Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2025 Oct 8.
Published in final edited form as: Curr Transplant Rep. 2025 Sep 28;12:10.1007/s40472-025-00487-3. doi: 10.1007/s40472-025-00487-3

Non-invasive approaches to living donor nephrectomy: Best practices and innovations

Ruchin Patel 1,*, Vidya A Fleetwood 2,*, Subarna Bhusal 1, Chintalapati Varma 2, Krista L Lentine 2, Chandra Bhati 1
PMCID: PMC12490746  NIHMSID: NIHMS2108041  PMID: 41050393

Abstract

Purpose of review:

Living donor nephrectomy is a cornerstone of kidney transplantation. Minimally invasive approaches offer reduced morbidity and faster recovery over open techniques. The purpose of this review is to elucidate recent advances and best practices in minimally invasive living donor nephrectomy procedures.

Recent Findings:

Although robotic living donor nephrectomies have longer operative and warm ischemia times compared to the open and laparoscopic techniques, early and late graft function including graft survival are comparable in the open, robotic and laparoscopic groups. Enhanced recovery after surgery (ERAS) protocols are increasingly being used to improve perioperative outcomes.

Summary:

This review focuses on the innovation of minimally invasive approaches to living donor nephrectomy over time and highlights the best practices during donor selection and the choice of surgical technique.

Keywords: Kidney donation, Living donation, Robotic surgery

Introduction

While almost 20,000 kidney transplant candidates were transplanted with deceased donor kidneys (DDKT) in 2022, over 4,000 listed potential recipients died waiting for a kidney transplant, and over 28,000 patients with over three years of dialysis time were still waiting.1 Living donors fill this gap by increasing access to kidney transplantation and reducing the wait time for transplant recipients. However, living donation remains underrepresented in kidney transplant: for patients waitlisted in 2017–2019, only 14.0% underwent living donor kidney transplants (LDKT), fewer than half of those who received DDKT (28.9%.)1

To increase living kidney donation, the transplant community must address multiple barriers to donation including individual donor health risks, financial considerations, and psychosocial concerns.2 The choice of surgical approach interacts with all of these considerations: more minimally invasive approaches may decrease risk for future postoperative complications, facilitate earlier return to work, and mitigate both pain and body image changes associated with donation.

Despite the advantages of enhancing surgical approach to living kidney donation, there is no consensus regarding the ideal technique. A 2014 consensus conference3 on best practices in living kidney donation did not address approach; and the 2017 KDIGO guidelines on the evaluation and care of living kidney donors4 recommend hand-assisted or laparoscopic nephrectomy and discourages against the use of robotic nephrectomy, which now constitutes 8% of living donor nephrectomies.5 [2] In this review, we discuss the different surgical approaches, current evidence for utilizing each technique, and the individualized preoperative and postoperative considerations that may inform the surgeon’s choice.

Surgical technique: Evolution and Innovation

Laparoscopic living donor nephrectomy

Kavoussi and Ratner performed the first laparoscopic living donor nephrectomy (LLDN) in 1995.6,7 The earliest study reporting laparoscopic living donor nephrectomy outcomes, published in 1997, compared 70 LLDN patients with historic open donor nephrectomy subjects and showed reduced morbidity with significantly less blood loss, length of stay, parenteral narcotic requirements, resumption of diet and return to normal activity.8 As the technique was adopted more widely, a meta-analysis of over 6500 patients9 demonstrated similar morbidity benefits, as did a systematic review.10,11 Laparoscopic completion of the nephrectomy was possible in most cases, with early rates of conversion to open surgery for laparoscopic donor nephrectomies ranging from around 0.2% to 2.1%.12,13 Reoperation rates were similarly low, under 1% in the LLDN groups.12 Rare complications sometimes presented, and case reports describe incidences of chylous ascites,14 gas embolism,15 retroperitoneal hernia with partial small bowel obstruction,16 parenchymal transection,17 and degloving of the renal capsule.18

Despite benefits to the donor, early concerns were raised regarding increased warm ischemia times and operative times with LLDN compared to open nephrectomies,13,19,20 but theses did not appear to impact rejection rates or graft function.19

Complex anatomy was not a deterrent, as even in the presence of multiple renal arteries, the one year patient and graft survival rates were similar in the LLDN and open groups.21 Initially, LLDN procedures were preferred for the left kidney due to technical concerns related to the length of the right renal vein.22 In 2000, Gill et al addressed this shortcoming by describing the technique of laparoscopic retroperitoneal living donor right nephrectomy (LRDN) in a case series of 5 patients.23 Subsequent studies proved this approach to be a safe method,24,25 including one meta-analysis that compared intraperitoneal LLDN and LRDN, finding significantly lower transfusion rates, fewer patients with decreased graft function, fewer vessel injuries and less frequent conversion to open with the retroperitoneal approach than with the laparoscopic intraperitoneal approach.26 On the right kidney, LRDN had the added benefit of direct access to the renal hilum without colon mobilization.27 Despite these advantages, LRDN has not been widely adopted but remains an option in the case of short right renal vein.

