Laparoscopic Donor Nephrectomy Group Research Articles

Robotic living donor nephrectomy is associated with reduced post-operative opioid use compared to hand-assisted laparoscopic approach.

Robotic donor nephrectomy (RDN) has emerged as a safe alternative to laparoscopic donor nephrectomy (LDN). Having previously demonstrated comparable efficacy, this study aims to examine postoperative analgesia use (opioid and non-opioid) in the two groups. We conducted a retrospective review of 300 living donor nephrectomies performed at our center, comparing 150 RDN's with a contemporary cohort of 150 hand-assisted LDN's. In addition to clinical and demographic information, data on postoperative inpatient opioid and non-opioid analgesia (from patient's arrival to the surgical floor after surgery till the time of discharge) was collected. Opioid dosages were standardized by conversion to morphine milligram equivalents (MME). All patients were managed post-operatively under a standardized ERAS pathway for living donor nephrectomy patients. There were no significant differences in donor age, gender, and BMI between RDN and LDN groups. Total post-operative opioid use (MME's) was significantly lower in RDN patients (RDN 27.1 vs. LDN 46.3; P < 0.0001). Breakdown of opioid use with post-operative (POD) day demonstrated significantly lower use in RDN group on POD1 (RDN 8.6 vs. LDN 17.0; P < 0.05), and POD2 (RDN 3.9 vs LDN 10; P < 0.05). RDN patients had a shorter post-operative length of stay (LOS) (RDN 1.69days vs. LDN 1.98; P = 0.0003). There were no differences between groups in non-opioid medication use, complications, and readmission rates. RDN has comparable safety to hand-assist LDN and offers additional benefits of lower postoperative opioid requirement and a shorter hospital LOS.

Robot-assisted versus laparoscopic living donor nephrectomy: superior outcomes after completion of the learning curve

The use of robots in donor nephrectomy has increased in recent years. However, whether robot-assisted methods have better outcomes than traditional laparoscopic methods and how surgical experience influences these outcomes remains unclear. This meta-analysis compares the outcomes of robot-assisted donor nephrectomy (RADN) with those of laparoscopic donor nephrectomy (LDN) and to investigate the effects of surgical experience on these outcomes. A systematic literature search was conducted in Medline (through PubMed) and Web of Science databases. Perioperative data were extracted for meta-analysis. To assess the impact of the learning curve, a subgroup analysis was performed to compare outcomes between inexperienced and experienced surgeons. Seventeen studies with 6970 donors were included. Blood loss was lower (mean difference [MD] = – 13.28, p < 0.01) and the warm ischemia time was shorter (MD = – 0.13, p < 0.05) in the LDN group than the RADN group. There were no significant differences in terms of conversion to open surgery, operation time, surgical complications, hospital stay, costs, and delayed graft function between the groups. Subgroup analysis revealed that operation time (MD = – 1.09, p < 0.01) and length of hospital stay (MD = – 1.54, p < 0.05) were shorter and the rate of conversion to open surgery (odds ratios [OR] = 0.14, p < 0.0001) and overall surgical complications (OR = 0.23, p < 0.05) were lower in experienced RADN surgeons than in experienced LDN surgeons. Surgical experience enhances the perioperative outcomes following RADN more than it does following LDN. This suggests that RADN could be the method of choice for living donor nephrectomy as soon as surgeons gain sufficient experience in robotic surgery.

