Outcomes of Transperitoneal Laparoscopic Living Donor Nephrectomy: A Single-Center Study in Vietnam

Outcomes of Transperitoneal Laparoscopic Living Donor Nephrectomy: A Single-Center Study in Vietnam | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Outcomes of Transperitoneal Laparoscopic Living Donor Nephrectomy: A Single-Center Study in Vietnam Nguyen Vu Le, Minh Phuc Cao, Long Hoang, Quang Nghia Nguyen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6884776/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Jul, 2025 Read the published version in International Urology and Nephrology → Version 1 posted You are reading this latest preprint version Abstract Purpose (i) describe renal vascular anatomy in Vietnamese donors with 256-slice MSCT; (ii) relate imaging to operative metrics and early outcomes of trans-peritoneal laparoscopic donor nephrectomy (LDN). Methods All consecutive living-kidney donors who underwent trans-peritoneal LDN at Viet Duc University Hospital between January 2023 and June 2024 were prospectively enrolled. Eligibility required compliance with national donation criteria, informed consent, and complete clinical documentation. MSCT data (vessel number, length, diameter, variants) and surgical variables (trocar use, warm-ischaemia time, blood loss, complications) were extracted from electronic records. Results 166 donors (41.6 ± 10.2 year, 59% female) were analyzed. MSCT showed a single renal artery in 77.3% of kidneys and ≥ 2 arteries in 22.7%; multiple veins were more common on the right (14.7%). The left renal vein was far longer than the right (66.0 ± 14.0 vs 25.3 ± 7.4 mm, p < 0.001). Vessel number was predicted correctly in 95.8% of cases, although pedicle length was over-estimated by 3–9 mm (p < 0.001). All nephrectomies were completed laparoscopically. Mean operative time was 118 ± 23 min; warm-ischaemia time 4.5 ± 1.1 min; blood loss 70 ± 33 mL with no transfusions. Intra-operative morbidity was 4.2% (minor only) and 30-day morbidity 9.6%, almost entirely self-limited lymphatic leaks. Drains were removed after 3.5 ± 0.7 days; donors were discharged after 7.2 ± 2.0 days; creatinine fell from 110 to 92 µmol L⁻¹ within one month. Conclusion 256-slice MSCT provides highly accurate vascular mapping that correlates closely with intra-operative findings. When combined with trans-peritoneal LDN, it yields short operative times, low complication rates, and rapid donor recovery, supporting its routine use in living-donor programs in resource-constrained settings. Living kidney donor laparoscopic donor nephrectomy CT angiography renal vascular anatomy kidney transplantation INTRODUCTION End-stage renal disease (ESRD) continues to pose a growing global health burden, requiring effective renal replacement therapies. Among these, kidney transplantation from living donors has emerged as the preferred option due to its shorter waiting time, superior graft function, and better long-term survival outcomes compared to deceased donor transplantation. Parallel to the development of transplant programs, surgical techniques for living donor nephrectomy have undergone significant refinement. Transperitoneal laparoscopic donor nephrectomy (LDN) has become the most commonly adopted method worldwide due to its advantages of minimal invasiveness, faster postoperative recovery, reduced postoperative pain, improved cosmetic results, and proven safety profile. Preoperative imaging plays a pivotal role in ensuring the success of LDN. Multislice computed tomography (MSCT), especially with 256-slice systems, is currently the gold standard for evaluating renal vascular anatomy and kidney morphology. Sahani and Kalva demonstrated that MSCT offers high accuracy in detecting the number, course, and diameter of renal arteries and veins, including vascular anomalies [ 1 ]. Troppmann emphasized that failure to recognize anatomical variations preoperatively could increase intraoperative complications and compromise donor safety [ 2 ]. According to Gupta et al., approximately 24% of donors present with accessory renal arteries, which may influence surgical planning and donor kidney selection [ 3 ]. Despite substantial global data on the use of MSCT and the safety of laparoscopic donor nephrectomy, there remains a lack of integrated studies correlating preoperative vascular imaging with intraoperative surgical outcomes in real-world practice, particularly in resource-limited or Asian settings. In addition, key technical aspects such as vascular dissection techniques, vessel length and caliber post-resection, warm ischemia time, and postoperative complications have not been consistently analyzed. This single-center study conducted at Viet Duc University Hospital aims to fill this gap by (i) characterizing renal vascular anatomy in Vietnamese living donors using 256-slice CT angiography and (ii) evaluate how these findings translate into operative strategy and short-term outcomes of trans-peritoneal LDN. The results are expected to provide valuable insights for optimizing donor selection, improving surgical planning, and enhancing safety in living donor kidney transplantation programs in developing countries. MATERIALS AND METHODS Study design We conducted a prospective descriptive observational study of consecutive living-kidney donors who underwent trans-peritoneal LDN at Viet Duc University Hospital between January 2023 and June 2024. Donors were eligible if they satisfied all Vietnamese Ministry of Health criteria for living donation, had been cleared for surgery by the institutional transplant board, provided written informed consent after detailed counselling, and possessed a complete medical record that included 256-slice MSCT angiography and a standardised operative report. Potential donors assessed outside the study window, those who declined participation or later withdrew consent, and those whose charts lacked essential data were excluded. A total of 166 donors met these requirements and were enrolled. The study protocol was approved by the ethics committees of Hanoi Medical University and Viet Duc University Hospital; all procedures conformed to national regulations, and data were anonymised before analysis [ 4 ]. Data collection Data were captured with a structured case-report form (CRF) created from the study objectives. The CRF contained four sections: Donor demographics and baseline data – age, sex, side selected for nephrectomy and (when available) body-mass index. Pre-operative MSCT variables – number, laterality, length and diameter of main renal arteries and veins, presence of accessory vessels, early branching, polar arteries and short venous pedicles. Intra-operative variables – total operative time, warm-ischaemia time, number of trocars, estimated blood loss, method of vascular control (clips or stapler), need for conversion and any intra-operative complication. Early post-operative variables – day of drain removal, length of stay, pain category (mild / moderate / severe), serum creatinine on post-operative day 1 and at one month, and all complications within 30 days. All data were extracted directly from electronic medical