Hand-assisted laparoscopic nephrectomy

The trend of hand-assisted laparoscopic living donor nephrectomy (HA-LLDN) started in the early 2000’s to address increased warm ischemia times, increased operative times and the steep learning curve associated with LLDNs.28,29 Tactile feedback and manual dissection allowed for superior hemostasis. Right HA-LLDN had longer operation times compared to left sided HA-LLDN.30 A 2007 meta-analysis reported reduced intraoperative blood loss in the HA-LLDN group; additionally, intraoperative and postoperative complications were similar in both the donor and recipient, including delayed graft function and primary nonfunction.31

Hand-assisted retroperitoneoscopic nephrectomy was also reported in an initial 10 case series of hand-assisted retroperitoneoscopic living-donor nephrectomies (HA-RLDN).32 Subsequent study did not find any significant differences in intra- and post-operative complications between HA-RLDN and LLDN.33

One study reported hand port placement as a risk factor for incisional hernia.34 Hand port may occupy space in the operative field and make the procedure more complex, especially in the retroperitoneal space.35

Robotic donor nephrectomy

In 2002, Horgan et.al published the first successful 12-case series of robotic-assisted laparoscopic donor nephrectomies (RA-LLDN) using the da Vinci Surgical System.36 A 13-case series study published in 2006 found RA-LLDN was associated with very low morbidity among donors. The average operative and warm ischemia times were of greater duration but had no adverse effects on short-term graft function.37 RA-LLDN was safe regardless of the presence of vascular anomalies.38

Little evidence exists to support advantages of robotic donor nephrectomy over laparoscopic nephrectomy, although early data shows decreased opioid requirement when compared to hand-assisted nephrectomy.39 In terms of graft outcomes LLDN and RA-LLDNs have similar outcomes.40 In terms of length of hospital stay, studies lack a common consensus with some suggesting better results with RA-LLDN.41–43 Some authors deem RA-LLDN unnecessary citing the steeper learning curve, longer warm ischemia time and cost issues in resource limited settings.44 However, a three dimensional view of the operative field, endo-wrist instruments, ergonomics and greater instrument articulation for difficult anatomy must be considered in favor of RA-LLDN.45 RA-LLDN is better suited for complex hilar dissection, including retrocaval or inter-aorto-caval right renal artery.46 Robotic nephrectomy is an approachable skill: a cumulative sum (CUSUM) analysis deemed the learning curve of RA-LLDN to be 26 cases compared to 23 cases in LLDN and 45 cases in HA-LLDN.42 For retroperitoneal RA-LLDN approach, 33 procedures were needed to reach proficiency.45

Single-port surgery and natural orifice surgery

Some centers have expressed interest in using natural orifice transluminal endoscopic surgery (NOTES) to extract the kidney with fewer incisions and less scarring, typically through the vagina. Laparoscopic right and left nephrectomy have been described with extraction through the vagina since 201047,48 including with robotic assistance.49 Some authors perform similar procedures utilizing a single port as laparoendoscopic single site surgery (LESS),50 later described also with a Pfannenstiel incision.51

Single-incision surgery has drawn similar levels of attention but like NOTES, has not reached primetime. A 4-patient case series in 2008 described a single-port transumbilical living donor nephrectomy (E-NOTES) with an unprecedented opportunity for scar-free surgery.52 Single incision robotic-assisted LLDN was also described.53 A single port RA-LLDN has the ability for instruments to move at the elbow and wrist minimizing the technical challenges associated with laparoendoscopic single site procedures.54 Additionally, it minimizes surgical scars. In a study with sixty-three consecutive RA-LLDN procedures, among iliac, umbilical and transvaginal kidney extraction, there were similar results with iliac retrieval requiring a slightly longer hospital stay.55 In the same study, authors prepared the extraction site at the beginning of the procedure to reduce warm ischemia time.

Comparison of techniques

A Cochrane review56 published in May 2024 studied open donor nephrectomy (ODN), LLDN, HA-LLDN and RA-LLDN techniques for living kidney donors. LLDN compared to ODN had lower analgesia use and shorter hospital stay. Interestingly, there was no overall difference in blood loss, although the evidence was of low certainty. Historically, LLDN outcome studies showed relatively lower blood loss compared to ODN.9 Between LLDN and HA-LLDN no differences were found for analgesia requirement, hospital stay, duration of procedure, blood loss and perioperative complications.56 Between RA-LLDN and LLDN, there were no differences in duration of procedure, blood loss, perioperative complications, reoperations or hospital stay. Lower analgesia requirements have been observed when comparing robotic nephrectomy to HA-LLDN.39

Surgical approach for multiple renal arteries

Injury to vessels including renal vein rupture and dislodgement of clips may contribute to open conversion. Because of limited visualization of posterior and medial aspects of kidneys and renal veins during laparoscopic donor nephrectomy, preoperative evaluation of renal vasculature should be performed57 with multidetector CT angiography (CTA) or magnetic resonance angiography (MRA). A detailed evaluation of the number, course and branching pattern of renal vasculature, especially the renal vein, is vital for donor selection, surgical planning and minimizing complications.58

