Right Laparoscopic Donor Nephrectomy: A Large-Volume, Single-Center Experience

摘要

OBJECTIVES: The right kidney is not commonly selected for donor nephrectomy compared with the left kidney. Most left donor nephrectomies are performed by laparoscopic approach, whereas open donor nephrectomies are preferred on the right side. We present our experience of right laparoscopic donor nephrectomy, which was a substantial percentage of all performed laparoscopic donor nephrectomies. MATERIALS AND METHODS: We retrospectively analyzed all the donor nephrectomies performed at a single center, including indicators for right side open donor nephrectomy, as well as the demographic details of donors and intraoperative events, complications, and hospital stay for right side laparoscopic donor nephrectomy. Recipients were evaluated for outcome and complications. RESULTS: We performed 850 donor nephrectomies, including 640 left donor nephrectomies and 210 right donor nephrectomies. Of 210 right donor nephrectomies, 160 cases were performed laparoscopically, and 50 cases were open surgeries. Common indications for choice of right open donor nephrectomy were related to the donor. Factors related to the recipient included obesity, left iliac fossa transplant, and robotic transplant to the recipient. The surgical outcomes or complication rates in right side laparoscopic donor nephrectomy were not significantly different. Regarding recipients, we found that graft function, perioperative parameters, and vascular complications did not differ much in right side laparoscopic donor nephrectomy. CONCLUSIONS: The right side laparoscopic donor nephrectomy is as safe as left laparoscopic donor nephrectomy or right side open donor nephrectomy. Careful consideration of recipient factors is very important along with donor factors before opting for an open or laparoscopic approach on the right side. Slight modifications in technique may provide a few additional millimeters of length, which can significantly increase the incentive to choose laparoscopic donor nephrectomy on the right side.