Retroperitoneoscopic Approach in Live Donor Left Nephrectomy: Insights From a Single-Center Case Series in the Sub-Himalayan Region.

Background and objective Living donor nephrectomy demands a surgical approach that ensures donor safety while preserving optimal graft function. The retroperitoneoscopic approach provides direct access to the renal hilum, potentially reducing bowel manipulation and postoperative morbidity. This study aimed to evaluate the feasibility, safety, and perioperative outcomes of laparoscopic retroperitoneoscopic donor nephrectomy (LRDN) in a small case series, with a particular emphasis on donor recovery and clinical outcomes. Methods From November 2022 to January 2023, seven patients underwent retroperitoneoscopic donor nephrectomy (RDN) performed by a single surgeon during the surgeon's initial independent experience, following participation in more than 100 RDN procedures at a high-volume center. All procedures were performed using a standardized retroperitoneoscopic approach. None of the donors had a history of previous abdominal surgery, and the retroperitoneoscopic approach was adopted as the standard technique. Perioperative parameters, including operative time, warm ischemia time, cold ischemia time, estimated blood loss, intraoperative complications, conversion to open surgery, length of hospital stay, and postoperative complications, were analyzed. Complications were graded according to the Clavien-Dindo classification. Donor recovery and outcomes were evaluated during the follow-up period. Results All seven procedures were successfully completed using the retroperitoneoscopic approach without conversion. The procedure was performed on the left side in all cases. The donor cohort comprised two males and five females, with a mean age of 46 years (range: 30-60 years). The mean operative time was 210 ± 22.9 minutes, with a mean estimated blood loss of 100.71 ± 16.94 mL. Three patients had two renal arteries. The mean warm ischemia time was 265 ± 21.41 seconds. The mean hospital stay was 3.86 ± 0.90 days. Donor recovery was uneventful in all patients, with no postoperative complications observed. Conclusions LRDN is a feasible and safe technique with favorable donor and graft outcomes based on the findings of this small case series. The procedure offers the advantages of minimal postoperative pain and rapid recovery, although it requires technical expertise and involves an associated learning curve.