The Non-Muscle-Splitting Mini-Incision Donor Nephrectomy Remains a Feasible Technique in the Laparoscopic Era of Living Kidney Donation

Laparoscopic donor nephrectomy (LDN) is the current gold standard in kidney donation. Mini-incision open donor nephrectomy (MINI) techniques have been used extensively but have become less popular. The aim of the present study was to compare the results and safety of a non-muscle-splitting MINI technique with the current gold standard of LDN. A single center retrospective cohort study of all living donor nephrectomies between 2011 and 2019 was used for the study. The primary outcome of this study was short term (&lt;30 days) with Clavien–Dindo grade complications. Secondary outcomes included multivariable regression analysis of perioperative data. No differences in complication rates were observed between MINI and LDN and also after correction for known confounders. As expected, the operative time and first warm ischemia were significantly shorter in the MINI group and less blood loss was observed in the LDN group. Complications and conversion rate (LDN to open) among the LDN patients were in line with recent published meta-analyses. This study confirms the perioperative safety of living kidney donation in modern practice. Complication rates of both MINI and LDN procedures are limited and not different between procedures. In specific circumstances, the MINI procedure can still be considered a safe and feasible alternative for living kidney donation.

A Prospective Study Comparing Quality of Life after Laparoscopic Donor Nephrectomy versus Open Donor Nephrectomy.

Laparoscopic donor nephrectomy (LDN) has advantages over open donor nephrectomy (ODN), with less bleeding and pain, and earlier discharge. However, the quality of life (QOL) has not been compared between these techniques. All consecutive donors undergoing left LDN or ODN from 2013 to 2015 at our center were included. The donors' QOL was measured with the brief World Health Organization QOL (WHOQOL-BREF) and the Hospital Anxiety and Depression Scale (HADS) questionnaires preoperatively and at 3 and 6 months postoperatively. Cosmesis was measured by the body image questionnaire, and patient satisfaction was scored on a verbal rating scale at 3 and 6 months. Of the 264 donors, 228 met the inclusion criteria (100 - LDN and 128 - ODN). The LDN group showed no difference in WHOQOL-BREF scores at 3 months, and significant improvements in the psychological and social domains at 6 months versus the baseline. The ODN group showed a significant decrease in the physical, psychological, and environmental domains at 3 and 6 months versus the baseline. Compared with the ODN group, the LDN group had better QOL scores at 3 and 6 months in all domains. The responses to the HADS questionnaire were similar between the groups at all time points. The mean body image, cosmesis, and satisfaction scores were significantly better in the LDN group. LDN minimized the negative effects of surgery on the donors' QOL, with improvements in the long-term psychological and social aspects versus the baseline. LDN was more cosmetic and was associated with higher satisfaction than ODN.

Impact of the introduction of pure retroperitoneoscopic living‐donor nephrectomy on perioperative donor outcomes: A propensity score matching comparison with hand‐assisted laparoscopic living‐donor nephrectomy

We previously reported that the outcomes of pure retroperitoneoscopic donor nephrectomy are superior to those of hand-assisted retroperitoneoscopic donor nephrectomy. Consequently, we introduced pure retroperitoneoscopic donor nephrectomy in our hospital. Here, we compared perioperative outcomes between hand-assisted intra-abdominal laparoscopic donor nephrectomy and pure retroperitoneoscopic donor nephrectomy. We retrospectively reviewed data from 315 living-donor kidney transplantation procedures performed between October 2015 and December 2020 (213 involving hand-assisted intra-abdominal laparoscopic donor nephrectomy, October 2015 to June 2019; 102 involving pure retroperitoneoscopic donor nephrectomy, May 2019 to December 2020). After propensity score matching, 90 transplantations were included in each group (n=180 overall). Donors in the pure retroperitoneoscopic donor nephrectomy group had longer warm ischemia times (P< .001), lower serum C-reactive protein concentrations and white blood cell counts on postoperative day 1 (P< .001 and P< .001, respectively), and shorter postoperative stays (P< .001) than donors in the hand-assisted intra-abdominal laparoscopic donor nephrectomy group. Five (5.6%) modified Clavien-classifiable complications occurred in the hand-assisted intra-abdominal laparoscopic donor nephrectomy group; no complications occurred in the pure retroperitoneoscopic donor nephrectomy group (P= 0.008). One recipient in the hand-assisted intra-abdominal laparoscopic donor nephrectomy group had donor-related delayed graft function. There were no significant differences between groups in recipient estimated glomerular filtration on postoperative day 7. The introduction of pure retroperitoneoscopic donor nephrectomy was safe and effective. Moreover, it was less invasive and less harmful for donors, compared with hand-assisted intra-abdominal laparoscopic donor nephrectomy; recipient outcomes were equivalent.