Anomalous renal vascular anatomy is no longer a contraindication to minimally invasive donor nephrectomy. In one study of 214 donors, multiple renal arteries (MRA) were observed in 18.2% of cases; MRA presence was not associated with significantly different early and late creatinine levels, delayed graft function, graft rejection or postoperative complications.59 However, multiple renal arteries present a challenge in the method of obtaining vascular control. Hem-o-lock clips were used initially for vascular control of the renal vessels, but multiple case reports of adverse effects including death of a donor60 cued the FDA to issue an alert in 2006. Other popular methods of ligating the renal pedicle include staplers and clips. One study describes the placement of an endo-Satinsky clamp on the inferior vena cava introduced via the retroperitoneal space to control the renal vein.35 A 2022 systematic review and meta-analysis showed polymer clips had fewer device failures compared to staplers, although the pooled estimate of device failure occurrence was 0.1% for both polymers clips, staplers and there were no significant differences in mortality, severe hemorrhage or conversion to ODN.61

Ciancio et al recently described HA-LLDN with midline right renal hilum rotation with easier access to the right renal artery for stapling.62 In cases of short donor renal veins, gonadal veins and iliac veins are increasingly being used as donor vascular tissue to extend the renal vein.62,63 The short length of donor vessels makes right nephrectomy more challenging but several techniques are currently available to control the hilum including inverting the right kidney in the recipient adjacent to the external iliac vein.64

ERAS protocols in donor nephrectomy

In the late 1990s, the concept of enhanced recovery after surgery (ERAS) originated for colorectal surgery65 but is eminently translatable to donor nephrectomy. A 2015 single-center retrospective analysis presented 60 living kidney donors enrolled in their enhanced recovery protocol and demonstrated reduced length of stay from 2 to 1 days, with overall 50% reduction in narcotic use with similar pain scores.66 Since then, multiple ERAS protocols have been described.67,68 According to a 2021 systematic review[78], the preadmission optimizations used were smoking and alcohol cessation, nutritional support, optimizing existing diseases and discharge planning. The preoperative optimizations were structured education, carbohydrate loading, thromboprophylaxis, nausea and vomiting prophylaxis, avoiding prolonged fasting and bowel preparation. Interesting, minimally invasive surgery was an important intraoperative optimization, along with anesthesia standardization, maintenance of euvolemia, use of regional anesthesia, nasogastric tube removal before anesthetic reversal and maintenance of body temperature.68 Factors in the postoperative period were early mobilization, early oral intake, early catheter removal, early intravenous fluid cessation, prevention of ileus with peripheral opioid blockage, multimodal opioid-sparing analgesic regimens as well as multimodal anti-nausea and vomiting regimens. Use of laparoscopy over open surgery was also associated with lower pain scores and use of analgesia.69 Authors also noted that the presence of ERAS protocols in laparoscopic donor nephrectomy resulted in significantly better rate of complications, duration of stay, general and physical fatigue, pain and perceived physical function and general health.67 A 2023 retrospective study of 55 ERAS LLDN patients with perioperative carbohydrate intake were compared with 93 controls with perioperative fasting.70The authors validated previous findings: the ERAS cohort had shorter hospital stay and decreased time to tolerance of normal oral intake compared to controls.

Conclusion

Non-invasive approaches to living donor nephrectomy have significantly advanced, improving the safety, efficacy, and overall experience for donors. Innovations such as laparoscopic and robotic-assisted techniques have minimized surgical trauma, reduced recovery times, and enhanced cosmetic outcomes, making the donation process less daunting for potential donors. Best practices now emphasize minimally invasive surgery using laparoscopy or robotics, meticulous surgical planning, and the integration of enhanced recovery protocols to optimize outcomes.

Funding Statement

KLL is supported by the Mid-America Transplant/Jane A. Beckman Endowed Chair in Transplantation, and receives funding related to living donation and transplantation from the Mid-America Transplant Foundation and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK: R01DK139339 and R01DK120551).

Disclosures

KLL is a senior scientist of the Scientific Registry of Transplant Recipients (SRTR), scientific director of the SRTR Living Donor Collective, past chair of the American Society of Transplant (AST) Living Donor Community of Practice (COP), co-chair of the NLDAC Advisory Group, member of the American Society of Nephrology Transplant Committee, and member of the National Kidney Foundation Transplant Advisory Committee. Unrelated to this work, K.L.L. received consulting fees from CareDx, Calliditas, and Maze Therapeutics, and speaker honoraria from Sanofi.

