Presentation Authors: Mireia Musquera*, Maurizio D'Anna, Lluis Peri, Tarek Ajami, María José Ribal, Laura Izquierdo, Ricardo Álvarez-Vijande, Antonio Alcaraz, Barcelona, Spain
Introduction: Laparoscopic living donor nephrectomy (LDN) has encouraged living kidney donation thanks to the intrinsic advantages of minimally invasive surgery (lower morbidity and better cosmetic results). The purpose of our study is to analyse surgical evolution in LDN after the introduction of other minimally invasive techniques as laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES).
Methods: We analysed results from our prospective accrued database of LDN. Between March 2002 and December 2017, 616 laparoscopic or minimal invasive LDN donor nephrectomies were done in our center.
Results: All but one case were completed (the recipient died during anaesthetic induction). Of the 615 completed cases, 455 (74%) were done with conventional laparoscopic approach, 104 (16.9%) were transvaginal nephrectomies (NOTES) and 56 (9.1%) were done using LESS. There were 66.7% female and 33.3% male donors, with a mean age of 52.37 years. The most frequent donor-recipient relationship were conjugal [210 (34.1%)], parental [170 (27.6%)] and fraternal [139 (22.6%)].Four (7.1%) LESS nephrectomies and one (0.9%) NOTES nephrectomy were converted to conventional laparoscopy; two (0.4%) laparoscopic nephrectomies and one (1.8%) LESS nephrectomy were converted to open surgery. In two cases (0.32%), suprarenalectomy was needed to achieve good haemostasis. One patient needed urgent reoperation right after surgery because of uterine arteries bleeding. Other patient needed urgent splenectomy on the second post-operative day because of a delayed spleen rupture secondary to inadverted laceration during surgery. Median follow-up was 100.2 months (range 1-189). Average plasmatic creatinine levels after one year were 1.12 mg/dl (SD +/- 0.21). Seventeen patients (2.8%) needed incisional hernia repair.
Conclusions: Laparoscopic and minimal invasive living donor nephrectomy is safe, with a relative low complication rate. During the last 10 years, new minimally invasive techniques have been performed with good results and acceptable complication rate. Conventional and hand-assisted laparoscopic donor nephrectomy are still the most used techniques nowadays because of technical reproducibility.