The Differences Between the Right and Left Side Laparoscopic Donor Nephrectomy Outcomes: A Comparative Analysis of Single-Center Outcomes.

Objective:This study aimed to compare the right and left side laparoscopic donor nephrectomy (LDN) outcomes of a single center.Materials and Methods:The outcomes of patients who underwent LDN in our clinic between 2008 and 2020 were evaluated retrospectively. Two groups were consisted according to the side of the donor kidney. The gender, age, body mass index, duration of operation, amount of bleeding, warm ischemia time, drain removal time, and duration of hospitalization and complications were compared between groups.Results:A total of 314 patients were included in the study. Sixty-six patients underwent right LDN and 248 underwent left LDN. There was no difference between groups in terms of age, duration of operation, amount of bleeding, warm ischemia time, and complications (p>0.05). However, drain removal time and duration of hospitalization were longer in the left LDN group (p<0.05).Conclusions:The right LDN had similar intraoperative outcomes with the left LDN. However, failure on meticulous dissection of the lymphatic structures during left LDN might cause chylous drainage and prolonged hospitalization time.

Comparison of Outcomes of Open versus Laparoscopic Living Donor Nephrectomy in Nepal

Introduction Laparoscopic donor nephrectomy is the gold standard for kidney retrieval in live donors. Until recently, donor nephrectomies were performed only by open technique in Nepal. There is no information on the experience and outcomes of laparoscopic donor nephrectomy in Nepal. The study was done to compare the outcomes among donors undergoing open and laparoscopic nephrectomies, and to compare the graft related outcomes between the two groups receiving these kidneys.&#x0D; MethodsIn this retrospective study, 44 kidney donors from March 2019 to October 2019 were analyzed. Donors were divided into 2 groups: open donor nephrectomy (ODN) and laparoscopic donor nephrectomy (LDN). Parameters for analysis included demographic data, warm ischemia time, surgery time and length of hospital stay. Data on early graft function and complications in recipients till 30th post-operative day were compared.&#x0D; ResultsThere were 22 donors each in the ODN and LDN groups. Baseline characteristics of the donors were comparable between two groups. Mean surgery duration (183.55±43.31 minutes vs 117.73±18.75 minutes) and first warm ischemia time (11.22±4.34 minutes vs 2.3±0.8 minutes) was significantly high in LDN. Hemoglobin drop, post-operative complications in donors, creatinine of donors at discharge, mean hospital stay, graft function at one month and complications in recipients were comparable among ODN and LDN. Pain score in 1st post-operative day was comparable between two groups, however, pain was significantly less in second post-operative day in LDN.&#x0D; ConclusionLaparoscopic donor nephrectomy is feasible in Nepal and associated with acceptable morbidity and graft function when compared to ODN.

Obese living kidney donors: a comparison of hand-assisted retroperitoneoscopic versus laparoscopic living donor nephrectomy