Abbreviations:

CTA

computed tomography angiography

DDKT

deceased donor kidney transplant

E-NOTES

embryologic natural orifice transluminal endoscopic surgery

ERAS

enhanced recovery after surgery

HA-LLDN

hand-assisted laparoscopic living donor nephrectomy

HA-RLDN

hand-assisted retroperitoneoscopic living donor nephrectomy

KDIGO

kidney disease: improving global outcomes

LDKT

living donor kidney transplant

LESS

laparo-endoscopic single site surgery

LLDN

laparoscopic living donor nephrectomy

LRDN

laparoscopic retroperitoneal donor nephrectomy

MRA

magnetic resonance angiography

NOTES

natural orifice transluminal endoscopic surgery

ODN

open donor nephrectomy

RA-LLDN

robot-assisted laparoscopic living donor nephrectomy

Footnotes

Human and Animal Rights

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

  • 1.Lentine KL, Smith JM, Lyden GR, et al. OPTN/SRTR 2022 Annual Data Report: Kidney. Am J Transplant 2024;24(2s1):S19–s118. (In eng). DOI: 10.1016/j.ajt.2024.01.012. [DOI] [PubMed] [Google Scholar]
  • 2.Fleetwood VA, Lam NN, Lentine KL. Long-Term Risks of Living Kidney Donation: State of the Evidence and Strategies to Resolve Knowledge Gaps. Annu Rev Med 2025;76(1):357–372. (In eng). DOI: 10.1146/annurev-med-050223-112648. [DOI] [PubMed] [Google Scholar]
  • 3.LaPointe Rudow D, Hays R, Baliga P, et al. Consensus conference on best practices in live kidney donation: recommendations to optimize education, access, and care. Am J Transplant 2015;15(4):914–22. (In eng). DOI: 10.1111/ajt.13173. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Lentine KL, Kasiske BL, Levey AS, et al. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation 2017;101(8S Suppl 1):S1–s109. (In eng). DOI: 10.1097/tp.0000000000001769. [DOI] [Google Scholar]
  • 5.Zacharis A, Reimold P, Aksoy C, et al. Trends in kidney transplantation and living donor nephrectomy in Germany: a total population analysis from 2006 to 2021. World J Urol 2024;42(1):24. (In eng). DOI: 10.1007/s00345-023-04737-w. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Ratner LE, Montgomery RA, Kavoussi LR. Laparoscopic live donor nephrectomy. A review of the first 5 years. Urol Clin North Am 2001;28(4):709–19. (In eng). DOI: 10.1016/s0094-0143(01)80027-6. [DOI] [PubMed] [Google Scholar]
  • 7.Ratner LE, Ciseck LJ, Moore RG, Cigarroa FG, Kaufman HS, Kavoussi LR. Laparoscopic live donor nephrectomy. Transplantation 1995;60(9):1047–9. (In eng). [PubMed] [Google Scholar]
  • 8.Flowers JL, Jacobs S, Cho E, et al. Comparison of open and laparoscopic live donor nephrectomy. Ann Surg 1997;226(4):483–9; discussion 489–90. (In eng). DOI: 10.1097/00000658-199710000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Nanidis TG, Antcliffe D, Kokkinos C, et al. Laparoscopic versus open live donor nephrectomy in renal transplantation: a meta-analysis. Ann Surg 2008;247(1):58–70. (In eng). DOI: 10.1097/SLA.0b013e318153fd13. [DOI] [PubMed] [Google Scholar]
  • 10.Wilson CH, Sanni A, Rix DA, Soomro NA. Laparoscopic versus open nephrectomy for live kidney donors. Cochrane Database Syst Rev 2011(11):Cd006124. (In eng). DOI: 10.1002/14651858.CD006124.pub2. [DOI] [PubMed] [Google Scholar]
  • 11.Nogueira JM, Cangro CB, Fink JC, et al. A comparison of recipient renal outcomes with laparoscopic versus open live donor nephrectomy. Transplantation 1999;67(5):722–8. (In eng). DOI: 10.1097/00007890-199903150-00014. [DOI] [PubMed] [Google Scholar]
  • 12.Melcher ML, Carter JT, Posselt A, et al. More than 500 consecutive laparoscopic donor nephrectomies without conversion or repeated surgery. Arch Surg 2005;140(9):835–9; discussion 839–40. (In eng). DOI: 10.1001/archsurg.140.9.835. [DOI] [PubMed] [Google Scholar]
  • 13.Su LM, Ratner LE, Montgomery RA, et al. Laparoscopic live donor nephrectomy: trends in donor and recipient morbidity following 381 consecutive cases. Ann Surg 2004;240(2):358–63. (In eng). DOI: 10.1097/01.sla.0000133351.98195.1c. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Shafizadeh SF, Daily PP, Baliga P, et al. Chylous ascites secondary to laparoscopic donor nephrectomy. Urology 2002;60(2):345. (In eng). DOI: 10.1016/s0090-4295(02)01743-0. [DOI] [Google Scholar]
