Laparoscopic retroperitoneal live donor right nephrectomy for purposes of allotransplantation and autotransplantation

Purpose: We report the technique of and initial experience with retroperito neal laparoscopic live donor right nephrectomy for purposes of renal allotr ansplantation and autotransplantation. Materials and Methods: A total of 5 patients underwent retroperitoneoscopic live donor nephrectomy of the right kidney for autotransplantation in 4 an d living related renal donation in 1. Indications for autotransplantation i ncluded a large proximal ureteral tumor, a long distal ureteral stricture a nd 2 cases of the loin pain hematuria syndrome. In all cases a S-port retro peritoneal laparoscopic approach and a pelvic muscle splitting Gibson incis ion for kidney extraction were used. In patients undergoing autotransplanta tion the same incision was used for subsequent transplantation. Results: All procedures were successfully accomplished without technical or surgical complications. Total mean operating time was 5.8 hours and averag e laparoscopic donor nephrectomy time was 3.1 hours. Mean renal warm ischem ia time, including endoscopic cross clamping of the renal artery to ex vivo cold perfusion, was 4 minutes. Average blood loss for the entire procedure was 400 cc. Radionuclide scan on postoperative day 1 confirmed good blood flow and function in all transplanted kidneys. Mean analgesic requirement w as 58 mg. fentanyl. Mean hospital stay was 4 days (range 2 to 8), and conva lescence was completed in 3 to 4 weeks. Conclusions: In the occasional patient requiring renal autotransplantation live donor nephrectomy can be performed laparoscopically with renal extract ion and subsequent transplantation through a single standard extraperitonea l Gibson incision, thus, minimizing the overall operative morbidity. Furthe rmore, these data demonstrate that live donor nephrectomy of the right kidn ey can be performed safely using a retroperitoneal approach with an adequat e length of the right renal vein obtained for allotransplantation or autotr ansplantation.