A cost-effective technique for pure laparoscopic live donor nephrectomy.
OBJECTIVE
Compare two different techniques for laparoscopic live donor nephrectomy (LDN), related to the operative costs and learning curve.


METHODS
Between April/2000 and October/2003, 61 patients were submitted to LDN in 2 different reference centers in kidney transplantation. At center A (CA), 11 patients were operated by a pure transperitoneal approach, using Hem-O-Lok clips for the renal pedicle control and the specimens were retrieved manually, without using endobags. At center B (CB), 50 patients were also operated by a pure transperitoneal approach, but the renal pedicles were controlled with endo-GIA appliers and the specimens were retrieved using endobags.


RESULTS
Operative time (231 +/- 39 min vs. 179 +/- 30 min; p < 0.000), warm ischemia time (5.85 +/- 2.85 min vs. 3.84 +/- 3.84 min; p = 0.002) and blood loss (214 +/- 98 mL vs. 141 +/- 82 mL; p = 0.02) were statistically better in CB, when compared to CA. Discharge time was similar in both centers. One major complication was observed in both centers, leading to an open conversion in CA (9.1%). One donor death occurred in CB (2%). Regarding the recipients, no statistical difference was observed in all parameters analyzed. There was an economy of US$1.440 in each procedure performed in CA, when compared to CB.


CONCLUSIONS
Despite the learning curve, the technique adopted by CA, showed no deleterious results to the donors and recipients when compared with the CB. On the other hand, this technique was cheaper than the technique performed in the CB, representing an attractive alternative for LDN, mainly in developing centers.
Siqueira
Tiberio M
TM
Kidney Transplantation Center General Hospital, Federal University of Pernambuco, Recife, Pernambuco, Brazil. tiberiojr@uol.com.br
Mitre
Anuar I
AI
Simoes
Fabiano A
FA
Maciel
Andre F
AF
Ferraz
Alvaro M
AM
Arap
Sami
S
D003362:Cost-Benefit Analysis; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000379:methods; D019520:Living Donors; D009392:Nephrectomy / Q000191:economics* / Q000379:methods; D020858:Tissue and Organ Harvesting / Q000191:economics* / Q000379:methods