Objective. To assess the long-term graft survival of right-sided retroperitoneoscopic live donor nephrectomy (RPLDN), we compared the outcomes of right- and left-sided RPLDN. Methods. Five hundred and thirty-three patients underwent live donor renal transplantation with allografts procured by RPLDN from July 2001 to August 2010 at our institute. Of these, 24 (4.5%) cases were selected for right-sided RPLDN (R-RPLDN) according to our criteria for donor kidney selection. Study variables included peri- and postoperative clinical data. Results. No significant differences were found in the recipients' postoperative graft function and incidence of slow graft function. Despite significant increased warm ischemic time (WIT: mean 5.9？min versus 4.7？min, ) in R-RPLDN compared to that in L-RPLDN, there was no significant difference between the two groups regarding long-term patient and graft survival. The complication rate in R-RPLDN was not significantly different compared to that in L-RPLDN (17% versus 6.5%, ). No renal vein thrombosis was experienced in either groups. Conclusions. Although our study was retrospective and there was only a small number of R-RPLDN patients, R-RPLDN could be an option for laparoscopic live donor nephrectomy because of similar results, with the sole exception of WIT, in L-RPLDN, and its excellent long-term graft outcomes. 1. Introduction The first laparoscopic living-donor nephrectomy (LLDN) was performed by Ratner et al. [1]. Since then, there has been increased acceptance of the procedure in many countries. In Japan, the number of deceased donor kidneys available for transplantation has not shown any increase, but living donor kidney transplantation increases yearly [2]. Laparoscopic procurement can offer an advantage to living kidney donors. The recent outcome of laparoscopic donor nephrectomy seems to be greatly improved compared to that in the early years, but the procedure still remains challenging even for the most experienced laparoscopists [2–4]. This is apparent especially in contrast to open donor nephrectomy, in which the right kidney was removed in 24% to 35% of the patients. The rate of right-sided donor nephrectomy in various laparoscopic series ranges from 3.5% to 56.2% [5, 6]. According to the database from the United Network of Organ Sharing (UNOS), right LLDN represented only 10.5% of all LLDN in 2006 [7]. One reason for the reluctance to perform right-sided laparoscopic donor nephrectomy has been the high vascular complication rate and the technical difficulties reported in the initial series. Moreover,
References
[1]
L. E. Ratner, L. J. Ciseck, R. G. Moore, F. G. Cigarroa, H. S. Kaufman, and L. R. Kavoussi, “Laparoscopic live donor nephrectomy,” Transplantation, vol. 60, no. 9, pp. 1047–1049, 1995.
[2]
K. Yuzawa, M. Shinoda, and K. Fukao, “Outcome of laparoscopic living donor nephrectomy in 2007: national survey of transplantation centers in Japan,” Transplantation Proceedings, vol. 41, no. 1, pp. 85–87, 2009.
[3]
M. C. Rawlins, T. L. Hefty, S. L. Brown, and R. Thomas Biehl, “Learning laparoscopic donor nephrectomy safely. a report on 100 cases,” Archives of surgery, vol. 137, pp. 531–535, 2002.
[4]
L. M. Su, L. E. Ratner, R. A. Montgomery et al., “Laparoscopic live donor nephrectomy: trends in donor and recipient morbidity following 381 consecutive cases,” Annals of Surgery, vol. 240, no. 2, pp. 358–363, 2004.
[5]
C. S. Ng, S. C. Abreu, H. I. Abou El-Fettouh et al., “Right retroperitoneal versus left transperitoneal laparoscopic live donor nephrectomy,” Urology, vol. 63, no. 5, pp. 857–861, 2004.
[6]
Z. L. Gao, J. T. Wu, D. D. Yang, L. Shi, C. P. Men, and L. Wang, “Retroperitoneoscopic right living donor nephrectomy,” Chinese Medical Journal, vol. 120, no. 14, pp. 1270–1273, 2007.
[7]
J. W. Hsu, P. P. Reese, A. Naji, M. H. Levine, and P. L. Abt, “Increased early graft failure in right-sided living donor nephrectomy,” Transplantation, vol. 91, no. 1, pp. 108–114, 2011.
[8]
R. Ruszat, S. F. Wyler, T. Wolff et al., “Reluctance over right-sided retroperitoneoscopic living donor nephrectomy: justified or not?” Transplantation Proceedings, vol. 39, no. 5, pp. 1381–1385, 2007.
[9]
J. Wadstr？m, A. Biglarnia, H. Gjertsen, A. Sugitani, and J. Fronek, “Introducing hand-assisted retroperitoneoscopic live donor nephrectomy: learning curves and development based on 413 consecutive cases in four centers,” Transplantation, vol. 91, no. 4, pp. 462–469, 2011.
