[Introduction] Laparoscopic surgery has been a standard procedure of living donor nephrectomy. Transperitoneal laparoscopic donor nephrectomy (TPLN) has been commonly reported by many centers with excellent outcome. Retoperitoneal access enables to approach to the kidney directly without interfering with any of abdominal organs. However, few reports have described the outcome of retroperitoneoscopic living donor nephrectomy (RPN). The aim of this study is to evaluate the safety and efficacy of RPN. To this end, we compare TPLN with RPN.

[Patients & Methods] One hundred seventy-six kidney donors (64 men, 112 women) were enrolled in this study. Mean age of the donors was 53.5 ± 11.3 years. RPN was performed for 137 donors, and TPLN for 39 donors. Hand-assisted technique was applied for 3 cases in RPN and 22 cases in TPLN, respectively. The following end points were evaluated: operative time, blood loss, warm ischemia time, graft function, intraoperative adverse events and postoperative complication.

[Results] There was no difference in donor age, gender, operative time, and blood loss between the two groups. Although warm ischemic time was significantly longer in the RPN than in the TPLN (310 ± 109 sec versus 269 ± 106 sec; P=0.012), the incidence of delayed graft function was similar between the two groups (2.2% in RPN and 2.7% in TPLN). Furthermore, there was no difference in eGFR of recipients post-transplant 1-year between the two groups (54.5 ml/min in RPN and 59.7 ml/min in TPLN). Conversion rate showed no significant difference between the two groups (2 cases in RPN and none in TPLN). Intraoperative complication rate was 1.5% (2 vascular injury and 1 bowel injury) in RPN and 0 in TPLN (P = NS). Postoperative complication rate was 2.2% (2 surgical site infection and 1 ileus) in RPN and 2.7% (1 surgical site infection) in TPLN (P = NS).

[Conclusion] Both RPN and TPLN procedure are well acceptable with minimal complication rates and have similar impact on recipient's graft function. These results imply that RPN could be a feasible option for living donor nephrectomy as well as TPLN.

CITATION INFORMATION: Hirose T, Hotta K, Iwami D, Sasaki H, Higuchi H, Takada Y, Shinohara N. Retroperitoneoscopic Living Donor Nephrectomy Safely Secures Excellent Graft Function. Am J Transplant. 2017;17 (suppl 3).

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