Quality of Life, Pain and Return to Normal Activities Following Laparoscopic Donor Nephrectomy Versus Open Mini-Incision Donor Nephrectomy

Perry, Kent T.; Freedland, Stephen J.; Hu, Jim C.; Phelan, Michael W.; Kristo, Blaine; Gritsch, Albin; Rajfer, Jacob; Schulam, Peter G.

doi:10.1097/01.ju.0000067975.59772.b6

Cited by 121 publications

(102 citation statements)

References 15 publications

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“…[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.…”

Section: Discussionmentioning

confidence: 91%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Samarasekera

Kim

Wang

et al. 2013

CUAJ

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Background: 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. Methods: 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. Results: 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). Conclusions: 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. RésuméContexte : L'incision du flanc, la lombotomie dorsale et la laparoscopie sont des techniques efficaces pour une néphrectomie chez un donneur vivant. Même si la laparoscopie a connu une montée en popularité, aucune comparaison directe entre les trois modalités n'a été effectuée. Méthodologie : Nous avons procédé à un examen rétrospectif des dossiers de patients ayant subi une néphrectomie par incision du flanc, par lombotomie dorsale et par laparoscopie entre 2002 et 2010 dans un même établissement. Les caractéristiques des donneurs et des receveurs ainsi que les résultats de la chirurgie ont été évalués. Résultats : Les analyses ont porté sur 496 néphrectomies. En comparaison avec les donneurs ayant subi une incision du flanc ou une lombotomie dorsale, les donneurs ayant subi une laparoscopie présentaient la perte sanguine estimée la plus faible (p < 0,001), le taux le plus bas de complications (p < 0,01) et la plus courte durée du séjour en hôpital (p < 0,0001). Les donneurs qui ont subi une lombotomie dorsale ont utilisé en moyenne 60,12 ± 5,0 mg de morphine, soit une valeur significativement plus faible que celle notée chez les patients ayant subi une laparoscopie (93,2 mg, p < 0,0001) et une incision du flanc (111,82 mg, p < 0,001). Le taux moyen de créatinine sérique le lendemain de l'intervention était le plus élevé chez les patients ayant subi une incision du flanc (p < 0,0001 incision du flanc vs laparoscopie, p < 0,001 incision du flanc vs lombotomie dorsale), mais les différences entre...

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Samarasekera

Kim

Wang

et al. 2013

CUAJ

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“…In minimally invasive surgery alone, it has been used to describe health-related quality of life following laparoscopic cholecystectomy (33), Nissen fundoplication (34), inguinal hernia repair (35), colectomy (36) and gastric bypass (37). In the field of LLDN, Perry et al showed that patients had reached population norms in all eight SF-36 domains by 6 to 12 months (38), but this was the first study to use the SF-36 to describe the recovery process within weeks following the procedure. Our preoperative results are similar to the American age-matched reference values and normative data published by Ware et al (19) as well as the Canadian reference values published by Hopman et al (39).…”

Section: Standardized Outcomesmentioning

confidence: 99%

Measuring Surgical Recovery: The Study of Laparoscopic Live Donor Nephrectomy

Bergman

Feldman

Mayo

et al. 2005

American Journal of Transplantation

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“…16 Urologic studies describing the use of ketorolac for postoperative pain control are limited, and none of these studies have been double-blind, randomized, placebo-controlled trials. [5][6][7][17][18][19][20][21] This is unfortunate because there can be considerable postoperative narcotic use in certain urologic populations. Lingeman et al 22 reported a mean postoperative morphine use of 33.2 mg (range, 7.5-76 mg) during a mean hospital stay of 3.2 days for patients undergoing PNL.…”

Section: Discussionmentioning

confidence: 99%

A Double-Blind Randomized Controlled Trial of Continuous Intravenous Ketorolac vs Placebo for Adjuvant Pain Control After Renal Surgery

Grimsby

Conley

Trentman

et al. 2012

Mayo Clinic Proceedings

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Objective: To evaluate the efficacy and safety of a novel, continuous intravenous infusion of ketorolac, a powerful nonopioid analgesic, for postoperative pain control. Patients and Methods: A prospective, double-blind, randomized, placebo-controlled trial of a continuous infusion of ketorolac tromethamine in 1 L of normal saline vs placebo was performed in 135 patients aged 18 to 75 years after laparoscopic donor nephrectomy or percutaneous nephrolithotomy completed from October 7, 2008, through July 21, 2010. Primary study end points were the 24-hour differences in visual analog pain scores and total narcotic consumption, whereas secondary end points were differences in urine output, serum creatinine level, and hemoglobin level. Results: The study was stopped after randomization of 135 patients (68 in the ketorolac group and 67 in the placebo group) when interim analysis indicated that the difference in mean pain scores between the 2 groups (difference, 0.6) was smaller than the 1-point threshold set forth in the power calculations. No statistically significant change was noted in hemoglobin levels from preoperative to postoperative values (Pϭ.13) or in postoperative serum creatinine levels (Pϭ.13). Conclusion: Although continuous infusion of ketorolac produced only a modest decrease in the use of narcotics, it appears to offer a safe therapeutic option for nonnarcotic pain control. Trial Registration: clinicaltrials.gov Identifiers: NCT00765128 and NCT00765232

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Quality of Life, Pain and Return to Normal Activities Following Laparoscopic Donor Nephrectomy Versus Open Mini-Incision Donor Nephrectomy

Abstract: The laparoscopy group had significantly less postoperative pain and required less time to return to normal functional activities than the mini-incision group. In addition, the laparoscopic group showed significantly higher quality of life scores than the mini-incision group in 3 domains.

Cited by 121 publications

References 15 publications

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

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

Measuring Surgical Recovery: The Study of Laparoscopic Live Donor Nephrectomy

A Double-Blind Randomized Controlled Trial of Continuous Intravenous Ketorolac vs Placebo for Adjuvant Pain Control After Renal Surgery

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