records, the Picture Archiving and Communication System (PACS), and standardized operative reports within the hospital system. A multidisciplinary team comprising urology residents, transplant surgeons and radiology technologists abstracted the data in real time. To maximise reliability, each data point was triangulated across three sources: 256-slice MSCT images, standardised operative reports, and electronic medical records. Two investigators then independently verified every entry; discrepancies were resolved by consensus, after which the validated dataset was locked for statistical analysis. Data analysis Analyses were carried out with SPSS v 16.0 (IBM Corp., Armonk, NY, USA) [ 5 ]. Categorical variables are expressed as counts and percentages, differences between kidney sides were evaluated with the χ² test, or with Fisher’s exact test when an expected cell count was < 5. Continuous variables are reported as mean ± standard deviation (SD). Unpaired continuous outcomes were compared with the two-sample Student’s t-test, whereas paired measures (MSCT versus intra-operative vessel length) were analyzed with the paired Student’s t-test. All tests were two-tailed, and p < 0.05 was considered statistically significant [ 6 ]. RESULTS Table 1 Characteristics of living kidney donors (n = 166) Variable Value Age, years (mean ± SD) 41.6 ± 10.2 Female, n (%) 98 (59.0) Kidney harvested, n (%) Left side 132 (79.5) Right side 34 (20.5) SD: standard deviation Table 1 presents the demographic profile of the 166 living donors and shows the distribution of kidneys selected for retrieval by side. The mean age was 41.6 ± 10.2 years. Female donors accounted for 59 percent of the cohort. The left kidney was harvested in 79.5 percent of cases, whereas the right kidney was taken in 20.5 percent. Table 2 Pre-operative renal anatomy on MSCT (n = 166) Parameter Left kidney Right kidney p-value Renal length, mm (mean ± SD) 102.4 ± 7.8 100.2 ± 7.5 > 0.05* Main renal arteries, n (% kidneys) Single artery 103 (77.9) 26 (76.7) > 0.05** ≥ 2 arteries 29 (22.1) 8 (23.3) Length of main renal artery, mm (mean ± SD) 31.4 ± 10.6 40.0 ± 12.6 < 0.01* Main renal veins, n (% kidneys) Single vein 131 (99.2) 29 (85.3) < 0.01** ≥ 2 veins 1 (0.8) 5 (14.7) Vein length, mm (mean ± SD) 66.0 ± 14.0 25.3 ± 7.4 < 0.001* Vein diameter, mm (mean ± SD) 11.37 ± 2.47 13.05 ± 2.28 < 0.001* * Student’s t test ** Chi-square test Table 2 summarises pre-operative vascular anatomy obtained from 256-slice MSCT. Mean renal length did not differ significantly between sides (left 102.4 ± 7.8 mm vs right 100.2 ± 7.5 mm, p > 0.05). A single main renal artery was the predominant pattern on both sides (left 77.9%, right 76.7%). Nevertheless, the right main artery was significantly longer than the left (40.0 ± 12.6 mm vs 31.4 ± 10.6 mm, p < 0.01). Venous asymmetry was more pronounced: multiple renal veins were observed in 14.7% of right kidneys but in only 0.8% of left kidneys. Consistent with known anatomy, the left renal vein was markedly longer (66.0 ± 14.0 mm vs 25.3 ± 7.4 mm, p < 0.001), whereas the right vein had the greater diameter (13.05 ± 2.28 mm vs 11.37 ± 2.47 mm, p < 0.001). Table 3 Comparison of vessel lengths on MSCT and Intra-operative (n = 166) Vessel type MSCT, mm (mean ± SD) Intra-operative, mm (mean ± SD) Mean difference, mm p-value* Right artery 40.0 ± 12.6 35.8 ± 5.5 4.2 < 0.001 Left artery 31.4 ± 10.6 27.1 ± 4.2 4.3 < 0.001 Right vein 25.3 ± 7.4 22.3 ± 5.7 3.0 < 0.001 Left vein 66.0 ± 14.0 57.4 ± 7.6 8.6 < 0.001 * Paired Student’s t-test Table 3 comparisons of MSCT and Intra-operative. The right artery was shorter by 4.2 mm, the left artery by 4.3 mm, the right vein by 3.0 mm, and the left vein by 8.6 mm. These differences were statistically significant. Table 4 Operative metrics and vascular control by kidney side (n = 166) Metric Left LDN (n = 132) Right LDN (n = 34) p-value Operative time, min (mean ± SD) 120.3 ± 22.6 115.1 ± 22.8 > 0.05* Warm-ischaemia time, s (mean ± SD) 223.1 ± 52.1 326.7 ± 30.0 > 0.05* Estimated blood loss, mL (mean ± SD) 70.4 ± 33.4 ≥ 4 trocars used, n (%) 1 (0.8) 34 (100.0) < 0.001** Main artery controlled with clip, n (%) 163 (98.2) Right renal vein stapled, n (%) - 22 (64.7) - * Student’s t test ** Fisher’s exact test Table 4 summarises intra-operative performance by kidney side. All right-sided donor nephrectomies required four trocars, whereas 99.2% of left-sided cases were completed with three trocars; only one left case needed a fourth port. Vascular control was highly standardised: 98.2% of main renal arteries were secured with two Hem-o-lok clips and one titanium clip. Every left renal vein was clipped, but 64.7% of right renal veins were divided with a stapler because of their short pedicle. Mean operative time (left 120.3 ± 22.6 min vs right 115.1 ± 22.8 min) and warm-ischaemia time (left 223.1 ± 52.1 s vs right 326.7 ± 30.0 s) differed only marginally and without statistical significance. Intra-operative blood loss was low, about 70 mL on average, and no donor required transfusion. Table 5 Recovery and complications within 30 days (n = 166) Variable Value Drain removal, days (mean ± SD) 3.52 ± 0.7 Hospital stay, days (mean ± SD) 7.22 ± 1.96 Creatinine, POD 1 vs. 1 month, µmol L⁻¹ (mean ± SD) 110.0 ± 5.2 vs. 92.0 ± 6.3 Any complication ≤ 30 days, n (%) 16 (9.64) Lymphatic leak 15 (9.04) Post-operative pain: mild / moderate, n (%) 155 (93.4) / 11 (6.6) SD: standard deviation Table 5 summarises early postoperative recovery parameters and 30-day donor morbidity. Drains were removed after a mean of 3.5 days and the mean length of stay was just over 7 days. Serum creatinine fell from 110 µmol L⁻¹ on postoperative day 1 to 92 µmol L⁻¹ at one month, indicating stable renal function in the remaining kidney. Thirty-day morbidity was low at 9.6%, almost entirely low-grade lymphatic leakage (9.0%). Post-operative pain was mild in the vast majority of donors (93%) and never severe. These findings, together with the high proportion of well-perfused grafts (95.8%) and the successful management of multiple vessels, confirm that trans-peritoneal LDN in this series was both safe and well-tolerated. DISCUSSION Multislice CT angiography with 3-D reconstruction remains the most accurate modality for mapping renal vasculature in living donors. In our prospective series, 256-slice MSCT was applied to all 166 candidates and decisively guided side selection, identified anatomical variants and predicted technical challenges. These findings support current the American Society of Transplantation (AST) and the European Society for Organ Transplantation (ESOT) recommendations that rank CT angiography as the gold standard for donor evaluation, with accuracy exceeding 95% [ 7 , 8 ]. Our 95.8% concordance rate and small, systematic over-estimate of pedicle length (3–9 mm) replicate the near-perfect performance reported by Sahani et al. and should be factored in when planning stapler placement [ 9 ]. The prevalence of ≥ 2 renal arteries (22.7%) and multiple veins (7.6%) matches large meta-analyses (23–30%), indicating that Vietnamese donors resemble other Asian populations [ 10 , 11 ]. As