Is It Safe to Perform a Right-sided Laparoscopic Living Donor Nephrectomy Compared to the Open Technique? A Single-center Experience in Thailand

Objective: Living donor kidney transplantation is the treatment of choice for many patients with end-stage renal disease. Laparoscopic donor nephrectomy (LDN) offers the benefits of minimally invasive surgery to donors. However, right-sided LDN continues to raise concerns among some surgeons due to challenges related to donor safety and graft outcomes. This study aims to evaluate the surgical outcomes and graft function associated with right-sided LDN compared to the open donor nephrectomy. Materials and Methods: Between January 2001 and May 2024, a total of 128 right-sided living donor nephrectomies were performed at Siriraj Hospital, including 83 open and 45 laparoscopic procedures. A comparative analysis was conducted between the two surgical approaches. Results: The most common indication for right-sided nephrectomy was the presence of multiple or early-branching renal arteries on the left side (62.5%). The estimated blood loss was significantly lower in the laparoscopic group compared to the open group (80 mL vs 100 mL, p=0.004). However, operative and warm ischemic time were significantly longer in the LDN group (245 minutes vs. 180 minutes, p < 0.001 and four vs. two minutes, p < 0.001, respectively). Perioperative complication rates were comparable between the two groups. Only one case (2.22%) in the LDN group required conversion. From the recipient’s perspective, renal graft outcomes were comparable, with no instances of acute graft loss in either group. Conclusion: Based on our evidence, the laparoscopic approach for right-sided donor nephrectomy is both feasible and safe. Right-sided LDN should be considered for its benefits.