Laparoscopic Living Donor Nephrectomy: A Single Center Comparison of Three Different Techniques.

Background and objectives: In this study, we compare three different surgical approaches at a single institution. Pure laparoscopic donor nephrectomy with Pfannenstiel incision (PLDN) was compared with hand-assisted laparoscopic donor nephrectomy via midline hand port (HALDNM) and hand-assisted laparoscopic donor nephrectomy via left iliac hand port (HALDNL).

Methods: This study included all laparoscopic left donor nephrectomies performed at our institution between January 1, 2020 and December 31, 2021. Donor characteristics including age, sex, body mass index, number of renal arteries, duration of surgical procedure, warm ischemia time (WIT), and length of hospital stay were compared. Cosmetic scores were calculated by totaling the length of all incisions placed. Postoperative complications within 90 days were compared.

Results: During the study period 71 laparoscopic donor nephrectomies were performed of which 26 were HALDNM, 24 were HALDNL, and 21 were PLDN. Donor characteristics were similar in all three groups. Total operative time was significantly lower in HALDNM (181 minutes) than PLDN (233 minutes) and HALDNL (242 minutes) (p < 0.001). The WIT was comparable in all three groups: HALDNL (7.2 minutes), PLDN (4.1 minutes), and HALDM (4.9 minutes) (p = 0.913). Median cosmetic score was significantly better in the PLDN group (8.2 cm) when compared to HALDNM (11.1 cm) and HALDNL (9.9 cm) (p < 0.001).

Conclusion: Our results show that all three technical modifications of laparoscopic donor nephrectomy are safe and feasible with good postoperative outcomes. HALDNM has the added benefit of decreased operative time while PLDN has a cosmetic advantage.