Background: Living kidney transplant offers ideal therapy of end stage renal disease patients. A variety of minimal invasive techniques for donor nephrectomy have been described and practiced. Hand-Assisted Retroperitoneal Surgery (HARS) for left donor nephrectomy has been studied in the literature, however right HARS has little mention. The Aim of our study is to describe our two-instrument port right HARS procedure, review our own results and determine its safety and applicability.

Design and Methods: A retrospective, single center analysis. The test group was our first consecutive 25 cases of right HARS compared to a matched sample of left HARS in age, gender, number of arteries as per radiological findings and surgeon performing the donor surgeries performed within the same time period. Primary end-point was operative time. Other variables include body mass index, warm ischemia time, kidney size, working ports, status of peritoneum, conversion rate, estimated blood loss, blood transfusions, renal function at 3 and 90 days post-donation, complications within 30 days post-operative and hospital stay. Corresponding recipient graft function and surgical complications within 30 days of transplant were also reviewed.

Results: Baseline demographic data showed no statistical difference between the groups. Mean operative time was significantly shorter in the right HARS group than the left HARS group (123.8min Vs. 153.72min) (p = 0.005) with all other parameters showing no statistically significant difference. Donor complications were stratified based on the Calvien-dindo Classification and Comprehensive Complication Index with no statistical difference between the groups (p = 0.318). All donors showed adequate renal function at 3 and 90 days post-donation. Delayed graft function and urinary leak developed in 4 (16%) and 1 (4%) of the recipients of right HARS Vs. none in the controls (p = 0.110 and 0.990) respectively. All recipients from both groups showed adequate renal function by 90 days post-transplant excluding a single case that required transplant nephrectomy due to recurrence of deep vein thrombosis extending to the graft.

Conclusion: HARS techniques for right donor nephrectomy is safe and applicable within the scope of kidney donation.

CITATION INFORMATION: Alahdal H., Alghamdi F., Shoukri M., Brockmann J., Broering D. Making Right Donor Nephrectomy Great Again: Evaluating Right Hand Assisted Retroperitoneal Donor Nephrectomy Am J Transplant. 2017;17 (suppl 3).

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