expected, the right main artery was longer, whereas the left renal vein was 2.6-times longer than the right, reinforcing the routine choice of the left kidney for donation. Variant patterns, early arterial branching (4.7–5.8%), accessory arteries (3.5%), late venous confluence (8.1%), mirror earlier Asian series [ 12 , 13 ]. MSCT correctly predicted vessel number in 95.8% of donors; only 1.8% of accessory arteries were missed, similar to the 3–5% under-diagnosis reported by Troppmann et al. [ 14 , 15 ]. The modest length discrepancy (0.4–1.0 cm) reflects stapler bite and should be anticipated. Repeat imaging with optimised contrast timing detected several small occult arteries [ 16 , 17 ]. Importantly, every graft with ≥ 2 arteries was reconstructed successfully, confirming the planning value of MSCT. Trans-peritoneal LDN was carried out with three trocars on the left and an additional liver-retractor port on the right, consistent with European Association of Urology (EAU) 2023 guidance [ 18 ]. Two Hem-o-lok™ clips plus one titanium clip secured 98.2% of arterial pedicles. In line with AST advice and the Food and Drug Administration (FDA) alert on clip slippage, 64.7% of right renal veins were stapled, whereas all left veins were clipped [ 19 , 20 ]. Kidney retrieval via a Pfannenstiel incision reduced pain and improved cosmesis, corroborating outcomes reported by Kokkinos and endorsed by the EAU [ 21 , 22 ]. Mean operative time was 119 min and warm-ischaemia time remained < 5 min on both sides, satisfying thresholds proposed by Srivastava and Simforoosh [ 23 , 24 ]. Intra-operative complications were minor (4.2%) and no case converted to open surgery. Thirty-day morbidity was 9.64%, dominated by lymphatic leaks managed conservatively, a rate comparable to or below those in other Asian series [ 23 – 25 ]. Donors were discharged after 7 days, drains removed by day 3–4, pain was mild (VAS 3–4) and serum creatinine improved from 110 to 92 µmol L⁻¹ within a month. The study’s chief strengths are its prospective design, the uniform use of 256-slice CT for every donor, and complete 30-day follow-up without loss to follow-up. All imaging data were correlated with intra-operative findings, providing a real-world accuracy estimate rarely reported in low-middle-income settings. Nevertheless, the single-centre nature limits external validity, and the absence of multivariable analysis prevents identification of independent predictors of warm-ischaemia time or lymphatic leakage. Recipient outcomes and donor renal function beyond one month were not captured, so long-term safety could not be assessed. A workflow that combines 256-slice MSCT with trans-peritoneal LDN is safe, reproducible and suited to resource-constrained settings. Routine CT-based vascular mapping, a three-trocar template for left kidneys, and selective stapling of short right renal veins are practical measures for centres starting a living-donor programme in the region. CONCLUSION 256-slice MSCT offers highly accurate pre-operative vascular mapping, and its findings correlate closely with intra-operative anatomy. Trans-peritoneal LDN in this cohort achieved short operative times, low complication rates and prompt donor recovery. These data affirm the feasibility and safety of integrating advanced CT imaging with laparoscopic donor nephrectomy in Vietnam. Declarations Ethics approval and consent to participate The study was approved by the Hanoi Medical University’s ethical committee, number 3224/BM - HĐĐĐ. All participants provided written consent after being fully informed about the purpose of this study. Consent for publication Not applicable Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Authors' contributions Conceptualization: MPC, LH, QNN. Methodology and Investigation: MPC. Formal analysis and data curation: MPC. Writing – original draft preparation: NVL, MPC, LH, QNN. Writing – reviewing and editing: All authors. Acknowledgements The authors acknowledge the support from the Viet Duc University Hospital, Hanoi, Vietnam. References Sahani DV, Kalva SP (2008) Imaging the renal vasculature and transplant evaluation. Radiol Clin North Am 46(1):19–30. Troppmann C (2017) The donor nephrectomy: a current perspective. Transplant Rev (Orlando) 31(2):92–98. Gupta A, Bhalla AS, Sharma R, et al. (2020) CT evaluation of renal vascular variants and its implications in donor nephrectomy. Abdom Radiol (NY) 45(3):654–662. Ministry of Health (Vietnam) (2018) Circular 40/2018/TT-BYT: Guidelines on Criteria for Living Kidney Donors. Hanoi: Ministry of Health. IBM Corp (2007) IBM SPSS Statistics for Windows, Version 16.0. Armonk, NY: IBM Corp. Kirkwood BR, Sterne JAC (2003) Essential Medical Statistics. 2nd ed. Oxford: Blackwell Science. American Society of Transplantation (2021) AST Living Donor Kidney Transplantation Guidelines. https://www.myast.org/guidelines European Society for Organ Transplantation (2022) ESOT Consensus Report on the Evaluation and Care of Living Kidney Donors. Transpl Int 35:10103. https://doi.org/10.1111/tri.14103 Sahani DV, Kalva SP, Hahn PF, et al. (2004) Multidetector-row CT of the abdomen: value of isotropic imaging. Radiographics 24(3):705–722. https://doi.org/10.1148/rg.243035127 Kumar S, Tiwari S, Singh AK, et al. (2015) Anatomical variations of renal arteries and their embryological and clinical correlation: a cadaveric study from North India. J Clin Diagn Res 9(5):AC10–AC13. https://doi.org/10.7860/JCDR/2015/12767.5953 Gupta A, Singla RK, Goel A, et al. (2021) Prevalence and clinical significance of renal vascular variants in living kidney donors: a systematic review and meta-analysis. Int J Surg 93:106057. https://doi.org/10.1016/j.ijsu.2021.106057 Troppmann C, McBride MA, Baker TJ, et al. (2001) Vascular complications after living donor nephrectomy. Am J Transplant 1(4):357–362. https://doi.org/10.1034/j.1600-6143.2001.10412.x Luis EB, Vidya S, Mishra N, et al. (2018) Surgical management of renal vein variations in laparoscopic donor nephrectomy. Urol Ann 10(2):158–163. https://doi.org/10.4103/UA.UA_133_17 Kaur N, Singh A, Suri RK (2015) Early branching of renal artery: MDCT angiographic study and surgical implications. J Clin Imaging Sci 5:12. https://doi.org/10.4103/2156-7514.153405 Mehra S, Bansal P, Sharma R (2017) Clinical importance of renal artery variations: a multidetector CT angiographic study. J Clin Diagn Res 11(6):TC01–TC04. https://doi.org/10.7860/JCDR/2017/26523.10029 Kim JK, Kim SH, Yoon CS, et al. (2004) Living donor renal CT angiography: accuracy, reliability, and safety of 16-MDCT in evaluating renal vasculature. AJR Am J Roentgenol 183(3):845–849. https://doi.org/10.2214/ajr.183.3.1830845 Kawamoto S, Montgomery RA, Lawler LP, et al. (2004) Multidetector row CT evaluation of living renal donors prior to laparoscopic nephrectomy. Radiographics 24(2):453–466. https://doi.org/10.1148/rg.242035081 European Association of Urology (2023) EAU Guidelines on Renal Transplantation. https://uroweb.org/guidelines/renal-transplantation US Food and Drug Administration (2006) Public Health Notification: Hazards of Hem-o-lok® ligating clips. https://www.fda.gov Koo