Laparoscopic LDN Side May Not Matter
Right- and left-side living donor nephrectomies have similar profiles.
Right and left laparoscopic living-donor nephrectomies (LDN) are equivalent in operative parameters and postoperative results.
Eric K. Diner, MD, and his colleagues at Washington Hospital Center in Washington, D.C., re-viewed 167 patients who underwent LDN (127 left-sided and 40 right-sided). A right-side LDN can be technically more difficult because of liver retraction and the short, right renal vein, so most donor surgeons favor left LDN.
The mean operative time for a right-donor nephrectomy was 220 minutes compared with 228 minutes for LDN, Dr. Diner's group reported in Urology (2006;68:1175-1177).
Mean estimated blood loss was 115 mL for a right LDN compared with 106 mL for a left LDN. The mean warm ischemia times were 5.32 and 4.90 minutes for the right- and left-sided procedure, respectively. The median length of stay for both groups was 2.43 and 2.55 days. None of the differences between the two groups was statistically significant.
“Our experience has demonstrated that a group with moderate LDN experience can perform right LDN efficiently, safely, and effectively,” the authors wrote.
They also commented: “We believe that in the case of two normal kidneys, the smaller one should be harvested for donation, regardless of its side. Whenever the left kidney has an anatomic abnormality or multiple or complex vasculature, or the right kidney possesses a simple cyst, stone, or minor arterial lesion, the need for right LDN becomes even more obvious,” they said.