Retroperitoneal Laparoscopic Live Donor Nephrectomy: A Cost-effective Approach

ObjectivesTo establish a modified cost-effective and safe approach of retroperitoneal laparoscopic live donor nephrectomy (RPLLDN).MethodsBetween December 2003 and December 2008, total of 109 living related renal donors underwent consecutive three-port RPLLDNs. The initial retroperitoneal space was created by insertion of a rubber catheter attached to a saline-filled midfinger of a glove. The renal hilum and ureter were circumferentially mobilized. The tributaries of renal vessels were divided by harmonic scalpel without any clips. In laparoscopy, the ureter was sheared with scissors. A longitudinal 6-8 cm skin incision was enlarged form the primary trocar distally to retrieve the graft. The main renal vessels were controlled, using 2 Hem-o-lok clips placed at each proximal ends. The graft was retrieved manually through the skin incision.ResultsAll the 109 RPLLDNs were carried out successfully. The mean operation time and mean warm ischemic time was 129.7 ± 42.6 and 3.6 ± 1.2 minutes, respectively. The mean blood loss was 73.6 ± 53.7 mL. No blood transfusion or open conversion was required. No major complication occurred in the donors, and only 5% of the donors suffered from minor complications. A total of 3% and 4% of the recipients developed major and minor complications, respectively, and 12.8% of the donors required analgesics. The mean level of postoperative serum creatinine of the donors was 1.31 ± 0.22 mg/dL and the mean level of postoperative serum creatinine of the recipients at the first month was 1.59 ± 0.91 mg/dL.ConclusionsThe modified approach of RPLLDN could be a cost-effective and safe alternative for developing countries.