BackgroundThe aim of this study was to examine the difference in outcome between hand-assisted retroperitoneoscopic and laparoscopic living donor nephrectomy in obese donors, and the impact of donor body mass index on outcome.MethodsOut of 1108 living donors who underwent hand-assisted retroperitoneoscopic or laparoscopic donor nephrectomy between 2010 and 2018, 205 were identified having body mass index ≥ 30. These donors were included in this retrospective study, analyzing postoperative outcomes and remnant renal function.ResultsOut of 205 donors, 137 (66.8%) underwent hand-assisted retroperitoneoscopic donor nephrectomy and 68 donors (33.2%) underwent laparoscopic donor nephrectomy. Postoperative outcome did not show any significant differences between the hand-assisted retroperitoneoscopic donor nephrectomy group and the laparoscopic donor nephrectomy group in terms of major complications (2.2% vs. 1.5%, P = 0.72), postoperative pain scale (4 vs. 4, P = 0.67), and the length of stay (3 days vs. 3 days, P = 0.075). The results of kidney function in donors after nephrectomy demonstrated no significant differences between the groups. Additional analysis of 29 donors with body mass index ≥ 35 (14.1%) as compared with 176 donors with body mass index 30–35 (85.9%) revealed no significant differences between groups in postoperative outcomes as well as kidney function after donation.ConclusionOur results show that laparoscopic living donor nephrectomy for obese donors is safe and feasible with good postoperative outcomes. There were no significant differences regarding postoperative outcome between hand-assisted retroperitoneoscopic and laparoscopic donor nephrectomy. Furthermore, the outcome in donors with body mass index ≥ 35 was comparable to donors with body mass index 30–35.

Transumbilical laparoendoscopic single-site donor nephrectomy: evolving trends

We report our experience with laparoendoscopic single-site donor nephrectomy (LESS DN). Retrospective comparative study of data from 200 Consecutive left LESS DN (group A) compared to 205 consecutive conventional laparoscopic donor nephrectomy (LDN) (group B). Standard laparoscopic instruments were used in all patients. Right nephrectomies were excluded. From 05/2015 to 12/2017, 200 LESS DN (group A) and from 10/2011 till 04/2015, 205 LDN (group B) were performed. In group A and B, respectively, the mean operative time was 175.9 ± 24.9 versus 199.88 ± 37.06min (p = 0.0001), the mean warm ischemia time was 5.2 ± 1.02 versus 3.64 ± 1.38min (p = 0.0001), the mean BMI was 24.8 ± 4.5 versus 25.2 ± 4.7kg/m2, complex vascular anatomy was found in 60 (30%) and 68 (33.2%), average length of incision was 5.2 versus 7.7cm (p = 0.001), scar satisfaction rate 8 versus 6 (p = 0.004), mean morphine equivalents 81.0 versus 70.5mg; (p = 0.03), average timing for return to work was 42 versus 50days; (p = 0.001). There was no conversion to open surgery in both groups. One case converted to hand-assisted laparoscopic nephrectomy in group A. Pure LESS-DN was successfully completed in 169 patients (84.5%). In group A, due to technical difficulties, additional 1 or 2, 5-mm port(s) was added in 21 and 10 cases, respectively. Two negative explorations were performed in the first post-operative week for picture of small bowel obstruction. We had port site hernia in one donor, superficial wound infection in three donors and blood transfusion was required in two donors in group A. Our experience with LESS-DN is encouraging. LESSDN can be integrated as a standard approach for renal donation without additional donor risk. Moreover, LESS DN gives more flexibility by possibility to add one or more 5-mm ports in case of technical difficulties.

Laparoscopic Versus Finger-Assisted Open Donor Nephrectomy Techniques

Background Advances in minimally invasive surgery for live kidney donor nephrectomy have led to the use of the laparoscopic and robotic technique as the standard of care. The aim of the study was to compare an open finger-assisted open donor nephrectomy (FAODN) versus standard laparoscopic donor nephrectomy (LDN). Methods Retrospective demographic and surgical data were analyzed using the electronic medical records at the University of Virginia and Imperial College Hospital. The analysis included 95 consecutive donors in each center undergoing donor nephrectomy. LDN and FAODN were compared using Fishers Exact Test and Likelihood Ratio Chi-Square. Results Overall, donor demographics and clinical characteristics were similar between groups. The FAODN group had less females donors (70.5% vs. 29.5%, p=0.003) with similar median body mass index (BMI) (28 vs. 26, p=0.032). The LDN group had longer operative duration (3.5 vs. 1.2 hours, p<0.001), longer combined length of incision (6 vs. 5 cm. p=0.001), with shorter median hospital length of stay (LOS) (3 vs. 4 days, p<0.001). Left nephrectomy was preferred in both groups. Minor postoperative complications occurred less often in the FAODN group (14.7% vs. 31.6%, p=0.0094) while rates of hernia, operative blood transfusions and postoperative bleeding episodes were similar between groups. Recipients of LDN donors demonstrated a higher creatinine (1.1 vs. 0.9 mg/dl, p<0.001), and lower recipient GFR at 1 year (60 vs. 89 ml/min/1.73m2, p<0.001) post-donation. Conclusions Our study demonstrates that FAODN is a successful alternative to LDN. It appears to provide kidney donors with favorable outcomes in terms of complications and outcomes, and recipients with excellent renal function at 1 year post-donation.

