Laparoendoscopic single-site donor nephrectomy with retroperitoneal and transperitoneal approach versus conventional laparoscopic techniques: A single-center retrospective comparative study

Purpose: Laparoendoscopic single-site donor nephrectomy (LESSDN) is a well-accepted technique in renal transplantation, yet data on the retroperitoneal (RP) approach are sparse. We compared LESSDN outcomes via transperitoneal (TP) and RP approaches against conventional laparoscopic donor nephrectomy (CLDN). Materials and methods: This study retrospectively evaluated patients undergoing CLDN, LESSDN-TP, and LESSDN-RP from May 2002 to April 2023, analyzing donor characteristics, perioperative outcomes, complications as categorized by the Clavien-Dindo classification, and cosmetic outcomes using a body image questionnaire and donor renal function. Additionally, recipient outcomes were assessed for 1 year. Results: Of the 36 laparoscopic donor nephrectomies, 13 were CLDN, 10 were LESSDN-TP, and 13 were LESSDN-RP. The operative time of LESSDN-RP (177 minutes) was shorter than that of LESSDN-TP (275 minutes) and CLDN (258 minutes). Warm ischemia times for LESSDN-TP (2.9 minutes) and LESSDN-RP (2.8 minutes) were shorter than CLDN (4.3 minutes). LESSDN-RP patients had the shortest hospital stays (4 days). Half of the LESSDN-TP cases required an extra port. Incision lengths for LESSDN-TP (6.1 cm) and LESSDN-RP (6.7 cm) were shorter than CLDN (9.2 cm). Pain scores were similar on postoperative day 3. No significant differences were found in complication rates, cosmetic outcomes, or recipient results across the 3 approaches. Conclusion: LESSDN-RP offers advantages in operative time, warm ischemia time, and hospital stay, with donor outcomes similar to those of CLDN and LESSDN-TP. Given its technical demands and high learning curve, selecting the approach in which the surgeon is most confident may provide the best outcomes. This is the first study to compare the RP and TP approaches in LESSDN alongside CLDN, demonstrating a potential reduction in recovery time without compromising clinical outcomes.