Modified anterior abdominal donor nephrectomy in comparison with laparoscopic donor nephrectomy.

Abstract

Recently with introduction of laparoscopic nephrectomy, the procedure has become more appealing to living donors because of smaller laparoscopic incision and decreased length of hospital stay. However, because of the relatively prolonged warm ischemia time, increased operating time, and delayed graft function, the current laparoscopic donor nephrectomy is still subject to further development. We introduced a modified anterior abdomen incision for donor nephrectomy with advantages of laparoscopic procedure but with shorter warm ischemia and operation time. In 15 donors, a 10 cm incision was performed in the upper side of the abdomen between the rectus muscle and the tip of the ribs, while the donor was in flank position. Then, the kidney was exposed and freed followed by ureter nephrectomy. Afterwards, the abdominal wall was repaired without drain. The time of operation (from incision skin to suturing of skin) was from 1-1.5 hours with a few seconds of warm ischemia time. The donors experienced tolerable pain and all of them were discharged from hospital two days post operation. All grafts in recipients started to diurese immediately. Cosmetic appearance of wounds after operation and six months later were good. In conclusion, the modified anterior abdominal incision is safe and comparable with the conventional laparoscopic procedure in the size of the incision, the cosmetic appearance, the incision pain, and time of discharge. It may be advised as an alternative laparoscopic nephrectomy procedure.