Feasibility and safety of transvaginal specimen extraction for laparoscopic living donor nephrectomy: an Indonesian perspective compared with three different approaches

Introduction: Laparoscopic live donor nephrectomy (LLDN) continues to expand in minimally invasive surgery; nevertheless, the studies are inadequate to compare standard kidney extraction with TV-NOSE in less-developed countries. This study compared TV-NOSE with conventional kidney specimen extractions. Objective: To examine the feasibility of TV-NOSE in live donor nephrectomy. Materials and Methods: 53 patients received LDN surgery at our hospital from September 2017 to December 2021. Retrospectively, living donor nephrectomy with TV-NOSE was compared to three different surgical procedures with standard specimen extraction. Results: 53 donor patients were included: 15 open (OLDN), 12 retroperitoneoscopic living donor nephrectomy (RPLDN), 10 transperitoneal living donor nephrectomy (TPLDN), and 16 standard laparoscopic living donor nephrectomy with transvaginal extraction (SLLDN TV-NOSE). SLLDN TV-NOSE’s longer operating time (p<0.0041) did not affect graft function. SLLDN TV-NOSE and RPLDN had shorter lengths of stay and better VAS trends than open LDN and TPLDN (p<0.05). SLLDN TV-NOSE donors reported acceptable surgical outcomes and unchanged sexual function. All patients had similar discharge creatinine levels, with 1-year transplant survival of 98 and just 1 graft loss in the TPLDN group. Conclusion: SLLDN TV-NOSE is equivalent to RPLDN and better than open LDN and TPLDN in terms of duration of stay, VAS score, surgical outcomes, and sexual function. TV-NOSE is a safe surgical procedure with an acceptable donor complication. TV-NOSE may be safely conducted in both developed and developing countries with proper patient selection.