Extraction of kidney via suprapubic or inguinal incision in total laparoscopic donor nephrectomy

INTRODUCTION: The objective of this study was to investigate the results of the first 48 patients who underwent total laparoscopic transperitoneal donor nephrectomy at a single institution and to present the impact of the kidney extraction site on ischemia time.
METHODS: The study included patients who underwent kidney donor surgery between February 2017 and December 2018. Evaluation of the kidney transplantation candidates was performed by the kidney transplantation council. A total of 4 trocars were used for a right-side nephrectomy, and 3 trocars were used for a left-side nephrectomy. The kidneys were extracted through a suprapubic incision in the first 18 cases and through the inguinal region in the last 30 cases. A comparison was made of the demographic characteristics and the intraoperative and postoperative results of the 2 groups.
RESULTS: Of the study patients, 30 were female and 18 were male, with a mean age of 48.0±9.6 years (range: 30–71 years). All of the patients underwent a total laparoscopic transperitoneal donor nephrectomy. Four patients underwent a right-side nephrectomy and 44 underwent a left-side nephrectomy. There was no case of conversion to open surgery. The mean operative time was 251.4±72.4 minutes (range: 127–420 minutes). In the first 18 cases, the organ was extracted through a suprapubic incision and the ischemia time was 318±140 seconds (range: 150–720 seconds). In the last 30 cases, the organ was extracted through an inguinal incision and the mean ischemia time was 151.5±55.1 seconds (range: 80–265 seconds). The mean length of hospital stay was 5.4±1.1 days (range: 3-10 days).
DISCUSSION AND CONCLUSION: The application of minimally invasive surgery in healthy individuals undergoing donor nephrectomy leads to better physical, psychological, and social outcomes. Surgical experience and the choice of extraction site can shorten the warm ischemia time significantly. Extraction through the inguinal region is recommended, as it provides for a faster removal and shortens the warm ischemia time. Laparoscopic donor nephrectomy can be used safely in centers with experience performing advanced laparoscopy.