V, Ahmed HU, Challacombe B, et al. (2013) Safety of Hem-o-lok clips in laparoscopic donor nephrectomy: analysis of 900 cases. J Endourol 27(2):208–211. https://doi.org/10.1089/end.2012.0239 Kokkinos C, Tsoulfas G, Paraskevas G (2021) Pfannenstiel incision for kidney retrieval in laparoscopic donor nephrectomy: a meta-analysis of outcomes. Transpl Proc 53(4):1150–1155. https://doi.org/10.1016/j.transproceed.2021.01.006 Greco F, Hoda MR, Wagner S, et al. (2012) Pfannenstiel versus midline incision in laparoscopic donor nephrectomy: a prospective randomized trial. Eur Urol 61(3):613–620. https://doi.org/10.1016/j.eururo.2011.11.009 Srivastava A, Singh P, Sharma RK, et al. (2016) Laparoscopic donor nephrectomy: current status and future perspectives. Indian J Urol 32(2):91–97. https://doi.org/10.4103/0970-1591.180487 Simforoosh N, Basiri A, Tabibi A, et al. (2015) Laparoscopic versus open donor nephrectomy: 10 years of experience with 2,500 cases. J Endourol 29(12):1447–1452. https://doi.org/10.1089/end.2015.0299 Koyama M, Tanaka T, Igawa T, et al. (2014) Clinical outcomes of laparoscopic donor nephrectomy in Japan: a multicenter retrospective study. Transplant Proc 46(2):452–456. https://doi.org/10.1016/j.transproceed.2013.12.040 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6884776","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":472557252,"identity":"452e2bd9-4b6c-4413-80f7-c5f2af9f8aed","order_by":0,"name":"Nguyen Vu Le","email":"","orcid":"","institution":"Viet Duc University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Nguyen","middleName":"Vu","lastName":"Le","suffix":""},{"id":472557254,"identity":"de6a17cc-5daa-4436-8860-caf1f01a5d1d","order_by":1,"name":"Minh Phuc Cao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3UlEQVRIiWNgGAWjYLCCBIYDDAYMDIyPYVyitTAbE6+FAaKFTZooLfzth49ueLjjTp65RPKz6sKcwwz87DkGzLw7cGuROJOWdiPxzLNiyxlpZrdnbjvMINnzBqjlDG4tBgw5ZjcS2w4nbriRw3abF6jF4EaOAePMNjxa+N8gtBSDtNgT1CKBZAsz2BaJHAOGj3i0SNx4lgbSUmxw5pmxNO+2dB6JM88KDuDTwt+ffOzmz7bDeQbHkx9+5t1mLcffnrzxQSIeLTCQAGPwgIgDhDUQG+OjYBSMglEwMgEAGtRX9/K7ccsAAAAASUVORK5CYII=","orcid":"","institution":"Hanoi Medical University","correspondingAuthor":true,"prefix":"","firstName":"Minh","middleName":"Phuc","lastName":"Cao","suffix":""},{"id":472557256,"identity":"91652fa4-da41-44a9-81fd-e9b3672ceed1","order_by":2,"name":"Long Hoang","email":"","orcid":"","institution":"Hanoi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Long","middleName":"","lastName":"Hoang","suffix":""},{"id":472557259,"identity":"e4ce220b-3465-4015-b6b8-7fa7a7880a6d","order_by":3,"name":"Quang Nghia Nguyen","email":"","orcid":"","institution":"Viet Duc University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Quang","middleName":"Nghia","lastName":"Nguyen","suffix":""}],"badges":[],"createdAt":"2025-06-13 05:23:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6884776/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6884776/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11255-025-04682-0","type":"published","date":"2025-07-21T15:58:11+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":87757607,"identity":"ae98733e-8a86-4e62-96ef-99ab969b354b","added_by":"auto","created_at":"2025-07-28 16:11:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":549924,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6884776/v1/d3477ad9-7f99-421e-b5fd-38f6b18df6ee.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Outcomes of Transperitoneal Laparoscopic Living Donor Nephrectomy: A Single-Center Study in Vietnam","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eEnd-stage renal disease (ESRD) continues to pose a growing global health burden, requiring effective renal replacement therapies. Among these, kidney transplantation from living donors has emerged as the preferred option due to its shorter waiting time, superior graft function, and better long-term survival outcomes compared to deceased donor transplantation.\u003c/p\u003e \u003cp\u003eParallel to the development of transplant programs, surgical techniques for living donor nephrectomy have undergone significant refinement. Transperitoneal laparoscopic donor nephrectomy (LDN) has become the most commonly adopted method worldwide due to its advantages of minimal invasiveness, faster postoperative recovery, reduced postoperative pain, improved cosmetic results, and proven safety profile.\u003c/p\u003e \u003cp\u003ePreoperative imaging plays a pivotal role in ensuring the success of LDN. Multislice computed tomography (MSCT), especially with 256-slice systems, is currently the gold standard for evaluating renal vascular anatomy and kidney morphology. Sahani and Kalva demonstrated that MSCT offers high accuracy in detecting the number, course, and diameter of renal arteries and veins, including vascular anomalies [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Troppmann emphasized that failure to recognize anatomical variations preoperatively could increase intraoperative complications and compromise donor safety [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. According to Gupta et al., approximately 24% of donors present with accessory renal arteries, which may influence surgical planning and donor kidney selection [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite substantial global data on the use of MSCT and the safety of laparoscopic donor nephrectomy, there remains a lack of integrated studies correlating preoperative vascular imaging with intraoperative surgical outcomes in real-world practice, particularly in resource-limited or Asian settings. In addition, key technical aspects such as vascular dissection techniques, vessel length and caliber post-resection, warm ischemia time, and postoperative complications have not been consistently analyzed.\u003c/p\u003e \u003cp\u003eThis single-center study conducted at Viet Duc University Hospital aims to fill this gap by (i) characterizing renal vascular anatomy in Vietnamese living donors using 256-slice CT angiography and (ii) evaluate how these findings translate into operative strategy and short-term outcomes of trans-peritoneal LDN. The results are expected to provide valuable insights for optimizing donor selection, improving surgical planning, and enhancing safety in living donor kidney transplantation programs in developing countries.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eWe conducted a prospective descriptive observational study of consecutive living-kidney donors who underwent trans-peritoneal LDN at Viet Duc University Hospital between January 2023 and June 2024. Donors were eligible if they satisfied all Vietnamese Ministry of Health criteria for living donation, had been cleared for surgery by the institutional transplant board, provided written informed consent after detailed counselling, and possessed a complete medical record that included 256-slice MSCT angiography and a standardised operative report. Potential donors assessed outside the study window, those who declined participation or later withdrew consent, and those whose charts lacked essential data were excluded.