Surgical techniques in living donor nephrectomy

• Donor mortality and major complications appear equivalent with laparoscopic and open donor nephrectomy. In open surgery, the risks appear related to perioperative complications including pulmonary emboli, pneumonia and ischaemic events. With laparoscopic surgery, complications are largely due to catastrophic intraoperative events related to securing of the vascular pedicle. Measures to reduce these specific problems should be undertaken and tailored to the technique used by individual transplant units. • Use of a non-transfixing mechanism for securing the renal artery is not recommended, particularly with laparoscopic donor nephrectomy. • Laparoscopic donor nephrectomy is more resourceintensive, but may offer advantages to many donors: – Increased operative time but equivalent hospitalization (based on hospital stay in five out of six randomized controlled trials) with laparoscopic compared with open donor nephrectomy – Reduced analgesic requirements and return to normal activities with laparoscopic donor nephrectomy compared with open surgery. • Death and major complications occur infrequently following donor nephrectomy. This limits the feasibility of randomized controlled trials comparing donor surgical techniques. The best available evidence will evolve over time with comprehensive registry data.