Complications of Laparoscopic Live Donor Nephrectomy: The First 175 Cases D.Y. Chan, M.D. Fabrizio, L.E. Ratner, and L.R. Kavoussi T HE FIRST laparoscopic live donor nephrectomy was performed in 1995. 1 Currently, over 70 institutions worldwide perform this procedure. Although laparoscopic live donor nephrectomy offers advantages to the donor including decreased pain, shorter hospitalization, and ear- lier return to daily activities, 2 concerns exist regarding complications when applying novel laparoscopic techniques to procedures traditionally approached in an open manner. 3 Laparoscopic donor nephrectomy must be equivalent to the “gold standard” open procedure. In this study, postopera- tive complications associated with laparoscopic live donor nephrectomy were evaluated. MATERIALS AND METHODS A retrospective review was conducted of all live donor renal transplants performed at our institution from January 1995 through March 1999. Intraoperative, perioperative, and long-term donor complications were assessed. RESULTS AND DISCUSSION Laparoscopic live donor nephrectomies were performed on 175 consecutive patients. The average age was 40.6 years. There were 106 female and 69 male donors. Only 16 right-sided donor nephrectomies were performed during this period. The average estimated blood loss was 304 mL. There were three intraoperative open conversions (1.7%): a defective endovascular GIA stapler malfunctioned, an ath- erosclerotic plaque ruptured during ligation, and anterior branch to the renal vein was torn during dissection. Six patients (3.4%) required blood transfusions. There were seven (4%) major complications: postoperative retroperito- neal bleeding requiring transfusion (two), GIA malfunction (one), epigastric artery injury (one), bowel injury (one), pneumonia (one), and incisional hernia (one). Minor com- plications occurred in 12 patients (6.9%): transient thigh paresthesia (seven), superficial wound infections (five), urinary tract infections (two), mucus plug/atelectasis (one), ileus (one), and epididymitis (one). The overall complica- tion rate in the laparoscopic group was 14%. There were no mortality, pneumothorax, small bowel obstruction, or sple- nectomy in our series. A recent multi-institutional review of 3657 open procedures revealed a 16% overall complications rate, ranging from 8% to 47%. 4 There was one mortality (0.03%) in the review of the open series. Complication rates in laparoscopic live donor nephrec- tomy appear equivalent to historic open series. Conversions in our laparoscopic donor nephrectomies were related to bleeding. Definition of complications, however, varies among series, and types of complications differ between laparoscopic and open approaches. REFERENCES 1. Ratner LE, Ciseck LJ, Moore RG, et al: Transplantation 60:1047, 1995 2. Ratner LE, Hiller J, Sroka M, et al: Transplant Proc 29:3402, 1997 3. Novick AC: Urology 53:668, 1999 4. Fabrizio MD, Ratner LE, Kavoussi LR: Urology 53:665, 1999 From the James Buchanan Brady Urological Institute (D.Y.C., D.F., L.R.K.) and Department of Surgery (L.E.R.), Johns Hopkins Medical Institution, Baltimore, Maryland. Address reprint requests to Louis R. Kavoussi, MD, Building A3C, Room 344, James Buchanan Brady Urological Institute, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224. 0041-1345/00/$–see front matter © 2000 by Elsevier Science Inc. PII S0041-1345(00)00979-9 655 Avenue of the Americas, New York, NY 10010 778 Transplantation Proceedings, 32, 778 (2000)