LAUSR

Background: Retroperitoneal laparoscopic donor nephrectomy (RPLDN) has gradually become the main approach to obtain the live donor kidneys. These techniques are considered less invasive for the donor, allowing lower postoperative analgesic requirements and faster return to daily activities. However, the shorter right renal vein limits its wider application. Aim: To evaluate the feasibility & safety of right sided retroperitoneal laparoscopic live donor nephrectomy. Methods: Between July 2014 & Dec 2019, a total of 2500 living donors underwent consecutive three port retroperitoneal laparoscopic donor nephrectomies out of which 300 right sided nephrectomies. The initial retroperitoneal space was created by insertion of a catheter attached to a saline filled mid finger of a glove. The renal hilum and ureter were circumferentially mobilized. The ureter was sheared with scissors. The main renal artery was controlled, using 2 Hem-o-lok clips placed at proximal end. In initial 100 cases we used single XL Hem-o-lok clip later on we started using Endo-TA stapler with 30mm articulating reload was applied on the IVC to get a cuff of IVC along the right renal vein stump. The graft retrieved through the inguinal incision. Results: All the 300 right RPLDN were carried out successfully. The average operation time and mean warm ischemic time was 74min & 4min, respectively. The average blood loss was 80ml. No blood transfusion or open conversion was required. No major complication occurred in the donors and donors were discharge after an average of 4 days. Among the 300 right RPLDN, 58 patients had multiple arteries.,25 patients had early branching of the main renal artery (1.0-1.5 cm from the aorta). In initial 100 cases we used single XL Hem-o-lok clip later on we started using Endo-TA stapler with 30mm articulating reload was applied on the IVC to get a cuff of IVC along the right renal vein stump. Anatomically, the right renal vein is short and thin walled to overcome this anatomical challenge associated with right RPLDN. Grafts with short renal vein were tackled by placing the kidney upside down during transplantation. We have not encountered the need for any back-table surgery on the right sided kidney grafts. Conclusions: Right sided retroperitoneal laparoscopic donor nephrectomy is safe even in patients with a complex vascular anatomy with no added morbidity and less operative time. The modified approach of retroperitoneal laparoscopic donor nephrectomy could be a cost effective and safe alternative. 450.2