\u003c/p\u003e \u003cp\u003eA total of 166 donors met these requirements and were enrolled. The study protocol was approved by the ethics committees of Hanoi Medical University and Viet Duc University Hospital; all procedures conformed to national regulations, and data were anonymised before analysis [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eData were captured with a structured case-report form (CRF) created from the study objectives. The CRF contained four sections:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eDonor demographics and baseline data \u0026ndash; age, sex, side selected for nephrectomy and (when available) body-mass index.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePre-operative MSCT variables \u0026ndash; number, laterality, length and diameter of main renal arteries and veins, presence of accessory vessels, early branching, polar arteries and short venous pedicles.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eIntra-operative variables \u0026ndash; total operative time, warm-ischaemia time, number of trocars, estimated blood loss, method of vascular control (clips or stapler), need for conversion and any intra-operative complication.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEarly post-operative variables \u0026ndash; day of drain removal, length of stay, pain category (mild / moderate / severe), serum creatinine on post-operative day 1 and at one month, and all complications within 30 days.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eAll data were extracted directly from electronic medical records, the Picture Archiving and Communication System (PACS), and standardized operative reports within the hospital system.\u003c/p\u003e \u003cp\u003eA multidisciplinary team comprising urology residents, transplant surgeons and radiology technologists abstracted the data in real time. To maximise reliability, each data point was triangulated across three sources: 256-slice MSCT images, standardised operative reports, and electronic medical records. Two investigators then independently verified every entry; discrepancies were resolved by consensus, after which the validated dataset was locked for statistical analysis.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eAnalyses were carried out with SPSS v 16.0 (IBM Corp., Armonk, NY, USA) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCategorical variables are expressed as counts and percentages, differences between kidney sides were evaluated with the χ\u0026sup2; test, or with Fisher\u0026rsquo;s exact test when an expected cell count was \u0026lt;\u0026thinsp;5. Continuous variables are reported as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD). Unpaired continuous outcomes were compared with the two-sample Student\u0026rsquo;s t-test, whereas paired measures (MSCT versus intra-operative vessel length) were analyzed with the paired Student\u0026rsquo;s t-test. All tests were two-tailed, and p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of living kidney donors (n\u0026thinsp;=\u0026thinsp;166)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eValue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98 (59.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKidney harvested, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft side\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e132 (79.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight side\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (20.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eSD: standard deviation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the demographic profile of the 166 living donors and shows the distribution of kidneys selected for retrieval by side. The mean age was 41.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2 years. Female donors accounted for 59 percent of the cohort. The left kidney was harvested in 79.5 percent of cases, whereas the right kidney was taken in 20.5 percent.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePre-operative renal anatomy on MSCT (n\u0026thinsp;=\u0026thinsp;166)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft kidney\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRight kidney\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenal length, mm (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100.2\u0026thinsp;\u0026plusmn;\u0026thinsp;7.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.05*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eMain renal arteries, n (% kidneys)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle artery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e103 (77.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (76.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.05**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;2 arteries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (22.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (23.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of main renal artery, mm (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.4\u0026thinsp;\u0026plusmn;\u0026thinsp;10.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.0\u0026thinsp;\u0026plusmn;\u0026thinsp;12.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eMain renal veins, n (% kidneys)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle vein\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e131 (99.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (85.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;2 veins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (14.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVein length, mm (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66.0\u0026thinsp;\u0026plusmn;\u0026thinsp;14.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVein diameter, mm (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.37\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.05\u0026thinsp;\u0026plusmn;\u0026thinsp;2.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e* Student\u0026rsquo;s t test\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e** Chi-square test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarises pre-operative vascular anatomy obtained from 256-slice MSCT. Mean renal length did not differ significantly between sides (left 102.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8 mm vs right 100.2\u0026thinsp;\u0026plusmn;\u0026thinsp;7.5 mm, p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). A single main renal artery was the predominant pattern on both sides (left 77.9%, right 76.7%). Nevertheless, the right main artery was significantly longer than the left (40.0\u0026thinsp;\u0026plusmn;\u0026thinsp;12.6 mm vs 31.4\u0026thinsp;\u0026plusmn;\u0026thinsp;10.6 mm, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Venous asymmetry was more pronounced: multiple renal veins were observed in 14.7% of right kidneys but in only 0.8% of left kidneys. Consistent with known anatomy, the left renal vein was markedly longer (66.0\u0026thinsp;\u0026plusmn;\u0026thinsp;14.0 mm vs 25.