Ureteral complications in the era of laparoscopic living donor nephrectomy: Do we need to preserve the gonadal vein with the specimen?

Background and Purpose: The aim of this study was to analyze the ureteral complication rate in recipients transplanted with laparoscopically retrieved kidneys in our institution's 8-year experience when the gonal vein was not preserved with the specimen during the donor procedure. Patients and Methods: We reviewed the records of 800 consecutive laparoscopic donor nephrectomy patients. Donor sex, age, body mass index, warm ischemia time, hospital length of stay, donor and recipient serum creatinine levels, and incidence and type of complications including the incidence of ureteral complications were recorded. Results: Mean patient age was 39±10 years. Mean body mass index was 27±5. A total of 482 cases were treated purely laparoscopically. Of them, 318 were performed hand assisted. Seven hundred and ninety-three procedures were done on the left side and seven were done on the right side. The overall rate of intraoperative complications was 2.9%. The overall open conversion rate was 1.4%. The overall rate of postoperative complications was 3.9%. The postoperative day-7 serum creatinine values of the donors were 1.4±0.3mg/dL. Mean creatinine in all patients at 1 week after transplantation was 1.5±0.2mg/dL. We had one case of ureteral stricture in the recipients of laparoscopically procured kidneys without gonadal vein preservation technique among 800 patients. Conclusion: Gonadal vein preservation with the entire specimen during laparoscopic donor nephrectomy procedure is not a necessary step to protect periureteral blood supply to prevent ureteral strictures.