FEASIBILITY AND SAFETY OF TRANSVAGINAL SPECIMEN EXTRACTION FOR LAPAROSCOPIC LIVING

DONOR NEPHRECTOMY: AN INDONESIAN PERSPECTIVE COMPARED WITH THREE DIFFERENT

APPROACHES

Ahmad Zulfan Hendri1, Indrawarman Soerohardjo1, Khaerani Arista Dewi1, Aria Danurdoro1
1
Division of Urology, Faculty of Medicine, Public Health and Nursing UGM, Yogyakarta, 55281, Indonesia

Background: Laparoscopic living donor nephrectomy (LLDN) continues to expand in minimally invasive
surgery; however, the literature is insufficient to compare the conventional kidney extraction with
transvaginal Natural Orifice Specimen Extraction (TV-NOSE) procedure, especially from developing
countries. Here we aim to compare the conventional specimen extractions and TV-NOSE in renal
transplant cases.

Objective: To report our initial experience with TV-NOSE in living donor nephrectomy compared to
previous conventional retrieval techniques and assess its feasibility.

Methods: From September 2017 to December 2021, 53 patients underwent living donor nephrectomy
(LDN) surgery in our hospital. Living donor nephrectomy with TV-NOSE was retrospectively compared to
the other three surgical techniques with conventional specimen extraction regarding the perioperative
outcome and graft function.

Results: A total of 53 donor patients, including 15 open (OLDN), retroperitoneoscopic (RPLDN), 10

transperitoneal (TPLDN), and 16 standard laparoscopic with transvaginal extraction (SLLDN TV-NOSE)
were included. Operative characteristics showed similar results for four techniques except for the longer
operating time in SLLDN TV-NOSE (P<0.0041) without interfering with the graft function. A significantly
shorter length of stay and a better trend of VAS score was shown in SLLDN TV-NOSE and RPLDN
compared to open LDN and TPLDN (p<0.05). In general, all SLLDN TV-NOSE donors reported satisfactory
surgical results and unchanged sexual function postoperatively. All recipients had comparable discharge
creatinine levels with overall 1-year graft survival of 98% —only 1 case of graft loss was recorded in the
TPLDN group.

Conclusion: Although it takes a longer operating time, SLLDN TV-NOSE is comparable to RPLDN and
better than open LDN and TPLDN in terms of length of stay and VAS score with satisfactory surgical
results and no disturbance to the sexual function. Thus, TV-NOSE is a feasible and safe surgical option
with an acceptable donor complication. With the proper patient selection, TV-NOSE can be safely
performed not only in well-established medical care countries but also in other developing regions.

Keywords: Laparoscopic Nephrectomy; Natural orifice specimen extraction (NOSE); Transvaginal

extraction; Laparoscopic living donor nephrectomy (LLDN)
 Gambar Lokasi Port Gambar Inspirasi

Transperitoneal Laparoscopic Living Donor Nephrectomy

(TPLDN)
 Gambar Lokasi Port Gambar Inspirasi

Standard Laparoscopic Living Donor Nephrectomy With

Transvaginal-Natural Orifice Specimen Extraction (SLLDN TV-
NOSE technique)
 Gambar Lokasi Port

Gambar Inspirasi

Retroperitoneoscopic Living Donor Nephrectomy (RPLDN)