Optimized Surgical Outcomes in Living Donor Nephrectomy: A Single-Center Experience with 250 Cases Using a Novel Technique

TL;DR

A new laparoscopic technique for kidney donation improves outcomes with less pain and fewer complications, based on 250 cases at a single hospital.

Contribution

A modified laparoscopic donor nephrectomy technique that minimizes colon mobilization and improves visualization.

Findings

The mean operative time was 72.8 minutes with low blood loss and no open surgery conversions.

Postoperative pain was low, and complication rates were minimal, including 0.8% major vascular injury.

High patient satisfaction scores suggest improved donor comfort and outcomes.

Abstract

Laparoscopic donor nephrectomy has become a standard of care for living kidney donors, providing reduced morbidity, quicker recovery, and enhanced patient satisfaction compared with open techniques. This study evaluates a modified laparoscopic donor nephrectomy technique designed to minimize colon mobilization while optimizing visualization, thereby improving donor outcomes.

A cross-sectional study of 250 consecutive living donor nephrectomies performed by a single surgeon between March 2022 and March 2024 was conducted. All donors underwent preoperative imaging (3D computed tomography and computed tomographic angiography). The modified approach avoided splenic flexure dissection and introduced early ligation of the adrenal vein. We analyzed intraoperative parameters (operative time, estimated blood loss, complications) and postoperative measures (hospital stay, pain scores, complication rates, satisfaction) were analyzed.

The mean operative time was 72.8 ± 16.2 minutes, with an estimated blood loss of 100 ± 40 mL. No conversions to open surgery or intraoperative transfusions were required. The mean length of hospital stay was 2.0 ± 1.0 days. Postoperative pain (mean Visual Analog Scale [VAS] 2.5 ± 1.8) was low, and major vascular injury occurred in 0.8% of cases. Wound infection and incisional hernia rates were each 0.8%. Patient satisfaction was high (Patient Satisfaction Questionnaire [PSQ] 3.3 ± 1.4), indicating favorable perceptions of comfort and outcomes.

This modified laparoscopic donor nephrectomy technique is safe, effective, and associated with enhanced patient comfort and reduced complications. The findings underscore its potential to improve donor experiences, potentially expanding the living donor pool. Further investigations should confirm these outcomes over a longer follow-up period.

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