Total laparoscopic live donor nephrectomy: a 6-year experience.

Background: Since the introduction of the laparoscopic live donor nephrectomy in 1995, attempts have been made to depart from the total laparoscopic approach to the hand-assisted approach to decrease surgical time and complications. We present our 6-year experience with the total laparoscopic approach.

Methods: Between December 1998 and November 2004 there were 168 total laparoscopic live donor nephrectomies performed at our institution. There were 163 left nephrectomies and 5 right nephrectomies.

Results: The procedure was performed in a systematic approach. The surgical time deceased from an average of 2:27 hours in the first year to 1:34 hours in the last year of the study. The overall average warm ischemia time was 3.5 minutes. Major bleeding requiring conversion to an open procedure occurred in 2 (1.2%) donors. Minor bleeding that was controlled laparoscopically occurred in 9 (5.4%) donors. Degloving of the renal capsule occurred in 2 (1.2%) donors with no consequences. Minor mesenteric rent occurred in 7 (4.2%) donors. All mesenteric complications were recognized and repaired laparoscopically. No ureteral or bowel injuries occurred. There were no mortalities. Eighty-three percent of donors were discharged the next day.

Conclusions: Total laparoscopic live donor nephrectomy is safe. It was performed successfully in 98.8% of donors with a short surgical time, low morbidity, and 0% mortality.