Hand-Assisted Laparoscopic Donor Nephrectomy: A Comparative Study With Conventional Open Donor Nephrectomy in a Single Chinese Center

Abstract

Background Traditional open donor nephrectomy (ODN) is associated with good outcomes and excellent allograft function; nevertheless, it causes too much injury to the donor. Hand-assisted laparoscopic donor nephrectomy (HLDN) may accomplish these goals with less damage. We compared the outcomes of the hand-assisted with the traditional open approach. We also investigated whether the availability of the HLDN approach affected a donor's decision and why he or she selected HLDN versus ODN. Materials and Methods We retrospectively analyzed donor and allograft outcomes for the first 65 patients undergoing HLDN at our institution compared with those of 32 patients undergoing traditional ODN. Patient data were obtained from medical record reviews and telephone interviews. Results HLDN and ODN were successfully completed in 97 (100%) donors. No conversion to open operation occurred among the HLDN group. The mean (standard deviation) operative durations were 157.92 (23.79) minutes for HLDN and 103.21 (19.63) minutes for ODN ( P = .000), and hospital stays were 5.00 (1.54) days for the HLDN group and 6.59 (0.79) days for the ODN group ( P = .000). There was no significant difference between the 2 groups in postoperative donor ( P = .541) and recipient ( P = .337) renal functions. The primary reason encouraging donors was family obligations and bonds (70.1%); the availability of HLDN did encourage the decision (29.9%). Although all renal donors were aware of the option of HLDN, 28 selected ODN because of financial reasons, another 4 patients due to safety concerns. The main reasons for choosing HLDN instead of ODN were less postoperative pain (60%) and cosmetic concerns (29.2%). Conclusions HLDN was safe and feasible to procure a normally functional organ for live donor transplantation. The availability of the HLDN approach did affect a donor's decision. The main reason for choosing HLDN instead of ODN was less postoperative pain.