Hand-assisted laparoscopic and laparoscopic donor nephrectomy: A comparison of surgical outcomes from two centres.

The aim of the study was to compare the different surgical approaches of two centers on outcomes of live donor laparoscopic nephrectomy. The first 98 patients of each centre who underwent laparoscopic donor nephrectomy (LDN) or hand-assisted laparoscopic donor nephrectomy (HALDN) were included in the study. The following data were used for analyses: donor age, weight, height, body mass index (BMI), transfusion requirement, operative time, ischemia time and postoperative complications. Median age, BMI, operation time and estimated blood loss (EBL) was 47.29 years, 27.91 kg/m2, 110.73 minutes, and 78.95 mL, respectively. Operation time was significantly shorter in the HALDN group (t=-3.554, p<0.01). EBL was not significantly different between the two groups. The difference in hospitalization time and warm ischemia times (WIT) was not significant between the two surgical technique groups (t=-1.554, t=1.258; p>0.05). No statistically significant difference was detected in the intraoperative and postoperative complication rates between two groups (p>0.05). The postoperative complication rate was 7.14% (n=7) and 6.12% (n=6) in the LDN and HALDN groups, respectively. There were two patients with conversion to open surgery in the HALDN group because of lumbar vein injury. The operative and postoperative outcomes for the two techniques were found to be similar. The HALDN technique preserves the benefits of minimally invasive surgery. In experienced urologic laparoscopy centres both techniques promise similar success rates.

Enhanced Recovery Open vs Laparoscopic Left Donor Nephrectomy: A Randomized Controlled Trial

To compare recovery outcomes between laparoscopic donor nephrectomy (LDN) and open donor nephrectomy within a specified enhanced recovery program (ERP) for left kidney donations. A phase III randomized trial was conducted between January 2013 and June 2015; eligible left-side donors were randomized to laparoscopic or open donor nephrectomy in a 1:1 ratio with recovery optimized within a standardized ERP. The primary outcome was patient-reported measure of physical fatigue, as measured by the physical fatigue domain of the translated Multidimensional Fatigue Inventory 20. Secondary outcomes included other donor recovery outcomes, postoperative pain scores, hospital stay, perioperative complications, and graft outcomes. A total of 224 donors (laparoscopy, n = 113; open surgery, n = 111) were randomly allocated. Six weeks postoperatively, physical fatigue domain scores in Multidimensional Fatigue Inventory 20 were significantly lower in the LDN group (mean: laparoscopy, 8.2 ± 3.2 vs open surgery, 13.05 ± 2.9) (P = .007). Median total hospital stay was also significantly shorter in the LDN group (median: laparoscopy, 2; interquartile range, 1-5 vs open surgery, 4; interquartile range, 2-9 days) (P = .002). LDN was associated with less pain scores and less non-opioid analgesic requirements. Warm ischemia times were not significantly different in both groups (mean: laparoscopy, 2.5 ± 0.8 vs open surgery, 2.2 ± 0.6) (P = .431). Even when optimized within an ERP, LDN was associated with less general and physical fatigue and better physical function at 6 weeks postoperatively when compared with open surgery for left kidney donations.

