Laparo-endoscopic single site（LESS）donornephrectomy：Initial experience in Japan

Abstract

  We present here the initial 6 patients undergoing laparo-endoscopic single site（LESS）live donor nephrectomy（LESS-DN）in Japan. Three trocars were inserted into the abdominal cavity through a 4-cm periumbilical longitudinal incision without special devices, such as R-Port. No extra skin incisions and trocar placement were made. Donor kidney was placed into the extraction bag and was retrieved through para-umbilical incision without any extra skin incision and transferred for bench preparation. Following case 3, pararectal incision was made and Rap Disk system was used. LESS-DN was successful in all 6 patients. Mean operative time was 299.3 minutes, blood loss was 228.3 ml, warm ischemia time was 5.9 minutes and hospital stay was 14 days. There were no intraoperative and postoperative complications. Each allograft functioned immediately on transplantation except for one case of hyperacute rejection and mean recipient serum creatinine levels were 1.14mg/dl at 1 month and 1.15 mg/dl at 3 months, respectively. LESS-DN could be carried out safely using standard instruments without complications in this initial series. Although LESS-DN had longer warm ischemia time comparing previous reports on standard laparoscopic living DN（LLDN）, early allograft function was comparable. LESS-DN has the potential to become a standard in the continuing evolution of minimally invasive surgery and should be evaluated in further randomized studies.