INTRODUCTION: In this study, we aimed to investigate our results of the first 48 patients who underwent total laparoscopic transperitoneal donor nephrectomy, and present the impact of the kidney extraction site on ischemia time.
METHODS: The study included the subjects who underwent the operation between February 2017 and December 2018. Evaluation of the kidney transplantation candidates was made by the kidney transplantation council. 4 trocars were placed for the right-side nephrectomy. 3 trocars were placed for the left-side nephrectomy. The kidneys were extracted through suprapubic incision in the first 18 cases, and through the inguinal region in the last 30 cases. We compared the demographic characteristics, intraoperative and postoperative results between the two groups.
RESULTS: Of the patients, 30 patients were female and 18 were male with a mean age of 48.0±9.6 (30-71). All patients underwent total laparoscopic transperitoneal donor nephrectomy. Four patients underwent right-side nephrectomy and 44 underwent left-side nephrectomy. There was not any conversion to open surgery. The mean operative time was 251.4 ± 72.4 (127-420) minutes. In the first 18 cases, the organ was extracted through a suprapubic incision and the ischemia time was 318±140 (150-720) seconds. In the last 30 cases, the organ was extracted through the inguinal incision and the ischemia time was 151.5±55.1 (80-265) seconds. The mean length of hospital stay was 5.4 ± 1.1 (3-10) days.
DISCUSSION AND CONCLUSION: The application of minimally invasive surgery in healthy individuals undergoing donor nephrectomy lead to better physical, psychological and social outcomes. Surgical experience and the extraction site shorten the warm ischemia time significantly. We routinely use and recommend the extraction through the ingual region as it provides a faster removal and shortens the warm ischemia time. LDN can be used safely in centers with experience of advanced laparoscopy.