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ORIGINAL ARTICLE
Retroperitoneal Single-port Donor Nephrectomy through

Lumbotomy Incision: An Experience of 30 Cases

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Navdeep Singh , Deepesh B Kenwar , Sarbpreet Singh , Soham Dasgupta , Kunal Kapoor , Sandeep Kumar , Ashish Sharma 7
AbstrAct
Introduction: Over the years, laparoscopic donor nephrectomy (LDN) has evolved as a preferred alternative to open-donor nephrectomy
(ODN). Laparoscopic donor nephrectomy can be performed either by transperitoneal or retroperitoneal route. Retroperitoneoscopic live donor
nephrectomy (RPLDN) results in less analgesic requirement, decreased hospital stay, and better cosmetic acceptance by the donors. Lumbotomy
incision has been thought to be an ideal approach without any muscle being cut but is limited by the amount of space in open surgery.
Materials and methods: Between November 2014 and September 2016, 350 donor nephrectomies were performed at our department. All the
surgeries were performed by a single surgeon. Thirty patients consented for translumbar RPLDN out of the 82 donor nephrectomies assigned
to that particular surgeon. Visual analog scale (VAS) was used to evaluate the severity of pain on postoperative day (POD)0 and POD1.
Results: Mean age of donors was 44.7 ± 11.4 years, M:F ratio 9:21. Average duration of surgery was 170.33 ± 52 minutes. Four patients (13.3%)
had double renal arteries and one patient had double renal vein. In one patient, retrieval was performed by an open approach. No patient had
surgical site infection. Most patients (28/30) had a VAS score of <4, and did not require any additional analgesics beyond POD0.
Conclusion: Single-site translumbar RPLDN is a feasible alternative approach to the donor surgery.
Keywords: Laparoscopic, Lumbotomy, Retroperitoneal, Single port.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1399

IntroductIon 1–7 Department of Renal Transplant Surgery, Postgraduate Institute of

Renal transplantation is the preferred treatment for patients Medical Education and Research, Chandigarh, India
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with end-stage renal failure. Outcomes after transplantation are Corresponding Author: Ashish Sharma, Department of Renal
superior with the use of live-donor kidneys as compared with those Transplant Surgery, Postgraduate Institute of Medical Education
from deceased donors but require a healthy person to undergo and Research, Chandigarh, India, Phone: +91 99142 02301, e-mail:
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an invasive procedure. A lot of progress has been made in the ashishpgi@gmail.com
recent years to minimize the discomforts associated with donor How to cite this article: Singh N, Kenwar DB, Singh S, et al.
nephrectomy. Laparoscopic donor nephrectomy (LDN) was first Retroperitoneal Single-port Donor Nephrectomy through Lumbotomy
introduced by Ratner et al in 1995 to reduce morbidity associated Incision: An Experience of 30 Cases. World J Lap Surg 2020;13(2):61–64.
with the open procedure which was the gold standard for kidney Source of support: Nil

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retrieval from living donors at that time. Over the years, LDN has Conflict of interest: None
evolved as a preferred alternative to open-donor nephrectomy
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(ODN) as the latter procedure results in a protracted convalescence including donor nephrectomy as they reduce the pain associated
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and has a high incidence wound-related morbidity. Both a recent with the procedure. There have been limited successful reports of
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meta-analysis and systematic review have suggested that retroperitoneoscopic laparoendoscopic single-site nephrectomy
LDN results in fewer complications, shorter hospital stay, and (LESS). However, the present study provides the first experience
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faster return to work compared with ODN. Laparoscopic donor in the literature of performing a single-port RPLDN through
nephrectomy can be performed either by transperitoneal or lumbotomy incision.
retroperitoneal route. The transperitoneal route of performing
donor nephrectomy has been classically described as it provides

a larger working space but the retroperitoneal procedure has MAterIAls And Methods
the advantages of no risk to intra-abdominal organs and direct Donors
access to the renal artery/vein. 8–10 Retroperitoneoscopic live
donor nephrectomy (RPLDN) results in less analgesic requirement, Selection Criteria
decreased stay, and better cosmetic acceptance by the donors. 11–14 Between November 2014 and September 2016, 350 donor
But it has the disadvantage of a muscle cutting/splitting incision nephrectomies were performed in our department. Preoperative
for the retrieval of donor kidney in addition to the multiple ports. donor evaluation included medical, surgical, and psychosocial
Lumbotomy incision has been thought to be an ideal approach to suitability for live kidney donation. Renal imaging like renal
reach kidneys without any muscle being cut but is limited by the angiography and differential renal function scan was performed
amount of space in open surgery. A single-port RPLDN performed in each patient. Patients with body mass index (BMI) of >30 were
through lumbotomy incision can provide a nearly ideal approach not considered for RPLDN for the initial experience. No patient had
to donor kidney. Single-site surgeries have been shown to further history of any previous retroperitoneal surgery. All the patients
hasten the recovery after surgery in a number of procedures received cefazolin 1 g 30 minutes before the start of the procedure.
© The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
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