[10]
K. Tanabe, N. Miyamoto, H. Ishida et al., “Retroperitoneoscopic live donor nephrectomy (RPLDN): establishment and initial experience of RPLDN at a single center,” American Journal of Transplantation, vol. 5, no. 4 I, pp. 739–745, 2005.
[11]
N. Kohei, O. Kazuya, T. Hirai et al., “Retroperitoneoscopic living donor nephrectomy: experience of 425 cases at a single center,” Journal of Endourology, vol. 24, no. 11, pp. 1783–1787, 2010.
[12]
A. K. Mandal, C. Cohen, R. A. Montgomery, L. R. Kavoussi, and L. E. Ratner, “Should the indications for laparascopic live donor nephrectomy of the right kidney be the same as for the open procedure? anomalous left renal vasculature is not a contraindication to laparoscopic left donor nephrectomy,” Transplantation, vol. 71, no. 5, pp. 660–664, 2001.
[13]
N. F. M. Kok, W. Weimar, I. P. J. Alwayn, and J. N. M. Ijzermans, “The current practice of live donor nephrectomy in Europe,” Transplantation, vol. 82, no. 7, pp. 892–897, 2006.
[14]
J. F. Buell, M. Edye, M. Johnson et al., “Are concerns over right laparoscopic donor nephrectomy unwarranted?” Annals of Surgery, vol. 233, no. 5, pp. 645–651, 2001.
[15]
S. C. Jacobs, E. Cho, C. Foster, P. Liao, and S. T. Bartlett, “Laparoscopic donor nephrectomy: the university of maryland 6-year experience,” Journal of Urology, vol. 171, no. 1, pp. 47–51, 2004.
[16]
J. R. Leventhal, S. Paunescu, T. B. Baker et al., “A decade of minimally invasive donation: experience with more than 1200 laparoscopic donor nephrectomies at a single institution,” Clinical Transplantation, vol. 24, no. 2, pp. 169–174, 2010.
[17]
L. F. C. Dols, N. F. M. Kok, I. P. J. Alwayn, T. C. Khe Tran, W. Weimar, and J. N. M. Ijzermans, “Laparoscopic donor nephrectomy: a plea for the right-sided approach,” Transplantation, vol. 87, no. 5, pp. 745–750, 2009.
[18]
E. Y. Ko, E. P. Castle, P. J. Desai et al., “Utility of the endovascular stapler for right-sided laparoscopic donor nephrectomy: a 7-Year experience at mayo clinic,” Journal of the American College of Surgeons, vol. 207, no. 6, pp. 896–903, 2008.
[19]
I. S. Gill, R. G. Uzzo, M. G. Hobart, S. B. Streem, D. A. Goldfarb, and M. J. Noble, “Laparoscopic retroperitoneal live donor right nephrectomy for purposes of allotransplantation and autotransplantation,” Journal of Urology, vol. 164, no. 5, pp. 1500–1504, 2000.
[20]
L. Ma, G. Li, Y. Huang et al., “Retroperitoneoscopic live-donor right nephrectomy: a Chinese single center,” Experimental and Clinical Transplantation, vol. 9, no. 1, pp. 20–25, 2011.
[21]
L. Ma, J. Ye, Y. Huang, X. Hou, L. Zhao, and G. Wang, “Retroperitoneoscopic live-donor nephrectomy: 5-year single-center experience in China,” International Journal of Urology, vol. 17, no. 2, pp. 158–162, 2010.
[22]
A. Bachmann, T. Wolff, R. Ruszat et al., “Retroperitoneoscopic donor nephrectomy: a retrospective, non-randomized comparison of early complications, donor and recipient outcome with the standard open approach,” European Urology, vol. 48, no. 1, pp. 90–96, 2005.
[23]
R. Ruszat, T. Sulser, M. Dickenmann et al., “Retroperitoneoscopic donor nephrectomy: donor outcome and complication rate in comparison with three different techniques,” World Journal of Urology, vol. 24, no. 1, pp. 113–117, 2006.
[24]
S. Y. Lee, B. H. Chung, S. G. Piao et al., “Clinical significance of slow recovery of graft function in living donor kidney transplantation,” Transplantation, vol. 90, no. 1, pp. 38–43, 2010.
[25]
A. D. Wright, T. A. Will, D. R. Holt, T. M. T. Turk, and K. T. Perry, “Laparoscopic living donor nephrectomy: a look at current trends and practice patterns at major transplant centers across the united states,” Journal of Urology, vol. 179, no. 4, pp. 1488–1492, 2008.
[26]
L. F. C. Dols, N. F. M. Kok, and J. N. M. Ijzermans, “Live donor nephrectomy: a review of evidence for surgical techniques,” Transplant International, vol. 23, no. 2, pp. 121–130, 2010.
