title: Laparoscopic versus open living-donor nephrectomy: experiences from a prospective, randomized, single-center study focusing on donor safety.
abstract: BACKGROUND
  Very few randomized studies on laparoscopic (L) versus open (O) living-donor nephrectomy (LDN) have been presented. The largest randomized series reported so far included 80 donors. In 2000, an Australian safety group concluded that the evidence base for L-LDN is inadequate to make recommendations regarding safety and efficacy.
  
  
  METHODS
  With this background, at our single national center, 122 donors were randomized to left-sided L-LDN (n=63) or O-LDN (n=59), from February 2001 to May 2004. This article summarizes our experiences, in particular regarding complications and safety.
  
  
  RESULTS
  There were significant differences in favor of O-LDN regarding operative time, warm ischemia time, and vessel lengths, whereas the analgesic requirements and pain data were significantly in favor of the laparoscopic procedure. In the L-LDN group, there were five major postoperative complications resulting in reoperations (8%), including two intestinal perforations. No major complications occurred in the O-LDN group.
  
  
  CONCLUSIONS
  These results from our randomized study do suggest that conventional O-LDN is a very secure procedure, superior to L-LDN regarding donor safety. There has been an unacceptably high rate of reoperations in our L-LDN series but without mortality or significant sequelae. A careful look at some other L-LDN series also suggests increased morbidity/mortality. Our data do, however, support the view that a perfect, uncomplicated L-LDN appears to be the superior procedure, and the laparoscopic procedure is still evolving. Donor safety may be improved by avoiding obese donors, stapling of the renal artery (not clipping), and perhaps by hand assistance. Furthermore, we will consider the retroperitoneal approach.
authors.affiliation: Department of Surgery, Rikshospitalet University Hospital, Oslo, Norway. ole.oyen@rikshospitalet.no
authors.forename: Ole
authors.initials: O
authors.lastname: Øyen
authors.forename: Marit
authors.initials: M
authors.lastname: Andersen
authors.forename: Lars
authors.initials: L
authors.lastname: Mathisen
authors.forename: Gunnvald
authors.initials: G
authors.lastname: Kvarstein
authors.forename: Bjørn
authors.initials: B
authors.lastname: Edwin
authors.forename: Pål-Dag
authors.initials: PD
authors.lastname: Line
authors.forename: Tim
authors.initials: T
authors.lastname: Scholz
authors.forename: Per F
authors.initials: PF
authors.lastname: Pfeffer
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000592:standards*; D019520:Living Donors; D009392:Nephrectomy / Q000379:methods* / Q000592:standards; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D011184:Postoperative Period; D012449:Safety
chemical_list: D000700:Analgesics