Long-Term Donor Outcomes after Pure Laparoscopic versus Open Living Donor Nephrectomy: Focus on Pregnancy Rates, Hypertension and Quality of Life

Introduction: The aim of the present study was to compare long-term donor outcomes after open and laparoscopic living donor nephrectomy. The focus was on pregnancy rates, hypertension and quality of life parameters. Materials and Methods: Data were retrospectively collected using our institution's electronic database and a structured questionnaire. The study included 30 donors after open donor nephrectomy (ODN) and 131 donors after laparoscopic donor nephrectomy (LDN). Results: Demographic data did not differ between groups. When asked for their preference, significantly more donors in the LDN group would choose the same surgical approach again. The overall frequency of postoperative complications was significantly lower in the LDN group. The incidence of grade III complications was 2% after LDN and 10% after ODN (p = 0.79). Only 2 out of 15 female donors aged between 18 and 45 years delivered a healthy child after DN. On interview, only 4 out of 15 female donors declared the desire to have children after DN. Conclusions: From the donor perspective, long-term outcomes after LDN are more favorable than after ODN. To ensure favorable functional outcomes, strict preoperative donor selection and diligent long-term donor follow-up are required.

Back-to-back comparison of mini-open vs. laparoscopic technique for living kidney donation.

Laparoscopic living donor nephrectomy is the standard of care at high-volume renal transplant centres, with benefits over the open approach well-documented in the literature. Herein, we present a retrospective analysis of our single-institution donor nephrectomy series comparing the mini-open donor nephrectomy (mini-ODN) to the laparoscopic donor nephrectomy (LDN) with regards to operative, donor, and recipient outcomes. From 2007-2011, there were 89 cases of mini-ODN, at which point our centre transitioned to LDN; 94 cases were performed from 2011-2014. In total, 366 patients were reviewed, including donor and recipient pairs. Donor and recipient demographics, intraoperative data, postoperative donor recovery, recipient graft outcomes, and financial cost were assessed comparing the surgical approaches. We demonstrate a reduced estimated blood loss (347.83 vs. 90.3 cc), lower intraoperative complication rate (4 vs. 11) and shorter length of hospital stay (2.4 vs. 3.3 days) for patients in the LDN group. Operative time was significantly longer for the LDN group (108.4 vs. 165.9 minutes), although this did not translate to a longer warm ischemia time (mean 2.0 minutes for each group). The rate of delayed graft function and recipient 12-month creatinine were comparable for ODN and LND. Overall cost of LDN was $684 higher for an uncomplicated admission. Despite a longer surgical time and higher upfront cost, our study supports that LDN yields several advantages over the mini-ODN, with a lower estimated blood loss, fewer intraoperative complications, and shorter length of hospital stay, all while maintaining excellent renal allograft outcomes.

Cost-Effectiveness of Hand-Assisted Retroperitoneoscopic Versus Standard Laparoscopic Donor Nephrectomy

Live kidney donation has a clear economical benefit over dialysis and deceased-donor transplantation. Compared with mini-incision open donor nephrectomy, laparoscopic donor nephrectomy (LDN) is considered cost-effective. However, little is known on the cost-effectiveness of hand-assisted retroperitoneoscopic donor nephrectomy (HARP). This study evaluated the cost-effectiveness of HARP versus LDN. Alongside a randomized controlled trial, the cost-effectiveness of HARP versus LDN was assessed. Eighty-six donors were included in the LDN group and 82 in the HARP group. All in-hospital costs were recorded. During follow-up, return-to-work and other societal costs were documented up to 1 year. The EuroQol-5D questionnaire was administered up to 1 year postoperatively to calculate quality-adjusted life years (QALYs). Mean total costs from a healthcare perspective were $8935 for HARP and $8650 for LDN (P = 0.25). Mean total costs from a societal perspective were $16,357 for HARP and $16,286 for LDN (P = 0.79). On average, donors completely resumed their daytime jobs on day 54 in the HARP group and on day 52 in the LDN group (P = 0.65). LDN resulted in a gain of 0.005 QALYs. Absolute costs of both procedures are very low and the differences in costs and QALYs between LDN and HARP are very small. Other arguments, such as donor safety and pain, should determine the choice between HARP and LDN.

