Abstract
ABSTRACTObjective: To compare two retrieval incisions, Pfannenstiel vs iliac fossa incision, in terms of operative technique-related variables and variables related to patient satisfaction postoperatively, in patients undergoing laparoscopic donor nephrectomy (LDN).Patients and methods: This prospective randomised study was conducted between May 2016 and April 2017. All the voluntary kidney donors aged 18–60 years were randomised into two groups. Group 1, comprised patients undergoing graft retrieval via an iliac fossa incision, and Group 2 comprised those undergoing graft retrieval via a Pfannenstiel incision. Intraoperative assessment of the incision by the surgeon was done using a Likert scale-based questionnaire. Other variables studied were the operative time, retrieval time, warm ischaemia time, and length of incision. Postoperatively, visual analogue scale pain scores, analgesia consumption, and hospital stay were compared. During follow-up cosmetic outcome was compared.Results: In all, 108 patients were enrolled in the study with 54 patients in each group. The mean operative time was shorter in Pfannenstiel-incision group, at 155.2 vs 171.67 min (P = 0.01). The retrieval incision length was significantly less in the Pfannenstiel arm, at 9.29 vs 9.85 cm (P < 0.001). In the surgeon Likert scale-based questionnaire, the Pfannenstiel incision scored better than the iliac fossa incision for ease of specimen retrieval (P = 0.015), ease of immediate check laparoscopy (P = 0.002), and ease of incision closure (P < 0.001). The Pfannenstiel-incision group required less postoperative analgesia, at a mean (SD) of 7.03 (8.82) vs 15.55 (11.1) mg nalbuphine (P < 0.001). During follow-up the Manchester Scar Scores were lesser in the Pfannenstiel-incision group (P < 0.001).Conclusion: The Pfannenstiel incision was considered preferable during the critical steps of the LDN and had a smaller retrieval incision, lesser operative time and postoperative analgesia requirement, and better cosmesis than the iliac fossa incision.Abbreviations: BMI: body mass index; LDN: laparoscopic donor nephrectomy; VAS: visual analogue scale; WIT, warm ischaemia time
Highlights
When it comes to offering a therapy for end-stage renal failure, kidney transplant is the therapy of choice [1]
Living-donor kidney transplantation is associated with advantages such as reduced waiting-list period, elective nature of the procedure, and better graft and patient survival compared to cadaveric kidney donation [2]
Our present study showed that during follow-up, neither of the incisions was associated with any postoperative wound complications
Summary
When it comes to offering a therapy for end-stage renal failure, kidney transplant is the therapy of choice [1]. The recipient can receive a kidney either from a cadaver or from a living donor. Living-donor kidney transplantation is associated with advantages such as reduced waiting-list period, elective nature of the procedure, and better graft and patient survival compared to cadaveric kidney donation [2]. Laparoscopic donor nephrectomy (LDN) is the ‘gold standard’ and preferred method for kidney harvest in renal transplant surgery [1]. Amongst the operative steps involved in LDN, graft retrieval is one of the most critical steps. The kidney can be retrieved through a Pfannenstiel, iliac fossa, midline periumbilical, or subcostal flank incision [3]
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