Two-port laparoscopic donor nephrectomy with simple retraction technique

Abstract

Objective: To present our experience of 2-port laparoscopic donor nephrectomy (TPLDN) and to introduce a simple retraction suture technique.

Material and methods: From October 2010 to November 2010, 10 consecutive, left TPLDNs were performed. The SILS Port was inserted through the umbilicus and was used for 5-mm laparoscope and laparoscopic instruments. A 12-mm trocar, for another working channel, was inserted along the midclavicular line at the umbilicus level. No articulating or bent laparoscopic instruments were needed. Two retraction sutures were used; a 3-0 Prolene suture was passed through the pericolic fat and then brought out of the abdominal wall and secured to the skin. Another suture was passed around the lower pole fat of the kidney, which was then fixed on the abdominal wall with a clamp.

Results: TPLDN was performed successfully in all patients, with no conversions to a conventional laparoscopic procedure or additional trocar insertion needed. The mean operative time was 152 ± 16.3 minutes, and the mean warm ischemia time was 2.9 ± 0.9. The average estimated blood loss was 77.3 ± 70 mL, and the postoperative hospital stay was 3.6 ± 0.6 days. No perioperative or postoperative complications were observed. Cosmesis was excellent, with a mean incision length of 5.6 ± 0.4 cm. All allografts functioned after transplantation.

Conclusion: Our initial experience suggests that TPLDN appears safe and cosmetically effective and a feasible option for donor nephrectomy. The appropriate use of retraction sutures, during TPLDN, helps to overcome the technical problems associated with the inadequate retraction and exposure.