Objectives: Laparoendoscopic single site donor nephrectomy (LESSDN) via the umbilicus has been our standard care for living donors. Although we have previously reported better cosmetic and comparable surgical outcomes of LESSDN compared to the conventional retroperitoneoscopic donor nephrectomy, the fascial incision for kidney extraction has been a hurdle for postoperative pain and recovery. We herein report our initial outcomes of hydrid-NOTES transvaginal laparoscopic donor nephrectomy (TVLDN).

Methods: First 12mm port was placed at the umbilicus and two more 5mm ports were placed. An extraction port was placed at the posterior vaginal vault. The followings were compared between TVLDN (n=10) and LESSDN (n=31): operation time (OT), blood loss, scar length sum, recipient serum creatinine at discharge (sCr), number of pain killer pills (PK), visual analogue scale of postoperative pain (VAS) at day 1, 2, 3, 6 and the length of hospital stay.

Results: OT (219 vs 226 min), blood loss (93 vs 82 g), sCr (1.2 vs 1.3 g/dL), hospital stay (6.6 vs 8.7 days), PK (2.6 vs 4.6) and VAS (1.0, 1.4, 0.2, 0 vs 4.1, 2.8, 2.0, 0.5) were less in TVLDN. between LESSDN and RPLDN. The total length of scars was shorter in TVLDN (1.5 vs 3.5 cm). There were only minor superficial wound infection in both groups (20% vs 13%).

Conclusions: TVLDN provided a better postoperative pain and cosmoses compared to LESSDN without compromising surgical outcomes, although its limited indication for women with sufficient vaginal wall elasticity.

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