Total Retroperitoneoscopic Living Donor Nephrectomy: Implementation at the First German Center

Marty Zdichavsky, MD¹, Martina Guthoff, MD², Nils Heyne, MD², Pranjal Modi, MD³, Jessica Lange, MD¹, Alfred Konigsrainer, MD¹, Silvio Nadalin, MD¹. ¹Department of General, Visceral and Transplant Surgery, University Hospital Tubingen, ²Department of Internal Medicine, Division of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University Hospital Tubingen, ³Department of Urology, Dr. HL Trivedi Institute of Transplantation Sciences, Asarwa, Ahmedabad, Gujarat, India

INTRODUCTION: Since laparoscopic living donor nephrectomy is well established in specific centers the purpose of this trial was to inaugurate a program for fully retroperitoneoscopic kidney donation according to Modi’s technique in our institution of transplant surgery.

METHODS AND PROCEDURES: Different techniques for living donor nephrectomies were studied and compared. At the first European Workshop for retroperitoneoscopic donor nephrectomies at the Royal Liverpool University Hospital in England in 2014, the fully retroperitoneoscopic kidney donation was the most convincing one for us in terms of safety, feasibility and technical aspects. In July 2015 three total retroperitoneoscopic living donor nephrectomies could be performed in our institution in attendance of Prof. P. Modi having the most experience in this procedure.

RESULTS: The first three retroperitoneoscopic donor nephrectomies were successfully performed without any complications. One right and two left kidneys were retrieved using a three trocar technique for the left side and one additional trocar for the right side. Organ harvesting was performed through an inguinal incision that was created just before renal vessel dissection and closed after organ harvesting. Mean operative time was 164min. Organs were instantly implanted in another operating room. Postoperative course was uneventful for all donors. Donors' satisfaction was very good in all three cases. All recipients could be discharged with a good kidney function. Mean recipient’s serum creatinine was 1.4 mg/dl on day 7 and 1.3 mg/dl on day 21, respectively.

CONCLUSION: Fully retroperitoneoscopic living donor nephrectomies could be implemented in our institution and performed without complications and a high level of patient’s satisfaction.