Laparoscopy, dorsal lumbotomy and flank incision live donor nephrectomy: comparison of donor outcomes

Flank incision (FL), dorsal lumbotomy (DL) and laparoscopic surgery have been effective approaches to donor nephrectomy. While laparoscopic donor nephrectomy (LDN) has become increasingly popular, there has yet to be a direct comparison of the three modalities. We performed a retrospective chart review of FL, DL and LDN operations between 2002 and 2010 within a single institution. Donor and recipient characteristics, as well as surgical outcomes, were assessed. There were 496 donor nephrectomy operations available for analyses. Patients in the LDN group had the lowest estimated blood loss, compared to the DL and FL groups (p < 0.001), lowest rate of complications (p < 0.01), and shortest hospital stay (p < 0.0001). Donors who underwent DL used an average of 60.12 ± 5.0 mg of morphine, which was significantly less than that used by patients in the LDN (93.2 mg, p < 0.0001) and FL (111.82 mg, p < 0.001) groups. Mean serum creatinine of recipients at day 1 post-op was the highest in the FL group (p < 0.0001 FL vs. LDN, p < 0.001 FL vs. DL), but there were no significant differences between the three groups at 2 weeks, 6, 12, 18, and 24 months post-operation (p > 0.45). Although a lower pain experience of LDN was not indicated, the use of LDN should be favoured over DL and FL as it is associated with fewer complications, and shorter length of stay. Of note, DL appears to be associated with higher complications and is likely not a preferred option for donor nephrectomy.

Long-Term Graft Function in a Randomized Clinical Trial Comparing Laparoscopic Versus Open Donor Nephrectomy

To evaluate and compare the long-term graft and survival rates in kidney transplant recipients who had undergone laparoscopic donor nephrectomy versus those who underwent open donor nephrectomy. Our study was done with 100 cases of laparoscopic donor nephrectomy and 100 cases of open donor nephrectomy, performed between July 2001 and September 2003. Mean follow-up of recipients in this study was 6.6 ± 2.4 years (range, 1-9.3 y). This study has a longer follow-up than previous randomized clinical trials. We compared patient and graft survival in recipients of laparoscopic donor nephrectomy versus those who had open donor nephrectomy. Mean duration of kidney warm ischemia time was 8.7 ± 2.7 minutes for laparoscopic donor nephrectomy and 1.8 ± 0.92 minutes for open donor nephrectomy. There were no significant differences in 5-year graft survival between the laparoscopic donor nephrectomy and open donor nephrectomy groups (89.5% vs 84.3%; P = .96). There were no differences in delayed graft function between the laparoscopic donor nephrectomy and open donor nephrectomy groups (8 and 11 patients; P = .135). There was a significant difference in 5-year graft survival between recipients with a history of delayed graft function and those without delayed graft function (63.2% vs 89.7%; P = .04). Despite a longer warm ischemia time in laparoscopic donor nephrectomy group (8.69 vs 1.87 min; P = .0001), warm ischemia time had no effect on graft outcome in long-term follow-up. Although earlier experiences with laparoscopic donor nephrectomies were associated with concerns about long-term effects of laparoscopic donation on the graft function in the recipient, our long-term results confirm that laparoscopic donor nephrectomy provides similar graft outcome to open donor nephrectomy.

