Upper pole first laparoscopic left donor nephrectomy: single surgeon experience from four centers in Jordan and Bahrain.

1.1.Background: The first laparoscopic donor nephrectomy was reported by Ratner in 1995. Subsequently, the procedure has been adopted by most transplant centers by replicating the open technique using either a total laparoscopic or hand-assisted technique.In 2011, Tunc reported the first direct upper pole kidney access in laparoscopic radical nephrectomy, with a reverse technique that started the dissection from the upper pole towards the renal hilum. We elected to apply a modification of this new technique to laparoscopic donor surgery to assess efficacy and safety.Methods: Retrospective analysis of sequential cohorts of 36 cases performed in 4 hospitals by the same surgeon over a period of 12 months compared to the previous 28 cases done by the same surgeon using a conventional laparoscopic technique. 1.2.Results: Mean operating time was lower with the upper pole first technique (62 ± 11 minutes vs. 87 ± 13 min) whereas warm ischemia times were similar between two groups (5 min vs 4.7 min). Mean recipient post-operative serum creatinine levels (0.92 vs 1.04 mg/dl) were likewise similar.. Mean blood loss was minimal in both groups2.Results: Mean operating time was lower with the upper pole first technique (62 ± 11 minutes vs. 87 ± 13 min) whereas warm ischemia times were similar between two groups (5 min vs 4.7 min). Mean recipient post-operative serum creatinine levels (0.92 vs 1.04 mg/dl) were likewise similar.Mean blood loss was minimal in both groups(<50 cc) with no transfusion requirement, and no conversion to open surgery in either group. 1.3.Conclusion: upper pole first laparoscopic donor nephrectomy is safe and a slightly faster method compared to the conventional total laparoscopic technique with similar outcomes. (1) Eye Specialty General Hospital, Amman, Jordan (2) Salmaniya Medical Complex, Manama, Bahrain (3) Al-Khaldi Medical Center (4) Istiklal Hospital (5) Albashir Medical Center (6) Specialty Hospital, Amman, Jordan