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4 mm, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), whereas the right vein had the greater diameter (13.05\u0026thinsp;\u0026plusmn;\u0026thinsp;2.28 mm vs 11.37\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47 mm, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of vessel lengths on MSCT and Intra-operative (n\u0026thinsp;=\u0026thinsp;166)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVessel type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMSCT, mm (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntra-operative, mm (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean difference, mm\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight artery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e40.0\u0026thinsp;\u0026plusmn;\u0026thinsp;12.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e35.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft artery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e31.4\u0026thinsp;\u0026plusmn;\u0026thinsp;10.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e27.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight vein\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e25.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e22.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft vein\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e66.0\u0026thinsp;\u0026plusmn;\u0026thinsp;14.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e57.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e* Paired Student\u0026rsquo;s t-test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e comparisons of MSCT and Intra-operative. The right artery was shorter by 4.2 mm, the left artery by 4.3 mm, the right vein by 3.0 mm, and the left vein by 8.6 mm. These differences were statistically significant.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOperative metrics and vascular control by kidney side (n\u0026thinsp;=\u0026thinsp;166)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMetric\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft LDN (n\u0026thinsp;=\u0026thinsp;132)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRight LDN (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperative time, min (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e120.3\u0026thinsp;\u0026plusmn;\u0026thinsp;22.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e115.1\u0026thinsp;\u0026plusmn;\u0026thinsp;22.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.05*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWarm-ischaemia time, s (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e223.1\u0026thinsp;\u0026plusmn;\u0026thinsp;52.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e326.7\u0026thinsp;\u0026plusmn;\u0026thinsp;30.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.05*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEstimated blood loss, mL (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e70.4\u0026thinsp;\u0026plusmn;\u0026thinsp;33.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;4 trocars used, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMain artery controlled with clip, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e163 (98.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight renal vein stapled, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (64.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e* Student\u0026rsquo;s t test\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e** Fisher\u0026rsquo;s exact test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e summarises intra-operative performance by kidney side. All right-sided donor nephrectomies required four trocars, whereas 99.2% of left-sided cases were completed with three trocars; only one left case needed a fourth port. Vascular control was highly standardised: 98.2% of main renal arteries were secured with two Hem-o-lok clips and one titanium clip. Every left renal vein was clipped, but 64.7% of right renal veins were divided with a stapler because of their short pedicle. Mean operative time (left 120.3\u0026thinsp;\u0026plusmn;\u0026thinsp;22.6 min vs right 115.1\u0026thinsp;\u0026plusmn;\u0026thinsp;22.8 min) and warm-ischaemia time (left 223.1\u0026thinsp;\u0026plusmn;\u0026thinsp;52.1 s vs right 326.7\u0026thinsp;\u0026plusmn;\u0026thinsp;30.0 s) differed only marginally and without statistical significance. Intra-operative blood loss was low, about 70 mL on average, and no donor required transfusion.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRecovery and complications within 30 days (n\u0026thinsp;=\u0026thinsp;166)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eValue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrain removal, days (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital stay, days (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.22\u0026thinsp;\u0026plusmn;\u0026thinsp;1.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine, POD 1 vs. 1 month, \u0026micro;mol L⁻\u0026sup1; (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e110.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2 vs. 92.0\u0026thinsp;\u0026plusmn;\u0026thinsp;6.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny complication\u0026thinsp;\u0026le;\u0026thinsp;30 days, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (9.64)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymphatic leak\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (9.04)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-operative pain: mild / moderate, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e155 (93.4) / 11 (6.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eSD: standard deviation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e summarises early postoperative recovery parameters and 30-day donor morbidity. Drains were removed after a mean of 3.5 days and the mean length of stay was just over 7 days. Serum creatinine fell from 110 \u0026micro;mol L⁻\u0026sup1; on postoperative day 1 to 92 \u0026micro;mol L⁻\u0026sup1; at one month, indicating stable renal function in the remaining kidney. Thirty-day morbidity was low at 9.6%, almost entirely low-grade lymphatic leakage (9.0%). Post-operative pain was mild in the vast majority of donors (93%) and never severe. These findings, together with the high proportion of well-perfused grafts (95.8%) and the successful management of multiple vessels, confirm that trans-peritoneal LDN in this series was both safe and well-tolerated.