First Prize: Standard Laparoscopic Donor Nephrectomy Versus Laparoendoscopic Single-Site Donor Nephrectomy: A Randomized Comparative Study

Abstract

The purpose of this study was to compare in a randomized fashion the clinical outcomes following standard laparoscopic and laparoendoscopic single-site (LESS) donor nephrectomies. Fifty voluntary renal donors who met the inclusion and exclusion criteria were randomized to standard laparoscopic (group A) and LESS (group B) donor nephrectomies. The primary end point of the study was patients' postoperative pain. The clinical outcomes, patient's quality of life, body image, and cosmetic scores on follow-up were also compared. The operating times were similar in both groups (175.83 ± 47.57 vs. 172.20 ± 38.33 minutes, p = 0.38). The surgeon's difficulty as measured using a visual analog scale was significantly more in group B in 4 of 10 defined steps. The postoperative patient pain scores were similar till 48 hours following surgery (3.84 ± 1.68 vs. 3.68 ± 0.75, p = 0.33), but following which the patients in group B had improved pain scores (2.08 ± 0.91 vs. 1.24 ± 0.72, p = 0.0004). Analgesic requirements were similar in both groups (p = 0.47). The warm ischemia times in group B (5.11 ± 1.01 vs. 7.15 ± 1.84 minutes, p < 0.0001) were longer but the total ischemia times in both groups were similar (62.55 ± 9.46 vs. 62.71 ± 12.14 minutes, p = 0.48). All grafts had on-table urine output in the recipient. Intraoperative (8% vs. 16%, p = 0.2) and postoperative complications (20% vs. 16%, p = 0.99) in both groups were comparable. The patients in group B had shorter hospital stay (4.56 ± 0.82 vs. 3.92 ± 0.76 days, p = 0.003). There was no graft loss in either group except for one recipient in group A who sustained sudden cardiac death. The estimated glomerular filtration rates of recipients at 1 year were comparable for both groups (80.87 ± 22.12 vs. 81.51 ± 29.01 mL/minute, p = 0.46). The donor's quality of life, body image, and cosmetic scores were comparable for both groups. In this select group of donors, LESS donor nephrectomy, although challenging to the surgeon with longer warm ischemic times, gave early pain relief with shorter hospital stay and comparable graft function.