Hand-assisted laparoscopic donor nephrectomy of the right or left kidney.

The number of living donor transplantations has increased during the past 20 years due to the
shortage of deceased kidney donors and an increased number of patients on the waiting list for renal transplantation. Living donor kidney transplantation is superior to deceased donor kidney transplantation because of the better patient and graft survival rates, better cost-effectiveness and improved quality of life (QoL) of the recipient (1,2). Open living donor nephrectomy is associated with disincentives including long hospital stay, prolonged postoperative pain, cosmetic problems and slow convalescence. These disincentives might be a drawback for potential donors to donate a kidney. With the advent of laparoscopic living donor nephrectomy a reduction in hospital stay, less postoperative analgesic requirements, improved cosmetics, and an earlier return to normal daily activities have been reported (3).
There is an ongoing discussion whether the right or the left kidney donor nephrectomy is to be preferred. Most centers prefer to use the left kidney for live kidney donation because of the longer renal vein, which is advantageous during the implantation. However, some surgeons prefer the right kidney because it is easier to recover than the left kidney and the risk of spleen laceration is decreased (4). A recent study demonstrate the negative effect of longstanding pneumoperitoneum on kidney function. Reduction of operation time with maintenance of the beneficial effect of the minimal invasive aspect of the laparoscopic donor nephrectomy is essential(5). There are no prospective studies comparing the outcome of left sided versus right sided laparoscopic donor nephrectomy in terms of operating time. Therefore a prospective single-center randomized trial was conducted performing either a left or a right sided hand-assisted laparoscopic donor nephrectomy.

The hypothesis was that donors who underwent a right sided HALDN would have a shorter operation time.

N/A

Specific preoperative donor evaluation included blood and urine examination, angiography, pyelography and renal scintigraphy.

In case of bilateral multiple arteries they were only included in the study if both kidneys were judged transplantable by the surgeon.

The hand-assisted laparoscopic donor nephrectomy (HALDN) is done transperitoneally.

After open dissection of the distal ureter and gonadal vein through a 7-8 cm Pfannenstiel incision the non dominant operators' hand is introduced through a handport and two 10-12 mm trocars are placed. The insufflation pressure was maximally 12 mmHg. The right or left colon was then mobilized. After transecting the ureter distally, the renal artery is transected with metal clips, while an endoscopic stapler is used to transect the renal vein. The kidney is extracted through the Pfannenstiel incision and cold flushed and preserved with University of Wisconsin solution (UW).

Postoperatively, all patients are treated equally with regard to feeding, pain regulation, mobilization and postoperative care.