Laparoscopic or open surgery for living donor nephrectomy.
BACKGROUND
The anterior extraperitoneal approach for living donor nephrectomy has been used in more than 700 living cases in the unit and proved to be safe for the donor. In 1998, laparoscopic nephrectomy was introduced as an option when technically feasible. We found it essential to investigate the consequences of the new technique.


METHODS
One hundred living donor kidney transplantations were performed from 1998 to June 2000, 45 with laparoscopic, 55 with open nephrectomy. The donors took part in a structured interview 4 weeks after the donation and their responses were categorized in three classes.


RESULTS
In each group, one recipient had delayed initial function. The serum creatinine levels after 3 and 7 days or the GFR values after 6 months did not differ. One graft has been lost following laparoscopic nephrectomy and four after open surgery. For the laparoscopy donors, the median number of post-operative days in hospital was 5.0 days (range 2-9), vs 6.0 (4-8) after open surgery (NS). The requirement of opoid analgesics post-operatively was 5.0 doses (1-22) vs 6.0 (1-38) (P=0.02); and after 4 weeks, 23 of 45 laparoscopic donors were free of pain vs eight of 55 open nephrectomy donors (P=0.0004). Approximately one-third of all donors felt some restriction of physical activity and the majority complained of impaired physical energy. There were no differences between the groups. The duration of sick-leave after laparoscopic surgery was median 6 (2-19) weeks vs 7 (1-16) (NS).


CONCLUSIONS
Laparoscopic nephrectomy is safe. Less post-operative pain is a definite advantage for the donor.
Lennerling
A
A
Transplant Unit, Sahlgrenska University Hospital, Göteborg, Sweden.
Blohmé
I
I
Ostraat
O
O
Lönroth
H
H
Olausson
M
M
Nyberg
G
G
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D010149:Postoperative Pain / Q000503:physiopathology; D012079:Renal Circulation; D013530:Surgical Wound Infection; D014515:Ureteral Diseases / Q000209:etiology; D014652:Vascular Diseases / Q000209:etiology