Impact of Right Nephrectomy on Outcomes of Renal Function and Complications in Retroperitoneoscopic Live Donor Nephrectomy: A Single-center Experience

BACKGROUND AND OBJECTIVE: Since 2001, we have been trying to establish the technique of retroperitoneoscopic live donor nephrectomy (RPLDN). In general, the left kidney from a living donor is preferred for renal transplantation because of its longer renal vein. However, not all potential donors have a right kidney which is anatomically and functionally conducive to left nephrectomy. Also, several series of studies have shown initially high rates of complications and graft loss with right laparoscopic live donor nephrectomy. In order to assess the safety, feasibility and usefulness of right RPLDN, we reviewed and compared the outcomes of right and left RPLDN. METHODS: Two hundred seventy six patients underwent live donor renal transplantation with allografts procured by RPLDN at our institute. Of these, 13 (4.7%) cases were of right sided RPLDN. Study variables included operative time, time to retrieval of the kidney, blood loss, warm ischemia time (WIT), hospital stay, number and length of renal vessels, graft function and complications. RESULTS: The indication for right RPLDN included renal cysts (n = 3), renal artery aneurysm (n = 3), inferior right renal function (n =2), renal artery stenosis (n = 2), right renal stone (n = 1), anomalous left renal artery (n = 1), or previous intra-peritoneal surgery on the left side (n = 1). No significant differences were found between the right and left RPLDN group regarding operative time (325}70 vs 312}73 min), time to retrieval of the kidney (260}72 vs. 246}71 min), blood loss (50 vs. 45 ml), hospital stay (4.5}1.3 vs. 4.1}1.7 days) or number of renal arteries (1.3}0.6 vs. 1.3}0.6). Despite statistically significantly increased WIT (6.0}1.9 vs. 5.0}1.7 min) and decreased renal vein length (1.8}0.4 vs. 3.9}0.8 cm), no patient showed relatively slow graft function or required hemodialysis after transplantation due to acute tubular necrosis. Subcutaneous emphysema (n =1) and postoperative bleeding (n = 1) occurred in right RPLDN patients. Venous extension was required in 3 patients due to a short renal vein. The saphenous vein was used for venous extension. No patient undergoing RPLDN required open conversion. CONCLUSIONS: Right RPLDN provided similar outcomes for postoperative graft function and complications compared with left RPLDN except for some patients who needed venous extension. These results indicate that right RPLDN could be an option for laparoscopic live donor nephrectomy because of its safety and feasibility.

Session: Poster of Distinction

Program Number: P009

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