Minimally Invasive Techniques in Live Donor Nephrectomy
Summary
Minimally invasive approaches to live donor nephrectomy have revolutionised kidney transplantation by reducing postoperative pain, shortening hospital stay and accelerating return to daily activities. Initially pioneered as pure laparoscopic operations, the field has diversified to include hand-assisted, retroperitoneoscopic, single-port and robot-assisted techniques. Key objectives are safe vascular control, minimisation of warm ischaemia time and preservation of graft quality. Advances in instrumentation—ranging from high-definition optics to articulating robotic arms—have enhanced surgical precision in complex anatomical situations such as early arterial bifurcation or anomalous venous drainage. Adoption has been driven by evidence that these approaches yield donor morbidity comparable to open nephrectomy while improving donor experience and maintaining equivalent long-term graft survival. Ongoing challenges include the steep learning curve for some platforms and the need for standardised training protocols to ensure consistent outcomes across centres worldwide.
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Minimally Invasive Techniques in Live Donor Nephrectomy publication trend
The graph below shows the total number of articles in minimally invasive techniques in live donor nephrectomy across all publications each year (not limited to Nature Index journals).
Technical terms
Laparoscopic donor nephrectomy (LDN): Removal of a donor kidney through multiple small abdominal incisions using a camera and specialised instruments.
Hand-assisted retroperitoneoscopic donor nephrectomy (HARP): A variation of LDN in which the surgeon inserts a hand through a small incision to facilitate mobilisation and dissection in the retroperitoneal space.
Robot-assisted laparoscopic donor nephrectomy (RALDN): Use of a robotic platform to perform laparoscopic nephrectomy, offering enhanced dexterity, three-dimensional vision and instrument articulation.
Warm ischaemia time (WIT): The duration between arterial clamping of the kidney and its cooling, during which the organ remains at body temperature.
Cumulative sum (CUSUM) analysis: A statistical method used to monitor performance over time, often applied to assess learning curves in surgery.
References
- Learning curves of minimally invasive donor nephrectomy in a high-volume center: A cohort study of 1895 consecutive living donors. International Journal of Surgery (2021).
- Donor and Recipient Outcomes following Robotic‐Assisted Laparoscopic Living Donor Nephrectomy: A Systematic Review. BioMed Research International (2019).
- A Comparison of Technique Modifications in Laparoscopic Donor Nephrectomy: A Systematic Review and Meta-Analysis. PLOS ONE (2015).
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