  • 15.Martay K, Dembo G, Vater Y, et al. Unexpected surgical difficulties leading to hemorrhage and gas embolus during laparoscopic donor nephrectomy: a case report. Can J Anaesth 2003;50(9):891–4. (In eng). DOI: 10.1007/bf03018734. [DOI] [PubMed] [Google Scholar]
  • 16.Knoepp L, Smith M, Huey J, Mancino A, Barber H. Complication after laparoscopic donor nephrectomy: a case report and review. Transplantation 1999;68(3):449–51. (In eng). DOI: 10.1097/00007890-199908150-00019. [DOI] [PubMed] [Google Scholar]
  • 17.Mohamed HK, Lin A, Savage SJ, Rajagopalan PR, Baliga PK, Chavin KD. Parenchymal transection of the kidney inflicted by endocatch bag entrapment during a laparoscopic donor nephrectomy. Am J Transplant 2006;6(1):232–5. (In eng). DOI: 10.1111/j.1600-6143.2005.01146.x. [DOI] [PubMed] [Google Scholar]
  • 18.Hammer C, Hawasli A, Meguid A, Oh H. Degloving of the renal capsule: a rare complication of laparoscopic live donor nephrectomy. J Laparoendosc Adv Surg Tech A 2006;16(4):362–4. (In eng). DOI: 10.1089/lap.2006.16.362. [DOI] [PubMed] [Google Scholar]
  • 19.Shokeir AA. Open versus laparoscopic live donor nephrectomy: a focus on the safety of donors and the need for a donor registry. J Urol 2007;178(5):1860–6. (In eng). DOI: 10.1016/j.juro.2007.07.008. [DOI] [PubMed] [Google Scholar]
  • 20.Ahearn AJ, Posselt AM, Kang SM, Roberts JP, Freise CE. Experience with laparoscopic donor nephrectomy among more than 1000 cases: low complication rates, despite more challenging cases. Arch Surg 2011;146(7):859–64. (In eng). DOI: 10.1001/archsurg.2011.156. [DOI] [PubMed] [Google Scholar]
  • 21.Gürkan A, Kaçar S, Başak K, Varilsüha C, Karaca C. Do multiple renal arteries restrict laparoscopic donor nephrectomy? Transplant Proc 2004;36(1):105–7. (In eng). DOI: 10.1016/j.transproceed.2003.11.064. [DOI] [PubMed] [Google Scholar]
  • 22.Johnson MW, Andreoni K, McCoy L, et al. Technique of right laparoscopic donor nephrectomy: a single center experience. Am J Transplant 2001;1(3):293–5. (In eng). DOI: 10.1034/j.1600-6143.2001.001003293.x. [DOI] [PubMed] [Google Scholar]
  • 23.Gill IS, Uzzo RG, Hobart MG, Streem SB, Goldfarb DA, Noble MJ. Laparoscopic retroperitoneal live donor right nephrectomy for purposes of allotransplantation and autotransplantation. J Urol 2000;164(5):1500–4. (In eng). [PubMed] [Google Scholar]
  • 24.Giessing M, Deger S, Ebeling V, Roigas J, Türk I, Loening SA. [Laparoscopic transperitoneal donor nephrectomy. Technique and results]. Urologe A 2003;42(2):218–24. (In ger). DOI: 10.1007/s00120-002-0281-4. [DOI] [PubMed] [Google Scholar]
  • 25.Hoznek A, Olsson LE, Salomon L, et al. Retroperitoneal laparoscopic living-donor nephrectomy. Preliminary results. Eur Urol 2001;40(6):614–8. (In eng). DOI: 10.1159/000049846. [DOI] [PubMed] [Google Scholar]
  • 26.He B, Bremner A, Han Y, Hamdorf JM. Determining the Superior Technique for Living-donor Nephrectomy: the Laparoscopic Intraperitoneal Versus the Retroperitoneoscopic Approach. Exp Clin Transplant 2016;14(2):129–38. (In eng). [PubMed] [Google Scholar]
  • 27.Tay WK, Kesavan A, Goh YSB, Tiong HY. Right Living Donor Nephrectomies: Retroperitoneoscopic vs Laparoscopic Transperitoneal Approach. Transplant Proc 2018;50(8):2333–2337. (In eng). DOI: 10.1016/j.transproceed.2018.03.051. [DOI] [PubMed] [Google Scholar]
  • 28.Buell JF, Hanaway MJ, Potter SR, et al. Hand-assisted laparoscopic living-donor nephrectomy as an alternative to traditional laparoscopic living-donor nephrectomy. Am J Transplant 2002;2(10):983–8. (In eng). DOI: 10.1034/j.1600-6143.2002.21017.x. [DOI] [PubMed] [Google Scholar]
  • 29.Nakajima I, Tojimbara T, Sato S, et al. Hand-assisted laparoscopic live donor nephrectomy: report of 100 cases. Transplant Proc 2004;36(7):1898–900. (In eng). DOI: 10.1016/j.transproceed.2004.07.045. [DOI] [PubMed] [Google Scholar]
