Technique, indications and outcomes of pure laparoscopic right donor nephrectomy

Purpose: Laparoscopic nephrectomy for living renal transplantation has emerged as the gold standard. Nevertheless, experience with this technique for procuring right kidneys is limited. We report our single institution results of pure laparoscopic right donor nephrectomy. Materials and Methods: Laparoscopic donor nephrectomy was initiated at the our institution in November 1999. Patient selection was initially limited to the left kidney but right surgery was started 2 years later after 97 operations had been performed. We prospectively acquired data on the donor and recipient, and specifically analyzed outcomes of the right kidneys. Results: In a 40-month period 300 laparoscopic donor operations were performed. Overall 44 procedures (15%) were on the right side with the fraction greater (22%) after removing exclusion of the right kidney from laparoscopic selection criteria. In this cohort mean operative time was 170 minutes, significantly less than the 190 minutes for 50 contemporaneous left kidneys (p = 0.001). No case of right donor nephrectomy required open conversion and vessels were of adequate length. Donor and recipient complications were similar in the 2 groups without technical graft loss in the entire series. Conclusions: Our method of laparoscopic right donor nephrectomy yields excellent graft quality with adequate vascular length and without the need for elaborate modifications or hand assistance. Moreover, the right operation is technically easier and it achieved comparable donor morbidity and recipient renal function. With sufficient experience the right kidney should be procured laparoscopically when indicated.