In 1999, our institution began a kidney transplant program with collaboration between the departments of General Surgery/Transplantation and Urology. From the onset, donor nephrectomies were performed laparoscopically, and are currently the domain of Urology, who had no prior laparoscopic experience prior to this undertaking. We reviewed our technique.

All laparoscopic donor nephrectomies are performed transperitoneally. We utilize a four port technique, two 12mm ports for the camera and dominant arm, and two 5mm ports for the non-dominant arm and an assistant. Pneumoperitoneum is established through a hand port that is placed through a lower midline or Pfannenstiel incision. Although the entire dissection is performed purely laparoscopically, the hand port facilitates extraction.

Donor S n=205
Mean age (years): 40.9 +/- 11.2
Male/Female: 76/129
Right/Left: 29/176
Average OR time (min): 112 +/- 39.5
Average extraction time (min): 1.6 +/- 1.1
EBL (cc): 120 +/- 230
LOS (days): 2.3 +/- 0.9

A total of 205 consecutive procedures were reviewed. In addition to the above table, we report low complication (14.1%) and open conversion (1.5%) rates. For the recipients, early (98.0%) and one-year (94.7%) graft survival, and ureteral ischemia (2.4%) rates were also appropriate with contemporary experience.

We demonstrate our technique of laparoscopic donor nephrectomy and give our results over our first 205 cases. Because of this experience, we have ventured into other horizons of urologic laparoscopy and currently produce enough volume to support a laparoscopic fellowship. We feel that a productive donor nephrectomy program can enhance urologic laparoscopic programs and should be taken advantage of when available.