  • 30.Minnee RC, Bemelman WA, Maartense S, Bemelman FJ, Gouma DJ, Idu MM. Left or right kidney in hand-assisted donor nephrectomy? A randomized controlled trial. Transplantation 2008;85(2):203–8. (In eng). DOI: 10.1097/TP.0b013e3181601486. [DOI] [PubMed] [Google Scholar]
  • 31.Kokkinos C, Nanidis T, Antcliffe D, Darzi AW, Tekkis P, Papalois V. Comparison of laparoscopic versus hand-assisted live donor nephrectomy. Transplantation 2007;83(1):41–7. (In eng). DOI: 10.1097/01.tp.0000248761.56724.9c. [DOI] [PubMed] [Google Scholar]
  • 32.Wadström J, Lindström P. Hand-assisted retroperitoneoscopic living-donor nephrectomy: initial 10 cases. Transplantation 2002;73(11):1839–40. (In eng). DOI: 10.1097/00007890-200206150-00024. [DOI] [PubMed] [Google Scholar]
  • 33.Dols LF, Kok NF, Terkivatan T, et al. Optimizing left-sided live kidney donation: hand-assisted retroperitoneoscopic as alternative to standard laparoscopic donor nephrectomy. Transpl Int 2010;23(4):358–63. (In eng). DOI: 10.1111/j.1432-2277.2009.00990.x. [DOI] [PubMed] [Google Scholar]
  • 34.DuBray BJ, Tompson JJ, Shaffer D, et al. Incisional Hernia Development after Live Donor Nephrectomy: Impact of Surgical Technique. Kidney360 2023;4(1):78–82. (In eng). DOI: 10.34067/kid.0005262022. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Zhong X, Huang C, Li L, Hu W, Wu R, Xiao Y. Endo-Satinsky Clamp Hybrid In Situ Perfusion in Retroperitoneoscopic Donor Nephrectomy For Right-sided Kidney. Urology 2019;130:191–195. (In eng). DOI: 10.1016/j.urology.2019.04.019. [DOI] [PubMed] [Google Scholar]
  • 36.Horgan S, Vanuno D, Sileri P, Cicalese L, Benedetti E. Robotic-assisted laparoscopic donor nephrectomy for kidney transplantation. Transplantation 2002;73(9):1474–9. (In eng). DOI: 10.1097/00007890-200205150-00018. [DOI] [PubMed] [Google Scholar]
  • 37.Renoult E, Hubert J, Ladrière M, et al. Robot-assisted laparoscopic and open live-donor nephrectomy: a comparison of donor morbidity and early renal allograft outcomes. Nephrol Dial Transplant 2006;21(2):472–7. (In eng). DOI: 10.1093/ndt/gfi150. [DOI] [PubMed] [Google Scholar]
  • 38.Gorodner V, Horgan S, Galvani C, et al. Routine left robotic-assisted laparoscopic donor nephrectomy is safe and effective regardless of the presence of vascular anomalies. Transpl Int 2006;19(8):636–40. (In eng). DOI: 10.1111/j.1432-2277.2006.00315.x. [DOI] [PubMed] [Google Scholar]
  • 39.Kiani AZ, Progar K, Hill AL, et al. Robotic living donor nephrectomy is associated with reduced post-operative opioid use compared to hand-assisted laparoscopic approach. Surg Endosc 2024;38(7):3654–3660. (In eng). DOI: 10.1007/s00464-024-10925-5. [DOI] [PubMed] [Google Scholar]
  • 40.Yang A, Barman N, Chin E, et al. Robotic-assisted vs. laparoscopic donor nephrectomy: a retrospective comparison of perioperative course and postoperative outcome after 1 year. J Robot Surg 2018;12(2):343–350. (In eng). DOI: 10.1007/s11701-017-0741-x. [DOI] [PubMed] [Google Scholar]
  • 41.Centonze L, Di Bella C, Giacomoni A, et al. Robotic Versus Laparoscopic Donor Nephrectomy: A Retrospective Bicentric Comparison of Learning Curves and Surgical Outcomes From 2 High-volume European Centers. Transplantation 2023;107(9):2009–2017. (In eng). DOI: 10.1097/tp.0000000000004618. [DOI] [PubMed] [Google Scholar]
  • 42.Takagi K, Kimenai H, Terkivatan T, Tran KTC, Ijzermans JNM, Minnee RC. Learning curves of minimally invasive donor nephrectomy in a high-volume center: A cohort study of 1895 consecutive living donors. Int J Surg 2021;86:7–12. (In eng). DOI: 10.1016/j.ijsu.2020.12.011. [DOI] [PubMed] [Google Scholar]
  • 43.Papa S, Popovic A, Loerzel S, et al. Laparoscopic to robotic living donor nephrectomy: Is it time to change surgical technique? Int J Med Robot 2023;19(6):e2550. (In eng). DOI: 10.1002/rcs.2550. [DOI] [PubMed] [Google Scholar]
