Donor nephrectomy is performed in a healthy human who otherwise does not require any surgery. Between 1954 and 1994, the open donor nephrectomy (ODN) through flank incision was considered as a standard procedure for kidney donation. Flank pain, incisional hernia, neuralgia, and muscle weakness were observed in large number of donors undergoing ODN. Ratner performed the first laparoscopic donor nephrectomy (LDN) in 1995; since then several other institutions have started performing LDN with the incentive to the donor having less pain, early ambulation, early resumption of regular activity, and rapid recovery.[2–6] All these studies with high levels of evidence-based results, either randomized, controlled trials or prospective, nonrandomized trials find that compared to ODN, LDN provides equal graft function, rejection rate, urological complications, and patient and graft survival. These studies, however, suggest slightly increased operative time, marginally increased warm ischemia time, and increased major complications requiring reoperation (especially in the early learning phase) in the laparoscopic cases compared to the open approach. A critical analysis of delayed graft function after LDN found that female donor kidneys into male recipients and highly HLA-mismatched donors were significant factors in delayed graft function, but that no variable related to the laparoscopic procedure itself (prolonged carbon dioxide pneumoperitoneum, warm ischemia time, renal artery length, use of right kidney) affected the functional outcome of the allograrft.
Recognizing the disincentives of the ODN and understanding the advantages of the small retrieval incisions performed during LDN, few surgeons have stared performing “mini- incision” ODN. The intention of this article is to review the status of “mini-incision” ODN in comparison to LDN.