patients were followed longitudinally with office visits and tel ephone interviews, These LDNs were compared with 50 ODN performed from Janu ary 1996 to October 1997, Results, LDN procedures took significantly longer than ODN (4.6 vs. 3.1 hr) , However, LDN was associated with significant reduction in i.v. narcotic u se, a rapid return to diet, and shorter hospital stay. Of the 80 LDN proced ures, a total of 75 (94%) were completed laparoscopically. Five patients we re converted to laparotomy: three for hemorrhage and two for complex vascul ar anatomy. ODN conversion was associated with large donor body habitus and /or obesity. Seven LDN patients had minor complications and 4 had major com plications. All major complications consisted of vascular injuries (2 lumba r vein injuries, 1 renal artery, and 1 aortic injury). All patients made co mplete recoveries. All LDN kidneys functioned immediately posttransplant. W e have observed 100% patient and 97% 1-year actuarial graft survival in LDN transplant recipients, There have been no short-or longterm urologic compl ications in this series. Conclusion. With increasing experience and standardization of technique, LD N is a safe and effective procedure. Patients undergoing LDN demonstrate cl inically significant, more rapid postoperative recoveries and shorter hospi tal stays than ODN patients. Excellent initial graft function and long-term graft survival have been observed with LDN kidneys. Urologic complications can be avoided, LDN has become the preferred surgical approach for living kidney donation at our center.