Hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy: HARP-trial

Abstract

BackgroundTransplantation is the only treatment offering long-term benefit to patients with chronic kidney failure. Live donor nephrectomy is performed on healthy individuals who do not receive direct therapeutic benefit of the procedure themselves. In order to guarantee the donor's safety, it is important to optimise the surgical approach. Recently we demonstrated the benefit of laparoscopic nephrectomy experienced by the donor. However, this method is characterised by higher in hospital costs, longer operating times and it requires a well-trained surgeon. The hand-assisted retroperitoneoscopic technique may be an alternative to a complete laparoscopic, transperitoneal approach. The peritoneum remains intact and the risk of visceral injuries is reduced. Hand-assistance results in a faster procedure and a significantly reduced operating time. The feasibility of this method has been demonstrated recently, but as to date there are no data available advocating the use of one technique above the other.Methods/designThe HARP-trial is a multi-centre randomised controlled, single-blind trial. The study compares the hand-assisted retroperitoneoscopic approach with standard laparoscopic donor nephrectomy. The objective is to determine the best approach for live donor nephrectomy to optimise donor's safety and comfort while reducing donation related costs.DiscussionThis study will contribute to the evidence on any benefits of hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy.Trial RegistrationDutch Trial Register NTR1433

Robotic surgery rapidly and successfully implemented in a high volume laparoscopic center on living kidney donation

“…All RADNs were performed with the da Vinci® S Surgical System by two surgeons, who were both trained endoscopically. The operation procedures for RADN, LDN and HARP are described elsewhere . Briefly, all three procedures were performed with the donor under general anaesthesia and placed in lateral right‐decubitus position.…”

Five-year follow-up after live donor nephrectomy - cross-sectional and longitudinal analysis of a prospective cohort within the era of extended donor eligibility criteria

“…All 190 donors of a randomized controlled trial comparing left‐sided hand‐assisted and laparoscopic donor nephrectomy conducted between July 2008 and September 2010 at the Radboud University Medical Center, Nijmegen, and the Erasmus University Medical Center, Rotterdam, were selected . The pre‐, intra‐ and postsurgery procedures were described previously .…”

“…All 190 donors of a randomized controlled trial comparing left‐sided hand‐assisted and laparoscopic donor nephrectomy conducted between July 2008 and September 2010 at the Radboud University Medical Center, Nijmegen, and the Erasmus University Medical Center, Rotterdam, were selected . The pre‐, intra‐ and postsurgery procedures were described previously . An amendment to the protocol was written and approved by the internal medical ethics committee to evaluate the 5‐year follow‐up data of all donors (MEC‐2015‐653), and a description of the ethical guidelines was followed.…”

“…The pre‐, intra‐ and postsurgery procedures were described previously . An amendment to the protocol was written and approved by the internal medical ethics committee to evaluate the 5‐year follow‐up data of all donors (MEC‐2015‐653), and a description of the ethical guidelines was followed.…”

Poor early graft function impairs long-term outcome in living donor kidney transplantation

“…From 2001 until 2004, donors were randomized for either a muscle splitting mini incision open or a laparoscopic nephrectomy [11, 12]. Thereafter, laparoscopic nephrectomy was the technique of first choice.…”