Complications of retroperitoneoscopic living donor nephrectomy: single center experience after 164 cases

OBJECTIVES: Retroperitoneoscopic living donor nephrectomy (RLDN) is used by only a few centers worldwide. Similar to laparoscopic living donor nephrectomy it offers the donor rapid convalescence and excellent cosmetic results. However, concerns have been expressed over the safety of endoscopic living donor nephrectomy. METHODS: We review the results of 164 consecutive RLDN from November 2001 to November 2007. Complications were classified into intra- and early postoperative. RESULTS: Mean donor age was 53.4 +/- 10.7 years (27-79). Left kidneys were harvested in 76% of cases. Mean operation time was 146 +/- 44 min (55-270), and warm ischemia time 131 +/- 45 s (50-280). In two patients (1.2%) conversion to open nephrectomy was necessary. The intraoperative complication rate was 3.0%. In the postoperative period we observed in 17.7% minor complications with no persisting impairments for the donor. The rate of major complications in the early postoperative period was 4.3%. Three patients (1.8%) necessitated revision, due to laceration of the external iliac artery in one patient and chyloretroperitoneum in two patients. Mean donor creatinine was 113.1 +/- 26.6 mg/dl (63-201) on the first postoperative day, and 102.0 +/- 22.2 mg/dl (68-159) on the fifth postoperative day. CONCLUSION: Retroperitoneoscopic living donor nephrectomy can be performed with acceptable intraoperative and early postoperative morbidity. Operation times and warm ischemia times are comparable to the open approach.