Jr. Leventhal et al., Laparoscopic live donor nephrectoriy - Is it safe? Analysis of 80 consecutive cases and comparison with open nephrectomy, TRANSPLANT, 70(4), 2000, pp. 602-606
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.