Background: Laparoscopic transperitoneal nephrectomy was firstly performed at Cho Ray hospital on 28 May 2004. Since August 2005, we completely performed retroperitoneal laparoscopic living donor nephrectomy (RLLDN) for kidney harvesting. To assess the safety, feasibility, and results of RPLDN, we analyzed the data of RLLDN to assess outcomes and evaluate our experience in the series of RLLDN operated on by a single team over a 10-year period at Cho Ray hospital.
Methods: Data were collected prospectively on 400 donors with RLLDN at Cho Ray hospital from August 2005 to May 2017. The donors were chosen by the Renal Transplantation Council of Cho Ray Hospital (donor national criteria). All of them were related living donors, except who can demonstrate the humanitarian motive and non-remunerated donor. To choose the side of the kidney to harvest, we prefer to remain the best function kidney (by renal isotopic scan) or the healthy kidney for the donor. The abnormally of kidney vessels with multiple arteries were not the main criteria of side choosing. Patient demographics, radiology findings, surgery results, peri-operative complications, warm ischemia time, hospital stay and follow-up results were recorded. The primary outcomes were intraoperative surgical results. The secondary outcomes were postoperative kidney function and postoperative complication.
Results: There were 400 cases of RLLDN (55.75% females and 44.25% males). The mean age of the series was 46.5 ± 8.9 years. The mean BMI was 22.2 ± 3.1 (17.1- 35.4). There were 124 right kidneys and 276 left kidneys. Donor nephrectomy was performed successfully in all patients, without conversion to open surgery. No intraoperative complication neither mortality was seen. The average of the warm ischemic time was 274.7 ± 84.8 seconds. Postoperative complications were two cases (0.5%) of post-transplant ureteral fistula and two cases (0.5%) of postoperative bleeding requiring surgical intervention. All of the grafts were functioned well in the first hour of transplantation. The remaining kidney functioned well with the average of serum creatinine were 1.3 ± 0.2 mg/dL to compare with 0.9 ± 0.5 mg/dL before the nephrectomy. The average hospitalized time was 4.8 ± 1.2 days.
Conclusion: At Cho Ray hospital, 400 RLLDN cases were performed successfully over a 10-year period. The technique was relatively simple and feasible in Vietnam with standard instruments for laparoscopic surgery. Generally, the transplantation kidney function was normal during the post-transplant period.
Key words: Living kidney donor, laparoscopic living donor nephrectomy for transplantation, laparoscopic surgery