Experience with laparoscopic donor nephrectomy among more than 1000 cases: low complication rates, despite more challenging cases.

HYPOTHESIS

Despite the overall acceptance of laparoscopic donor nephrectomy (LDNX), concern remains about the application of this technique in certain complex situations, such as right-sided nephrectomies and in donors with complex kidney anatomy and obese donors. This study was designed to determine if complication rates have remained stable as we have offered LDNX to all medically acceptable donors and to analyze the results of cases in each of the complex categories. We hypothesized that complication rates in the 3 complex categories would be equivalent to those among more straightforward cases.

DESIGN

Retrospective medical record review.

SETTING

Academic medical center.

PATIENTS

A total of 1045 patients who underwent LDNX between November 3, 1999, and August 28, 2009.

MAIN OUTCOMES MEASURES

Operative times, lengths of hospital stay, overall complications, major complications, conversions to open surgery, blood transfusions, readmissions, and reoperations.

RESULTS

The outcomes of the first 250 patients (when LDNX was selectively offered) were compared with the outcomes of the last 795 patients (when LDNX was offered to all medically acceptable donors). Overall operative times significantly improved (212 vs 176 minutes), overall complication rates did not change (6.4% vs 5.5%), and major complication rates significantly declined (4.0% vs 1.4%). Among the last 795 patients, 1 conversion to open surgery and 1 blood transfusion occurred. There were no deaths in the series. Moreover, no differences in overall or major complication rates were seen when cases involving 200 right-sided nephrectomies, 204 donors with complex kidney anatomy, and 148 obese donors were analyzed independently.

CONCLUSIONS

Low complication rates persist for LDNX, even when applied to more technically challenging cases. This procedure is offered to all medically acceptable donors, with an excellent safety profile, and should be considered the standard of care for kidney donation.