Laparoscopic donor nephrectomy.
BACKGROUND
Living kidney donation represents an important source of organs for patients with end-stage renal failure. Over the past decade, laparoscopic donor nephrectomy has replaced the conventional open procedure in many transplant centres. Using evidence-based methods, this study examines the current status of laparoscopic donor nephrectomy.


METHODS
A Medline literature search (PubMed database, 1999-2002) and manual cross-referencing were performed to identify all articles relating to laparoscopic donor nephrectomy. Safety and efficacy criteria were analysed systematically for each study. Studies included were categorized using an evidence-based level grading system.


RESULTS
Of 687 publications, 20 studies with level I-II evidence and 12 with level III evidence were analysed. Only one level I study could be identified. Level I and level II evidence suggests superiority of the laparoscopic approach in regard to postoperative analgesic consumption, hospital stay and return to work. Other safety and efficacy criteria, including donor and recipient outcomes, were similar between the two techniques.


CONCLUSIONS
Laparoscopic donor nephrectomy has gained community acceptance by physicians and patients over the past decade. Despite a lack of strong evidence, such as large prospective randomized studies, laparoscopic donor nephrectomy is likely to become the 'gold standard' for donor nephrectomy in the near future.
Department of Visceral and Transplant Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
A E
AE
Handschin
M
M
Weber
N
N
Demartines
P-A
PA
Clavien
D000700:Analgesics / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D003362:Cost-Benefit Analysis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D007902:Length of Stay; D019520:Living Donors; D009392:Nephrectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D009927:Tissue and Organ Procurement / Q000191:economics / Q000379:methods; D016896:Treatment Outcome
D000700:Analgesics