Laparoendoscopic Single Site Live Donor Nephrectomy: Initial Experience

Purpose: We present our initial experience in 40 patients undergoing laparoendoscopic single site donor nephrectomy. Materials and Methods: We prospectively collected data on 40 consecutive patients. A single access GelPOINT (TM) device was inserted into the abdomen through a 4 to 5 cm periumbilical incision. We used a bariatric camera with a right angle attachment for the light cord to maximize triangulation. Parameters analyzed included warm ischemia time, operative time, estimated blood loss, visual analog pain score, time to recipient creatinine less than 3 mg/dl, and recipient creatinine at discharge home, and 3 and 6 months. Results: A total of 38 left and 2 right donor nephrectomies were performed. Complete laparoendoscopic single site donor nephrectomy was successful in 38 cases. One left and 1 right case were converted to a hand assisted approach. Average +/- SD body mass index was 26.1 +/- 5.2 kg/m(2). Mean operative time to allograft extraction was 93.5 +/- 27.5 minutes and mean total operative time was 166.7 +/- 33.8 minutes. Average estimated blood loss was 106.7 +/- 93.5 cc. Mean warm ischemia time was 3.96 +/- 0.72 minutes. Mean hospital stay was 1.77 +/- 0.43 days and median time to recipient creatinine less than 3.0 mg/dl was 54.2 +/- 110.3 hours. Mean recipient creatinine at discharge home, and at 3 and 6 months was 1.48 +/- 0.67, 1.29 +/- 0.38 and 1.19 +/- 0.34 mg/dl, respectively. Complications included hyponatremia in 1 patient, wound infection in 1, and a grade III laceration in an allograft that was sustained during extraction. Conclusions: Our initial experience with laparoendoscopic single site donor nephrectomy is encouraging. This approach to kidney donation without an extra-umbilical incision could become particularly relevant to minimize morbidity in young, healthy organ donors.