Extending Anatomic Barriers to Right Laparoscopic Live Donor Nephrectomy

OBJECTIVE To analyze the effects of a right-sided-complex laparoscopic live donor nephrectomy, defined as bifurcation of the right renal artery behind the inferior vena cava. Right-sided laparoscopic live donor nephrectomy is now a widely accepted procedure when complex anatomy is encountered on the left. TECHNICAL CONSIDERATIONS The present retrospective case note review involved 59 of 303 laparoscopic live donor nephrectomy procedures performed in a single center from January 2001 to April 2010 (group 1, simple, n = 48; and group 2, complex, n = 11). The effect of a donor right procedure on warm ischemia, graft function, and donor/recipient complications was analyzed. RESULTS No difference in donor or recipient age or first and second warm ischemic times was found between the 2 groups. No difference was found in the estimated glomerular filtration rate or serum creatinine at 1 week and 3 and 6 months [estimated glomerular filtration rate (6/12), 49 +/- 15 vs 60 +/- 9 mL/min, P = .087; and serum creatinine (6 months), 159 +/- 116 vs 120 +/- 25 mu mol/L; P = .356]. No cases of delayed graft function were reported, and none of the grafts developed vascular thrombosis. The cumulative estimated glomerular filtration rate at 6/12 was 51 +/- 15 mL/min and the serum creatinine was 153 +/- 108 mu mol/L. Two patients (4%) required conversion to open surgery in group 1, and the cumulative conversion rate was 3.3%. In the complex group with retrocaval dissection, 8 kidneys were retrieved with a single artery and 3 had multiple vessels (2 with 2 vessels and 1 with 3 vessels; anastomotic time 26 +/- 6 minutes). CONCLUSION Complex vasculature in a right-sided donation should not be considered a contraindication, because the kidneys procured had excellent function compared with those with single vasculature with no increase in the conversion or vascular thrombosis rate. In addition, the described techniques permit improved arterial length and, importantly, organs procured with a single artery. UROLOGY 79: 465-469, 2012. (C) 2012 Elsevier Inc.