Abstract
We have read the letter to the editor regarding our article, “Re: Safety and Efficacy of Retroperitoneoscopic Living Donor Nephrectomy: Comparison of Early Complication, Donor and Recipient Outcome with Hand-Assisted Laparoscopic Living Donor Nephrectomy,” and appreciate the authors' concerns about our article.
There is a concern that retroperitoneoscopic living donor nephrectomy (RPLDN) on the right side is associated with the short renal vein and increased incidence of venous thrombosis. As they have noted, several reports indicate that a longer right renal vein could be obtained by the use of an Endo-TA stapler compared with Hem-o-lok clips in RPLDN. 1,2 That is useful and important information. In addition, it is important to mobilize the iliac vein by ligating and dividing the internal iliac vein and gluteal veins in the recipient. This procedure facilitates the performance of tension-free anastomosis. In our study, with this technique, there were no vascular complications with the subsequent 27 right renal allografts in the RPLDN group. 3 The modifications in both the donor and recipient surgeries can improve the outcome of kidney transplantation for right kidney graft.
Their second concern is that using Endo catch device increases the warm ischemic time (WIT). Indeed, WIT was significantly longer when a kidney graft was extracted with the Endo catch device (RPLDN) than by hand (hand-assisted laparoscopic living donor nephrectomy [HALDN]) in our study. We used a Pfannenstiel incision in RPLDN because Pfannenstiel incision is preferred for cosmetic reasons and it is reported to be less painful than when an expanded port site incision is employed. 4 However, it is difficult to extract a kidney graft by hand from a 6 cm Pfannenstiel incision. Despite different WIT, the graft outcome is similar between RPLDN and HALDN. Therefore, it is feasible to extract a kidney graft using Pfannenstiel incision and Endo catch device.