Technical modifications of laparoscopic donor nephrectomy: improved results with refinements in technique that mimic open nephrectomy.
INTRODUCTION: We have performed laparoscopic donor nephrectomy (lap Nx) since 2000. In June 2002, we modified the technique to minimize the known disadvantages of ATN and delayed graft function. We review our series of lap Nx before and after introduction of these modifications, respectively. METHODS: Four technical modifications of lap Nx were introduced following the initial previously described 28 cases (Group I) and applied to the consecutive 42 cases described herein (Group II): (1) decreasing the intra-abdominal pressure from 15 mm Hg to 8 mm Hg; (2) early dissection of the ureter and gonadal vein followed by vascular dissection (sharp and blunt using hydrodissection); (3) leaving the left gonadal vein in continuity with the left renal vein; and (4) early introduction of the Endocatch bag. RESULTS: Operative time was 276.6 +/- 67.1 min vs 210.0 +/- 38.0 min for groups I and II, respectively (P = .04). Warm ischemia was 4.9 +/- 1.9 min vs 1.5 +/- 0.9, min for groups I and II, respectively (P < .01). ATN occurred in 3/28 (10.7%) in group I vs 2/42 (4.8%) in-group II. There was one-vascular insult in the initial 5 Rt lap Nx, namely, transection of a segmental artery, that was reconstructed by bench repair without an impact on the outcome. Conversion was needed in 3/28 (10.7%) group I, but none of group II donors. CONCLUSION: The outcome of lap Nx can be significantly improved by applying technical modifications that simulate open Nx.