Comparison of three different techniques of extraction in laparoscopic donor nephrectomy

Aim: We compare the outcome of three different methods of graft extraction after a laparoscopic donor nephrectomy. Materials and Methods: After a conventional five port laparoscopic donor nephrectomy, specimen was extracted through one of three approaches: 1. Iliac fossa (IF) incision and hand extraction, 2. Midline (MD) periumbilical with a lower polar fat stitch incorporating gonadal vein for traction while retrieval, and 3. Pfannensteil (PF) with Gel port extraction. Estimated blood loss, operating time, warm ischemia time, incision length, pain score, analgesic consumption, hospital stay, wound complications, graft complications and recipient creatinine at 6 weeks were analyzed. Results: Warm ischemia time was significantly reduced in PF group when compared to other groups. Length of the incision was less in the MD group compared to other groups. Wound complications were significantly less in PF group when compared to other groups. Graft extraction complications were significantly high in MD group compared to other two groups. Conclusion: Based on the results obtained, our current method of preference is by Pfannensteil incision. A controlled extraction with the use of a hand assist device would be best for donor safety and to avoid graft related complications