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Background: Chylous leakage (CL) is a rare complication of laparoscopic live donor nephrectomy (LLDN). It may lead to malnutrition and immunological deficits because of protein and lymphocyte depletion., Methods: Data from 208 consecutive LLDN performed at two institutions, between April 2000 and September 2010, were reviewed to identify the anatomical basis behind CL along with its diagnostic and therapeutic options., Results: CL developed in eight donors (3.8%), as determined by high-volume drainage (range 540-800 mL/24 hr) of triglyceride-rich fluid. All donors were managed conservatively. Seven were put on total parenteral nutrition plus octreotide. One received low-fat diet, medium-chain triglyceride supplementation, and octreotide. Chylous fistulas resolved in 5 to 16 days (mean time 12.3 days). Drains were removed before hospital discharge, and no donor was readmitted and/or needed outpatient care., Conclusions: CL is a potentially insidious and perhaps misdiagnosed complication after LLDN. It occurs in nearly 4% of LLDN and it seems to be uniquely associated to left-sided kidney recovery because of distinctive lymphatics distribution around the periaortic area of dissection. Conservative therapy is effective in most donors and should be initially attempted. Surgical ligatures or fibrin sealants may be indicated in case of refractory CL before the arising of malnutrition and/or relevant immunodeficiency.

Introduction: Laparoscopic living donor nephrectomy (LLDN) is supposed to be safe and effective and it ensures an excellent allograft function in the recipient. The use of laparoscopic technique is rapidly spreading in most transplant programs since it offers advantages over the open procedure. Aim of our study is to evaluate both surgical outcome and post-operative course in the LLDN group comparing with an historical series of open donor nephrectomies (ODN)., Materials and Methods: From January 1992 to August 2008, 37 living donor nephrectomies were performed in our center. 23 nephrectomies were carried out, laparoscopically and 14 by open technique. Donors characteristics were comparable in both groups., Results: All laparoscopic nephrectomies were performed successfully without conversion. No significant differences were observed between the two groups for both surgical complication and graft and patient survival rates. Mean warm ischemia time (p < 0.04), resumption of oral intake (p < 0.03) and length of hospital stay (p < 0.0001) were shorter in the LLDN group. Mean operative time (p < 0.036) was longer in the LLDN group, whereas time to return to work and daily activities were similar (p < 0.52)., Conclusion: Laparoscopic nephrectomy provides some post-operative advantages over the open technique without additional surgical risk ensuring comparable graft and patient outcomes. Therefore, LLDN has become the standard approach in our transplant center. However, the laparoscopic procedure should be performed only by experienced surgical staff in order to prevent serious complications in the donors.

Introduction: The learning curve of laparoscopic donor nephrectomy (LDN) may represent a great technical challenge at centers with low volume of living donors. The number of LDNs required to overcome the learning curve is still unclear. Here we report the modality of approach to LDN at a low-volume living donor transplant center., Materials and Methods: We reviewed the records of two groups of donors operated by two different surgeons between January 2002 and October 2005. We compared donor hospital stay, operative time, presence of multiple renal arteries, blood loss, operative details, and complications., Results: The first six operations (group A) were performed by a well-trained laparoscopic surgeon (A.P.) with a consolidated experience in the LDN procedure, attended by our training surgeon (R.D.V.) who conducted the other six cases (group B). No conversion to an open procedure was necessary and there were no major minor complications. Mean operative time was 267.5 (+/-55.9) minutes in group A and 300 (+/-43.4) minutes in group B (P = .28). Mean warm ischemia time was 125 (+/-61.6) seconds in group A and 189.2 (+/-18.6) seconds in group B (P = .035). Mean hospital stay was 5.3 days in group A and 5.6 days in group B., Conclusions: LDN can be performed safely and efficiently in transplant centers with initial experience. A collaborative approach to this difficult procedure with a surgeon skilled in donor nephrectomy minimizes the risk to the donor and reduces the learning curve.