  • 44.Kawan F, Theil G, Fornara P. Robotic Donor Nephrectomy: Against. Eur Urol Focus 2018;4(2):142–143. (In eng). DOI: 10.1016/j.euf.2018.07.027. [DOI] [PubMed] [Google Scholar]
  • 45.Huang H, Qiu Y, Liu G, et al. Robot-assisted laparoscopic retroperitoneal donor nephrectomy: a safe and efficient improvement. World J Urol 2024;42(1):243. (In eng). DOI: 10.1007/s00345-024-04939-w. [DOI] [PubMed] [Google Scholar]
  • 46.Windisch OL, Matter M, Pascual M, et al. Robotic versus hand-assisted laparoscopic living donor nephrectomy: comparison of two minimally invasive techniques in kidney transplantation. J Robot Surg 2022;16(6):1471–1481. (In eng). DOI: 10.1007/s11701-022-01393-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47.Allaf ME, Singer A, Shen W, et al. Laparoscopic live donor nephrectomy with vaginal extraction: initial report. Am J Transplant 2010;10(6):1473–7. (In eng). DOI: 10.1111/j.1600-6143.2010.03131.x. [DOI] [PubMed] [Google Scholar]
  • 48.Alcaraz A, Musquera M, Peri L, et al. Feasibility of transvaginal natural orifice transluminal endoscopic surgery-assisted living donor nephrectomy: is kidney vaginal delivery the approach of the future? Eur Urol 2011;59(6):1019–25. (In eng). DOI: 10.1016/j.eururo.2011.03.021. [DOI] [PubMed] [Google Scholar]
  • 49.Kaouk JH, Khalifeh A, Laydner H, et al. Transvaginal hybrid natural orifice transluminal surgery robotic donor nephrectomy: first clinical application. Urology 2012;80(6):1171–5. (In eng). DOI: 10.1016/j.urology.2012.08.061. [DOI] [PubMed] [Google Scholar]
  • 50.White WM, Haber GP, Goel RK, Crouzet S, Stein RJ, Kaouk JH. Single-port urological surgery: single-center experience with the first 100 cases. Urology 2009;74(4):801–4. (In eng). DOI: 10.1016/j.urology.2009.04.030. [DOI] [PubMed] [Google Scholar]
  • 51.Andonian S, Herati AS, Atalla MA, Rais-Bahrami S, Richstone L, Kavoussi LR. Laparoendoscopic single-site pfannenstiel donor nephrectomy. Urology 2010;75(1):9–12. (In eng). DOI: 10.1016/j.urology.2009.08.074. [DOI] [PubMed] [Google Scholar]
  • 52.Gill IS, Canes D, Aron M, et al. Single port transumbilical (E-NOTES) donor nephrectomy. J Urol 2008;180(2):637–41; discussion 641. (In eng). DOI: 10.1016/j.juro.2008.04.028. [DOI] [PubMed] [Google Scholar]
  • 53.Galvani CA, Garza U, Leeds M, et al. Single-incision robotic-assisted living donor nephrectomy: case report and description of surgical technique. Transpl Int 2012;25(8):e89–92. (In eng). DOI: 10.1111/j.1432-2277.2012.01493.x. [DOI] [PubMed] [Google Scholar]
  • 54.Palese MA, Chin CP, Garden EB, et al. Comparison of Single-Port Robotic Donor Nephrectomy and Laparoscopic Donor Nephrectomy. J Endourol 2024;38(2):136–141. (In eng). DOI: 10.1089/end.2023.0364. [DOI] [PubMed] [Google Scholar]
  • 55.Abdessater M, Champy CM, da Costa JB, et al. Comparison of the iliac, vaginal and umbilical graft extraction in robot-assisted laparoscopic living donor nephrectomy. World J Urol 2021;39(7):2783–2788. (In eng). DOI: 10.1007/s00345-020-03462-y. [DOI] [PubMed] [Google Scholar]
  • 56.Kourounis G, Tingle SJ, Hoather TJ, et al. Robotic versus laparoscopic versus open nephrectomy for live kidney donors. Cochrane Database Syst Rev 2024;5(5):Cd006124. (In eng). DOI: 10.1002/14651858.CD006124.pub3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 57.Aghayev A, Gupta S, Dabiri BE, Steigner ML. Vascular imaging in renal donors. Cardiovasc Diagn Ther 2019;9(Suppl 1):S116–s130. (In eng). DOI: 10.21037/cdt.2018.11.02. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 58.Saidi R, Kawai T, Kennealey P, et al. Living donor kidney transplantation with multiple arteries: recent increase in modern era of laparoscopic donor nephrectomy. Arch Surg 2009;144(5):472–5. (In eng). DOI: 10.1001/archsurg.2009.49. [DOI] [PubMed] [Google Scholar]
  • 59.Şahin S, Özdemir O, Ekşi M, et al. The effect of single or multiple arteries in the donor kidney on renal transplant surgical outcomes. Ir J Med Sci 2023;192(2):929–934. (In eng). DOI: 10.1007/s11845-022-03024-8. [DOI] [PubMed] [Google Scholar]
