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Transition from laparoscopic to retroperitoneoscopic approach for live donor nephrectomy

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Abstract

Background

Laparoscopic donor nephrectomy has become the standard of care due to multiple benefits. Currently, there are various techniques employed with two different approaches: transperitoneal (TLDN) or retroperitoneoscopic (RLDN) approach. There is a lack of data to determine which technique is superior, although the RLDN offers an anatomical advantage by avoidance of manipulation of the intraperitoneal organs. The aims of this study were to explore the merits of RLDN to TLDN and assess the learning curve of transition from TLDN to RLDN.

Methods

From January 2010 to February 2017, 106 live donor nephrectomies were performed: 56 by TLDN and 50 by RLDN. Data on patient demographics, perioperative parameters, analgesic consumption, pain scores, and kidney graft function were collected and analysed. Data were compared with a Student’s t test or Mann–Whitney test. A CUSUM analysis was performed to investigate the learning curve.

Results

All live donor nephrectomies were successful with no conversion to open surgery. There was no blood transfusion, readmission, or mortality. No postoperative complications were graded over Clavien II. Kidney function was comparable in both groups. The follow-up period ranged from 3 to 78 months.

Conclusion

Retroperitoneoscopic live donor nephrectomy is a safe approach with comparable results to TLDN. RLDN has an anatomical advantage as it avoids manipulating the intraperitoneal organs and retains a virgin abdomen and hence translates to a lower perioperative complication risk.

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Abbreviations

RLDN:

Retroperitoneoscopic live donor nephrectomy

TLDN:

Transperitoneal live donor nephrectomy

LDN:

Live donor nephrectomy

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Acknowledgements

The authors would like to thank all their colleagues involved in the care of our donors and recipients and the theatre staff for their contribution.

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Authors and Affiliations

  1. WA Liver and Kidney Transplant Service, Sir Charles Gairdner Hospital, Perth, WA, Australia

    Zi Qin Ng & Bulang He

  2. Animal Care Services, University of Western Australia, Perth, WA, Australia

    Gabrielle Musk

  3. Centre for Applied Statistics, University of Western Australia, Perth, WA, Australia

    Alethea Rea

  4. School of Surgery, University of Western Australia, Perth, WA, Australia

    Bulang He

  5. WA Liver and Kidney Transplant Service, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia

    Zi Qin Ng & Bulang He

Authors
  1. Zi Qin Ng
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  2. Gabrielle Musk
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  3. Alethea Rea
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  4. Bulang He
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Correspondence to Zi Qin Ng or Bulang He.

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Disclosure

Dr Zi Qin Ng, Dr Gabrielle Musk, Dr Bulang He, and Alethea Rea have no conflicts of interest of financial ties to disclose.

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Ng, Z.Q., Musk, G., Rea, A. et al. Transition from laparoscopic to retroperitoneoscopic approach for live donor nephrectomy. Surg Endosc 32, 2793–2799 (2018). https://doi.org/10.1007/s00464-017-5981-3

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  • DOI: https://doi.org/10.1007/s00464-017-5981-3

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