Laparoscopic Donor Nephrectomy: A Plea for the Right-Sided Approach

Background. Laparoscopic donor nephrectomy (LDN) has become the preferred procedure for live donor nephrectomy. Most transplant surgeons are reluctant toward right-sided LDN (R-LDN) fearing short vessels and renal vein thrombosis. Methods. In our institution, Selection of the appropriate kidney for donation was based on the same criteria that traditionally governed open donor nephrectomy. All intraoperative and postoperative data were prospectively recorded. Results. One hundred Fifty-nine R-LDNs (56%) and 124 left-sided LDNs (L-LDN, 44%) were performed. Demographics did not significantly differ. Complications occurred in 10 (6%) vs. 23 (19%) procedures (R-LDN vs. L-LDN, P=0.002), resulting in 2 and 11 conversions, respectively. Right-sided kidney donation was the only independent preventative factor for complications in multivariate analysis (P=0.008, Odds ratio 0.33). R-LDN was associated with shorter operation time (mean 202 vs. 247 min, P<0.001) and less blood loss (139 vs. 294 mL, P<0.001). Hospital stay was 3 days in both groups. With regard to the recipients, the second warm ischemia time was similar (29 vs. 28 min, P = 0.699). Conclusions. R-LDN is faster and safer than L-LDN and does not adversely affect graft function. R-LDN may be advocated to allow donors to benefit from the advantages of laparoscopic surgery.