donor nephrectomy has been performed using minimally invasive surgery.
The first laparoscopic living donor nephrectomy was carried out
in 1995 at the Johns Hopkins Medical Centre and since then many
centres in the USA and elsewhere, including at least two in the
UK, have undertaken laparoscopic living donor nephrectomy.3 Advocates
of laparoscopic nephrectomy (or laparoscopic assisted nephrectomy)
argue that it substantially reduces the wound-related problems associated
with open nephrectomy.4,5,6,7 There have not been any controlled
clinical trials of laparoscopic versus open living donor nephrectomy.
However, blood loss, requirement for post-operative analgesia, length
of hospital stay and time until return to normal activity are all
lower in patients undergoing laparoscopic nephrectomy than in historical
controls undergoing open nephrectomy.4,5,6,7 During laparoscopic
nephrectomy, warm ischaemia times of 3-5 minutes are reported, raising
concern that ischaemic injury may result. Although data following
laparoscopic living donor nephrectomy is still limited, immediate
function rate and graft survival appear broadly comparable to that
reported for open nephrectomy. Laparoscopic living donor nephrectomy
requires expertise in advanced laparoscopic techniques and should
only be undertaken by surgeons with appropriate training in the
technique. This requirement may limit the availability of laparoscopic
living donor nephrectomy in the UK, at least for the time being.