Randomized controlled trial of hand-assisted laparoscopic versus open surgical live donor nephrectomy.
BACKGROUND
Laparoscopic live donor nephrectomy for renal transplantation is being performed in increasing numbers with the goals of broadening organ supply while minimizing pain and duration of convalescence for donors. Relative advantages in terms of recovery provided by laparoscopy over standard open surgery have not been rigorously assessed. We hypothesized that laparoscopic as compared with open surgical live donor nephrectomy provides briefer, less intense, and more complete convalescence.


METHODS
Of 105 volunteer, adult, potential living-renal donors interested in the laparoscopic approach, 70 were randomly assigned to undergo either hand-assisted laparoscopic or open surgical live donor nephrectomy at a single referral center. Objective data and subjective recovery information obtained with telephone interviews and validated questionnaires administered 2 weeks, 6 weeks, and 6-12 months postoperatively were compared between the 23 laparoscopic and 27 open surgical patients.


RESULTS
There was 47% less analgesic use (P=0.004), 35% shorter hospital stay (P=0.0001), 33% more rapid return to nonstrenuous activity (P=0.006), 23% sooner return to work (P=0.037), and 73% less pain 6 weeks postoperatively (P=0.004) in the laparoscopy group. Laparoscopic patients experienced complete recovery sooner (P=0.032) and had fewer long-term residual effects (P=0.0015).


CONCLUSIONS
Laparoscopic donor nephrectomy is associated with a briefer, less intense, and more complete convalescence compared with the open surgical approach.
Wolf
J S
JS
Section of Urology, Department of Surgery, The University of Michigan, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-0330, USA. wolfs@umich.edu
Merion
R M
RM
Leichtman
A B
AB
Campbell
D A
DA
Magee
J C
JC
Punch
J D
JD
Turcotte
J G
JG
Konnak
J W
JW
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001334:Automobile Driving; D003289:Convalescence; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods* / Q000534:rehabilitation; D010149:Postoperative Pain / Q000453:epidemiology; D011336:Probability; D011795:Surveys and Questionnaires; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000379:methods