Minimally invasive surgery aims to the reduction of complications, pain and scars. Thus, vaginal extraction of the donor's kidney has been reported as an option for organ removal in anecdotal case-reports of robotic-assisted donor nephrectomy. This study reports surgical technique and outcome of robotic-assisted laparoscopic donor nephrectomy with transvaginal extraction of the kidney as a routine technique.

From november 2011 to march 2015, 36 patients have undergone a robotic-assisted laparoscopic donor nephrectomy, 15 of which with transvaginal extraction of the kidney (VE) and 21 with iliac extraction (IE). Patients were placed in a right lateral position. In case of transvaginal extraction, patients were place with legs apart to allow access to the genital area, and a 12 mm vaginal trocar was inserted through the posterior fornix of vagina to extract the kidney. In the EV group, patients were allowed to resume sexual intercourse at one month. Per operative data and outcome including sexual satisfaction at 6 weeks and renal function at 6 months (MDRD decrease) were collected prospectively.

Mean patient age was 45.2 years old. One patient planned for vaginal extraction eventually had an iliac extraction. There were no statistical difference in mean operative time between IE and VE groups (respectively 133 min vs 142 min, p = 0.6), peroperative BL (69 ml vs 80 ml, p = 0.6), nor WIT (5.1 min vs 7.1 min, p = 0.1). Post operative complications consisted in one abdominal hematoma in each group and one vaginal hemorrhage requiring surgical revision in VE group. Average length of hospital stay was shorter in the VE group (4.8 days vs 5.8 days, p = 0.01). In VE group, no pain or discomfort during sexual intercourse has been reported. No difference in MDRD decrease at 6 months was observed (-24.1 ml/min/1,73m² in the IE group vs -23.8 ml/min/1,73m² in the VE group,p = 0.9). All donated kidneys have been successfully transplanted with no delayed graft function.

Robotic-assisted laparoscopic surgery with transvaginal extraction for donor nephrectomy is technically feasible, allowing to combine the advantages of robotic-surgery for dissection, with vaginal extraction. This technique leads to a shorter length of hospital stay without adverse sexual outcome. Transvaginal extraction was not associated with impaired donor or recipient renal outcome.

CITATION INFORMATION: Champy C, Salomon L, Cholley I, Hoznek A, Yiou R, Vordos D, Grimbert P, Lang P, De La Taille A. Robotic-Assisted Laparoscopic Donor Nephrectomy with Transvaginal Extraction of the Kidney. Am J Transplant. 2016;16 (suppl 3).

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