  • 60.Ay N, Dinc B, Dinckan A, Yilmaz VT, Erdogan O, Gurkan A. The safety of hem-o-lock clips at donor nephrectomies. Ann Transplant 2010;15(1):36–9. (In eng). [PubMed] [Google Scholar]
  • 61.Kaushik M, Bagul A, Yates PJ, Elwell R, Nicholson ML. Comparison of techniques of vascular control in laparoscopic donor nephrectomy: The leicester experience. Transplant Proc 2006;38(10):3406–8. (In eng). DOI: 10.1016/j.transproceed.2006.10.142. [DOI] [PubMed] [Google Scholar]
  • 62.Ciancio G, Farag A, Gaynor JJ, Morsi M, Chen L, Burke GW. Midline Rotation of the Right Renal Hilum During Hand-Assisted Laparoscopic Living Donor Nephrectomy. Jsls 2021;25(2) (In eng). DOI: 10.4293/jsls.2021.00018. [DOI] [Google Scholar]
  • 63.Mikhalski D, Hoang AD, Bollens R, Laureys M, Loi P, Donckier V. Gonadal vein reconstruction for extension of the renal vein in living renal transplantation: two case reports. Transplant Proc 2007;39(8):2681–4. (In eng). DOI: 10.1016/j.transproceed.2007.08.088. [DOI] [PubMed] [Google Scholar]
  • 64.Thomas AJ, Kekre NS. Right laparoscopic donor nephrectomy and the use of inverted kidney transplantation: an alternative technique. BJU Int 2008;101(8):1052; author reply 1052–3. (In eng). DOI: 10.1111/j.1464-410X.2008.07609_1.x. [DOI] [PubMed] [Google Scholar]
  • 65.Willemsen PJ, Appeltans BM. Hospital stay of 2 days after open sigmoidectomy with a multimodal rehabilitation programme. Br J Surg 1999;86(7):968–9. (In eng). [Google Scholar]
  • 66.Waits SA, Hilliard P, Sheetz KH, Sung RS, Englesbe MJ. Building the case for enhanced recovery protocols in living kidney donors. Transplantation 2015;99(2):405–8. (In eng). DOI: 10.1097/tp.0000000000000328. [DOI] [PubMed] [Google Scholar]
  • 67.Byrne MHV, Mehmood A, Summers DM, Hosgood SA, Nicholson ML. A systematic review of living kidney donor enhanced recovery after surgery. Clin Transplant 2021;35(7):e14384. (In eng). DOI: 10.1111/ctr.14384. [DOI] [PubMed] [Google Scholar]
  • 68.Rege A, Leraas H, Vikraman D, et al. Could the Use of an Enhanced Recovery Protocol in Laparoscopic Donor Nephrectomy be an Incentive for Live Kidney Donation? Cureus 2016;8(11):e889. (In eng). DOI: 10.7759/cureus.889. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 69.Dong X, Burton BN, Little C, et al. Intraoperative opioid and analgesic adjuvant administration practice patterns following implementation of an enhanced recovery after surgery protocol for laparoscopic donor nephrectomy. J Clin Anesth 2022;79:110751. (In eng). DOI: 10.1016/j.jclinane.2022.110751. [DOI] [PubMed] [Google Scholar]
  • 70.Kuiper M, Gillingham M, Martin J, Gardner D, Van Calcar S. The Effect of Preoperative Carbohydrate Intake on Length of Stay and Postoperative Recovery Following Laparoscopic Living Donor Nephrectomy. J Ren Nutr 2023;33(3):405–411. (In eng). DOI: 10.1053/j.jrn.2022.12.005. [DOI] [PubMed] [Google Scholar]

Key References

  1. Zacharis A, Reimold P, Aksoy C, Jung J, Martin T, Eisenmenger N, Thoduka SG, Groeben C, Huber J, Flegar L (2024) Trends in kidney transplantation and living donor nephrectomy in Germany: a total population analysis from 2006 to 2021. World J Urol 42:24. [DOI] [PMC free article] [PubMed] [Google Scholar]; Provides data on recent trends on choice of the procedure. Major importance
  2. Kourounis G, Tingle SJ, Hoather TJ, Thompson ER, Rogers A, Page T, Sanni A, Rix DA, Soomro NA, Wilson C (2024) Robotic versus laparoscopic versus open nephrectomy for live kidney donors. Cochrane Database Syst Rev. 10.1002/14651858.CD006124.pub3 [DOI] [Google Scholar]; Cochrane review that compares outcomes between open and minimally invasive donor nephrectomy techniques. Major importance
  3. Basu A, Pasilan RMF (2024) Outcomes in LD70s Redefining the Limits of Kidney Donation: Insights From Living Donors Aged 70 Years and Older. Kidney Int Rep 9:1157–1159 [DOI] [PMC free article] [PubMed] [Google Scholar]; Provides insight on kidney donors older than 70 years. Of importance

RESOURCES