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eMultislice CT angiography with 3-D reconstruction remains the most accurate modality for mapping renal vasculature in living donors. In our prospective series, 256-slice MSCT was applied to all 166 candidates and decisively guided side selection, identified anatomical variants and predicted technical challenges. These findings support current the American Society of Transplantation (AST) and the European Society for Organ Transplantation (ESOT) recommendations that rank CT angiography as the gold standard for donor evaluation, with accuracy exceeding 95% [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur 95.8% concordance rate and small, systematic over-estimate of pedicle length (3\u0026ndash;9 mm) replicate the near-perfect performance reported by Sahani et al. and should be factored in when planning stapler placement [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe prevalence of \u0026ge;\u0026thinsp;2 renal arteries (22.7%) and multiple veins (7.6%) matches large meta-analyses (23\u0026ndash;30%), indicating that Vietnamese donors resemble other Asian populations [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. As expected, the right main artery was longer, whereas the left renal vein was 2.6-times longer than the right, reinforcing the routine choice of the left kidney for donation. Variant patterns, early arterial branching (4.7\u0026ndash;5.8%), accessory arteries (3.5%), late venous confluence (8.1%), mirror earlier Asian series [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMSCT correctly predicted vessel number in 95.8% of donors; only 1.8% of accessory arteries were missed, similar to the 3\u0026ndash;5% under-diagnosis reported by Troppmann et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The modest length discrepancy (0.4\u0026ndash;1.0 cm) reflects stapler bite and should be anticipated. Repeat imaging with optimised contrast timing detected several small occult arteries [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Importantly, every graft with \u0026ge;\u0026thinsp;2 arteries was reconstructed successfully, confirming the planning value of MSCT.\u003c/p\u003e \u003cp\u003eTrans-peritoneal LDN was carried out with three trocars on the left and an additional liver-retractor port on the right, consistent with European Association of Urology (EAU) 2023 guidance [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTwo Hem-o-lok\u0026trade; clips plus one titanium clip secured 98.2% of arterial pedicles. In line with AST advice and the Food and Drug Administration (FDA) alert on clip slippage, 64.7% of right renal veins were stapled, whereas all left veins were clipped [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Kidney retrieval via a Pfannenstiel incision reduced pain and improved cosmesis, corroborating outcomes reported by Kokkinos and endorsed by the EAU [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMean operative time was 119 min and warm-ischaemia time remained\u0026thinsp;\u0026lt;\u0026thinsp;5 min on both sides, satisfying thresholds proposed by Srivastava and Simforoosh [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Intra-operative complications were minor (4.2%) and no case converted to open surgery. Thirty-day morbidity was 9.64%, dominated by lymphatic leaks managed conservatively, a rate comparable to or below those in other Asian series [\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Donors were discharged after 7 days, drains removed by day 3\u0026ndash;4, pain was mild (VAS 3\u0026ndash;4) and serum creatinine improved from 110 to 92 \u0026micro;mol L⁻\u0026sup1; within a month.\u003c/p\u003e \u003cp\u003eThe study\u0026rsquo;s chief strengths are its prospective design, the uniform use of 256-slice CT for every donor, and complete 30-day follow-up without loss to follow-up. All imaging data were correlated with intra-operative findings, providing a real-world accuracy estimate rarely reported in low-middle-income settings. Nevertheless, the single-centre nature limits external validity, and the absence of multivariable analysis prevents identification of independent predictors of warm-ischaemia time or lymphatic leakage. Recipient outcomes and donor renal function beyond one month were not captured, so long-term safety could not be assessed.\u003c/p\u003e \u003cp\u003eA workflow that combines 256-slice MSCT with trans-peritoneal LDN is safe, reproducible and suited to resource-constrained settings. Routine CT-based vascular mapping, a three-trocar template for left kidneys, and selective stapling of short right renal veins are practical measures for centres starting a living-donor programme in the region.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003e256-slice MSCT offers highly accurate pre-operative vascular mapping, and its findings correlate closely with intra-operative anatomy. Trans-peritoneal LDN in this cohort achieved short operative times, low complication rates and prompt donor recovery. These data affirm the feasibility and safety of integrating advanced CT imaging with laparoscopic donor nephrectomy in Vietnam.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Hanoi Medical University\u0026rsquo;s ethical committee, number 3224/BM - HĐĐĐ. All participants provided written consent after being fully informed about the purpose of this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: MPC, LH, QNN. Methodology and Investigation: MPC. Formal analysis and data curation: MPC. Writing \u0026ndash; original draft preparation: NVL, MPC, LH, QNN. Writing \u0026ndash; reviewing and editing: All authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge the support from the Viet Duc University Hospital, Hanoi, Vietnam.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSahani DV, Kalva SP (2008) Imaging the renal vasculature and transplant evaluation. Radiol Clin North Am 46(1):19\u0026ndash;30.\u003c/li\u003e\n\u003cli\u003eTroppmann C (2017) The donor nephrectomy: a current perspective. Transplant Rev (Orlando) 31(2):92\u0026ndash;98.\u003c/li\u003e\n\u003cli\u003eGupta A, Bhalla AS, Sharma R, et al. (2020) CT evaluation of renal vascular variants and its implications in donor nephrectomy. Abdom Radiol (NY) 45(3):654\u0026ndash;662.\u003c/li\u003e\n\u003cli\u003eMinistry of Health (Vietnam) (2018) Circular 40/2018/TT-BYT: Guidelines on Criteria for Living Kidney Donors. Hanoi: Ministry of Health.\u003c/li\u003e\n\u003cli\u003eIBM Corp (2007) IBM SPSS Statistics for Windows, Version 16.0. Armonk, NY: IBM Corp.\u003c/li\u003e\n\u003cli\u003eKirkwood BR, Sterne JAC (2003) Essential Medical Statistics. 2nd ed. Oxford: Blackwell Science.\u003c/li\u003e\n\u003cli\u003eAmerican Society of Transplantation (2021) AST Living Donor Kidney Transplantation Guidelines. https://www.myast.org/guidelines\u003c/li\u003e\n\u003cli\u003eEuropean Society for Organ Transplantation (2022) ESOT Consensus Report on the Evaluation and Care of Living Kidney Donors. Transpl Int 35:10103. https://doi.org/10.1111/tri.14103\u003c/li\u003e\n\u003cli\u003eSahani DV, Kalva SP, Hahn PF, et al. (2004) Multidetector-row CT of the abdomen: value of isotropic imaging. Radiographics 24(3):705\u0026ndash;722. https://doi.org/10.1148/rg.243035127\u003c/li\u003e\n\u003cli\u003eKumar S, Tiwari S, Singh AK, et al. (2015) Anatomical variations of renal arteries and their embryological and clinical correlation: a cadaveric study from North India. J Clin Diagn Res 9(5):AC10\u0026ndash;AC13. https://doi.org/10.7860/JCDR/2015/12767.5953\u003c/li\u003e\n\u003cli\u003eGupta A, Singla RK, Goel A, et al. (2021) Prevalence and clinical significance of renal vascular variants in living kidney donors: a systematic review and meta-analysis. Int J Surg 