Objectives: Retroperitoneoscopic Donor Nephrectomy (RPLDN) has been our standard care for living donors, using 3 flank ports and Pfannenstiel extraction. Our conventional strategy for RPLDN was to shorten convalescence and reduce complications by avoiding manipulation of intraperitoneal organs, and hiding extraction scar in the pubic hair. Recent development in techniques and instruments allowed laparoendoscopic single site (LESS) surgery. The aim of this study was to clarify the merits of LESS donor nephrectomy (LESSDN).

Methods: RPLDN (n=30) and LESSDN (n=15) was performed by an experienced single surgeon. RPLDN was performed as above. LESSDN was performed via a 3-port single umbilical incision with standard laparoscopic instruments. The following data were prospectively compared between LESSDN and RPLDN: operation time (OT), blood loss, scar length sum, warm ischemic time (WIT), recipient serum creatinine at discharge (sCr), number of pain killer pills (PK), length of hospital stay and the surgical cost.

Results: OT was shorter in LESSDN (226 vs 255 min). WIT was shorter in LESSDN (6 vs 3 min). Blood loss (42 vs 146g), sCr (1.2 vs 1.3 g/dL), hospital stay (8 vs 8 days) and PK (4 vs 5) were comparable between LESSDN and RPLDN. The total length of scars was shorter in LESSDN (3.5 vs 10cm). There were no surgical complication or no delayed graft function in both groups.

Conclusions: LESSDN resulted in shorter wound hiding in the umbilicus with no compromise in surgical outcomes. Umbilical incision in LESSDN provided wider opening than the visible scar, allowing duplication of standard laparoscopic procedures without acrobatic skills, and with cost-effective standard instruments.

« Back to 2013 American Transplant Congress