2121 RANDOMIZED CONTROLLED TRIAL OF LAPAROENDOSCOPIC SINGLE SITE DONOR NEPHRECTOMY VERSUS. CONVENTIONAL LAPAROSCOPIC DONOR NEPHRECTOMY FOR LIVING KIDNEY DONORS

Abstract

INTRODUCTION AND OBJECTIVES: Laparoendoscopic single site (LESS) surgery has been increasingly used to perform donor nephrectomies. However it remains unclear if the benefits of LESS are limited to improved cosmesis. We performed a randomized controlled trial of LESS versus conventional laparoscopic donor nephrectomy (LDN) to assess potential benefits in clinical outcomes. METHODS: After IRB approval, 100 consecutive patients were randomized to a donor nephrectomy utilizing either the LESS or LDN technique starting January 2011 at a single center. Donors were stratified by laterality, single or multiple arteries, and body mass index (BMI). All LESS procedures utilized the GelPoint system (Applied Medical, RanchoSanta Margarita, CA). Subjects are followed postdonation for complications and satisfaction with validated questionnaires at 2-, 6-, and 12-months. Ninety-three patients had follow-up data for at least 2 months postoperatively. RESULTS: Baseline characteristics were similar between the two treatment arms. There were no significant differences in the overall operative time, warm ischemia time, estimated blood loss, and conversion to hand-assisted laparoscopy rates (p 0.05). There were similarly no differences in the 30and 90-day postoperative complication rates (p 0.05). Of those with follow up of at least 2 months (n 93), 97% of those who underwent LESS reported full recovery at two months, compared to 80% of LDN (p 0.03). There were no significant differences in surgical scar rating or overall satisfaction between LESS and LDN (p 0.05). All allografts had immediate graft function, and donor and graft survival are 100% to date. CONCLUSIONS: In this randomized controlled trial, we found that LESS donor nephrectomies could be performed with similar operative outcomes and postoperative complication rates. LESS donor nephrectomies have a significantly faster recovery time compared to LDN, with no impact on allograft function. Table 1: Outcomes in LDN vs LESS