Comparison of laparoscopic and mini incision open donor nephrectomy: single blind, randomised controlled clinical trial

Abstract

Objectives To determine the best approach for live donor nephrectomy to minimise discomfort to the donor and to provide good graft function. Design Single blind, randomised controlled trial. Setting Two university medical centres, the Netherlands. Participants 100 living kidney donors. Interventions Participants were randomly assigned to either laparoscopic donor nephrectomy or to mini incision muscle splitting open donor nephrectomy. Main outcome measures The primary outcome was physical fatigue using the multidimensional fatigue inventory 20 (MFI-20). Secondary outcomes were physical function using the SF-36, hospital stay after surgery, pain, operating times, recipient graft function, and graft survival. Results Conversions did not occur. Compared with mini incision open donor nephrectomy, laparoscopic donor nephrectomy resulted in longer skin to skin time (median 221 v 164 minutes, P < 0.001), longer warm ischaemia time (6 v 3 minutes, P < 0.001), less blood loss (100 v 240 ml, P < 0.001), and a similar number of complications (intraoperatively 12% v 6%, P = 0.49, postoperatively both 6%). After laparoscopic nephrectomy, donors required less morphine (16 v 25 mg, P = 0.005) and shorter hospital stay (3 v 4 days, P = 0.003). During one year's follow-up mean physical fatigue was less (difference − 1.3, 95% confidence interval − 2.4 to − 0.1) and physical function was better (difference 6.2, 2.0 to 10.3) after laparoscopic nephrectomy. Function of the graft and graft survival rate of the recipient at one year censored for death did not differ (100% after laparoscopic nephrectomy and 98% after open nephrectomy). Conclusions Laparoscopic donor nephrectomy results in a better quality of life compared with mini incision open donor nephrectomy but equal safety and graft function.

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

“…[4][5][6][12][13][14] Morphine equivalents used in our LDN group were actually higher than that of our DL group and not different from that of the FL group. However, 62% (n = 85) of our FL patients used adjuvant epidural analgesia, which was not included in our morphine equivalent measure of pain management.…”

“…5,6,12,13 Dorsal lumbotomy patients also had shorter hospital stays than FL patients, likely related to the application of muscle-splitting rather than a muscle-cutting approach.…”

“…6 It was hypothesized that these factors would lead to an increased rate of graft dysfunction and failure; however, the literature fails to corroborate this. [10][11][12] Hazebroek and colleagues showed that pneumoperitoneum during LDN does not adversely affect the renal function of donors or recipients. 7 London and colleagues reported that increased intraoperative fluid administration could overcome decreased renal blood flow during LDN and prevent renal ischemia.…”

“…Several studies comparing LDN to a standard FL and mini-FL have found similar results in living renal donor surgery. [12][13][14][15] To our knowledge, this study represents one of the only studies that directly compare LDN with standard FL and DL approaches. Braga and colleagues examined open flank, DL and laparoscopic procedures to treat ureteropelvic junction obstruction; they also observed that the laparoscopic approach had the longest operative time, but the shortest hospital stay, which is similar to our results.…”

“…Although techniques such as mini-FL have been promoted as alternatives to LDN, direct comparisons have shown that laparoscopic donors require less analgesia, and have shorter hospital stays and faster recovery to routine duties. [12][13][14] The DL incision is seldomly used by contemporary North American surgeons for live donor nephrectomy due to its technically challenging nature and poor hilar visualization. As a result, there are no studies comparing LDN and DL, and few comparing DL and FL.…”