93:106057. https://doi.org/10.1016/j.ijsu.2021.106057\u003c/li\u003e\n\u003cli\u003eTroppmann C, McBride MA, Baker TJ, et al. (2001) Vascular complications after living donor nephrectomy. Am J Transplant 1(4):357\u0026ndash;362. https://doi.org/10.1034/j.1600-6143.2001.10412.x\u003c/li\u003e\n\u003cli\u003eLuis EB, Vidya S, Mishra N, et al. (2018) Surgical management of renal vein variations in laparoscopic donor nephrectomy. Urol Ann 10(2):158\u0026ndash;163. https://doi.org/10.4103/UA.UA_133_17\u003c/li\u003e\n\u003cli\u003eKaur N, Singh A, Suri RK (2015) Early branching of renal artery: MDCT angiographic study and surgical implications. J Clin Imaging Sci 5:12. https://doi.org/10.4103/2156-7514.153405\u003c/li\u003e\n\u003cli\u003eMehra S, Bansal P, Sharma R (2017) Clinical importance of renal artery variations: a multidetector CT angiographic study. J Clin Diagn Res 11(6):TC01\u0026ndash;TC04. https://doi.org/10.7860/JCDR/2017/26523.10029\u003c/li\u003e\n\u003cli\u003eKim JK, Kim SH, Yoon CS, et al. (2004) Living donor renal CT angiography: accuracy, reliability, and safety of 16-MDCT in evaluating renal vasculature. AJR Am J Roentgenol 183(3):845\u0026ndash;849. https://doi.org/10.2214/ajr.183.3.1830845\u003c/li\u003e\n\u003cli\u003eKawamoto S, Montgomery RA, Lawler LP, et al. (2004) Multidetector row CT evaluation of living renal donors prior to laparoscopic nephrectomy. Radiographics 24(2):453\u0026ndash;466. https://doi.org/10.1148/rg.242035081\u003c/li\u003e\n\u003cli\u003eEuropean Association of Urology (2023) EAU Guidelines on Renal Transplantation. https://uroweb.org/guidelines/renal-transplantation\u003c/li\u003e\n\u003cli\u003eUS Food and Drug Administration (2006) Public Health Notification: Hazards of Hem-o-lok\u0026reg; ligating clips. https://www.fda.gov\u003c/li\u003e\n\u003cli\u003eKoo V, Ahmed HU, Challacombe B, et al. (2013) Safety of Hem-o-lok clips in laparoscopic donor nephrectomy: analysis of 900 cases. J Endourol 27(2):208\u0026ndash;211. https://doi.org/10.1089/end.2012.0239\u003c/li\u003e\n\u003cli\u003eKokkinos C, Tsoulfas G, Paraskevas G (2021) Pfannenstiel incision for kidney retrieval in laparoscopic donor nephrectomy: a meta-analysis of outcomes. Transpl Proc 53(4):1150\u0026ndash;1155. https://doi.org/10.1016/j.transproceed.2021.01.006\u003c/li\u003e\n\u003cli\u003eGreco F, Hoda MR, Wagner S, et al. (2012) Pfannenstiel versus midline incision in laparoscopic donor nephrectomy: a prospective randomized trial. Eur Urol 61(3):613\u0026ndash;620. https://doi.org/10.1016/j.eururo.2011.11.009\u003c/li\u003e\n\u003cli\u003eSrivastava A, Singh P, Sharma RK, et al. (2016) Laparoscopic donor nephrectomy: current status and future perspectives. Indian J Urol 32(2):91\u0026ndash;97. https://doi.org/10.4103/0970-1591.180487\u003c/li\u003e\n\u003cli\u003eSimforoosh N, Basiri A, Tabibi A, et al. (2015) Laparoscopic versus open donor nephrectomy: 10 years of experience with 2,500 cases. J Endourol 29(12):1447\u0026ndash;1452. https://doi.org/10.1089/end.2015.0299\u003c/li\u003e\n\u003cli\u003eKoyama M, Tanaka T, Igawa T, et al. (2014) Clinical outcomes of laparoscopic donor nephrectomy in Japan: a multicenter retrospective study. Transplant Proc 46(2):452\u0026ndash;456. https://doi.org/10.1016/j.transproceed.2013.12.040\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Living kidney donor, laparoscopic donor nephrectomy, CT angiography, renal vascular anatomy, kidney transplantation","lastPublishedDoi":"10.21203/rs.3.rs-6884776/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6884776/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003e(i) describe renal vascular anatomy in Vietnamese donors with 256-slice MSCT; (ii) relate imaging to operative metrics and early outcomes of trans-peritoneal laparoscopic donor nephrectomy (LDN).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAll consecutive living-kidney donors who underwent trans-peritoneal LDN at Viet Duc University Hospital between January 2023 and June 2024 were prospectively enrolled. Eligibility required compliance with national donation criteria, informed consent, and complete clinical documentation. MSCT data (vessel number, length, diameter, variants) and surgical variables (trocar use, warm-ischaemia time, blood loss, complications) were extracted from electronic records.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e166 donors (41.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2\u0026nbsp;year, 59% female) were analyzed. MSCT showed a single renal artery in 77.3% of kidneys and \u0026ge;\u0026thinsp;2 arteries in 22.7%; multiple veins were more common on the right (14.7%). The left renal vein was far longer than the right (66.0\u0026thinsp;\u0026plusmn;\u0026thinsp;14.0 vs 25.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4 mm, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Vessel number was predicted correctly in 95.8% of cases, although pedicle length was over-estimated by 3\u0026ndash;9 mm (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). All nephrectomies were completed laparoscopically. Mean operative time was 118\u0026thinsp;\u0026plusmn;\u0026thinsp;23 min; warm-ischaemia time 4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1 min; blood loss 70\u0026thinsp;\u0026plusmn;\u0026thinsp;33 mL with no transfusions. Intra-operative morbidity was 4.2% (minor only) and 30-day morbidity 9.6%, almost entirely self-limited lymphatic leaks. Drains were removed after 3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 days; donors were discharged after 7.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0 days; creatinine fell from 110 to 92 \u0026micro;mol L⁻\u0026sup1; within one month.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003e256-slice MSCT provides highly accurate vascular mapping that correlates closely with intra-operative findings. When combined with trans-peritoneal LDN, it yields short operative times, low complication rates, and rapid donor recovery, supporting its routine use in living-donor programs in resource-constrained settings.\u003c/p\u003e","manuscriptTitle":"Outcomes of Transperitoneal Laparoscopic Living Donor Nephrectomy: A Single-Center Study in Vietnam","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-19 11:37:12","doi":"10.21203/rs.3.rs-6884776/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d4401f95-aad8-4380-ba8d-e4e24a6306a4","owner":[],"postedDate":"June 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-28T16:10:11+00:00","versionOfRecord":{"articleIdentity":"rs-6884776","link":"https://doi.org/10.1007/s11255-025-04682-0","journal":{"identity":"international-urology-and-nephrology","isVorOnly":false,"title":"International Urology and Nephrology"},"publishedOn":"2025-07-21 15:58:11","publishedOnDateReadable":"July 21st, 2025"},"versionCreatedAt":"2025-06-19 11:37:12","video":"","vorDoi":"10.1007/s11255-025-04682-0","vorDoiUrl":"https://doi.org/10.1007/s11255-025-04682-0","workflowStages":[]},"version":"v1","identity":"rs-6884776","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6884776","identity":"rs-6884776","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}