Comparison of Laparoendoscopic Single-site Donor Nephrectomy and Conventional Laparoscopic Donor Nephrectomy: Donor and Recipient Outcomes

To present a comparison of perioperative donor outcomes and recipient graft function in a series of patients undergoing laparoendoscopic single-site donor nephrectomy (LESS-DN) versus conventional laparoscopic donor nephrectomy (LDN). Data were collected for 50 consecutive LESS-DN patients and a matched cohort of 50 LDN patients. The donor outcomes analyzed included operative time, estimated blood loss, complications, visual analog pain scores, and recovery time. The recipient outcomes analyzed included serum creatinine at discharge and follow-up and the incidence of delayed graft function. The mean total operative time was shorter in the LDN group than in the LESS-DN group (P < .0001). Linear regression analysis of the LESS-DN operative times relative to case number showed a significant decrease in the operative time with increasing case number (r(2) = 0.19, P = .002). No statistically significant differences were found in estimated blood loss, warm ischemia time, length of stay, or visual analog pain scores between the 2 groups. However, the surgical incision was significantly smaller in the LESS-DN group (P < .0001). After discharge, the patient-reported time to complete recovery was faster in the LESS-DN group (P = .01). The incidence of complications was similar in both groups; however, major complications only occurred in the LDN group. No differences were found in the recipient serum creatinine values or the incidence of delayed graft function. Our initial experience with LESS-DN is encouraging. This retrospective matched-pair comparison between LESS-DN and LDN suggests that the single-port approach might be associated with quicker convalescence. Longer operative times in the LESS-DN group could simply represent the learning curve of a novel procedure.

Implementation and learning of laproscopic donor nephrectomy by a non-transplant general surgeon with advanced laparoscopic skills

Traditionally performed by vascular surgeons or urologists, laparoscopic nephrectomy for live kidney donor transplantation has emerged as a new effective and safe technique. This study examines the implementation of this technique at our centre, as performed by a single general surgeon with expertise in advanced laparoscopic surgery. Patient records for 78 live donor transplants performed between February 2002 and September 2008 were divided into two groups (with 39 patients each) analyzed. A variety of outcome variables were compared. The same individual surgeon performed all laparoscopic donor nephrectomy (LDN) procedures. A significant advantage was noted for LDN with respect to hospital stay (LDN 5.1 ± 1.1 days vs open donor nephrectomy [ODN] 6.4 ± 2.6 days, P=0.01) while ODN had a significant advantage with respect to operative time (LDN 241.1 ± 55.7 min vs ODN 152.0 ± 27.7 min, P<0.01). Within the LDN group, we noted a significant shortening in the operation time with each case as experience increased (see graph; P<0.01). The total postoperative complication rate was similar in both groups (LDN: 31% vs ODN: 44%, P=0.25). There was a trend towards more respiratory complications in ODN (ODN 11/39 [28%] vs LDN 5/39 [13%], P=0.09). While implementing a new procedure may result in longer operative times initially, these improve with time, and our data demonstrates no compromise in patient safety or outcomes. The LDN procedure proved to be a desirable alternative to ODN, with shorter hospital stay and improved operator skills with each case, and without significant compromise in allograft recovery.

Pure Laparoscopic Versus Open Live Donor Nephrectomy: Evaluation of Health Survey and Graft Functions

Background Laparoscopic donor nephrectomy (LDN) has become the gold standard in many kidney transplantation centers seeking to increase the number of potential live donors. This study was designed to compare the health surveys and graft functions between LDN and open donor nephrectomy (ODN). Methods We retrospectively analyzed all patients who underwent donor nephrectomy between December 2005 and September 2009 who had at least 1 year of follow-up. We reviewed demographic data, operative time, warm ischemia period, graft function, and quality of life. Results Among the 132 cases, 98 were pure LDN and 34 were ODN. Demographic data were similar in both groups. Operative times were significantly longer in the ODN group but warm ischemia times significantly longer in the LDN group. However, graft functions were similar in both groups. There was 1 graft loss due to arterial thrombosis of the transplanted kidney among the LDN group. Short-Form 36 health survey scores were similar except for the role-physical subscale. Conclusion Although we failed to observe a significant difference between ODN and LDN as far as the quality of life and graft functions were concerned, the previously documented advantages of laparoscopy with similar operative results suggest? LDN to be the gold standard for this procedure in our institution.