Laparoscopic live donor nephrectomy: The University of Maryland 3-year experience

Purpose: We determined whether laparoscopic living donor nephrectomy decrea ses the morbidity of renal donation for the donor, while providing a renal allograft of a quality comparable to that of open donor nephrectomy. Materials and Methods: In a 3-year period laparoscopic donor nephrectomy wa s performed via the transperitoneal approach. We evaluated donor and recipi ent medical records for preoperative donor characteristics, intraoperative parameters and complications, and postoperative recovery and complications. Results: Of the 320 laparoscopic donor nephrectomies performed the left kid ney was removed in 97.5%. Intraoperative complications, which developed in 10.4% of cases, tended to occur early in the experience and required conver sion to open nephrectomy in 5. Average operative time was 3 1/2 hours and w arm ischemia time was 2 1/2 minutes. As the series progressed, blood loss a s well as laparoscopic port size and number decreased but extraction site s ize remained constant at 7 cm. Urinary retention, prolonged ileus, thigh nu mbness and incisional hernia were the most common postoperative complicatio ns. Postoperative analgesic requirements were low and average hospitalizati on was 66 hours. Conclusions: Laparoscopic donor nephrectomy appears to be safe and decrease s morbidity in the renal donor. Allograft function is comparable to that in open nephrectomy series. The availability of laparoscopic harvesting may b e increasing the living donor volunteer pool.