Comparison of laparoscopic and mini incision open donor nephrectomy: single blind, randomised controlled clinical trial.
OBJECTIVE
To determine the best approach for live donor nephrectomy to minimise discomfort to the donor and to provide good graft function.


METHODS
Single blind, randomised controlled trial.


METHODS
Two university medical centres, the Netherlands.


METHODS
100 living kidney donors.


METHODS
Participants were randomly assigned to either laparoscopic donor nephrectomy or to mini incision muscle splitting open donor nephrectomy.


METHODS
The primary outcome was physical fatigue using the multidimensional fatigue inventory 20 (MFI-20). Secondary outcomes were physical function using the SF-36, hospital stay after surgery, pain, operating times, recipient graft function, and graft survival.


RESULTS
Conversions did not occur. Compared with mini incision open donor nephrectomy, laparoscopic donor nephrectomy resulted in longer skin to skin time (median 221 v 164 minutes, P < 0.001), longer warm ischaemia time (6 v 3 minutes, P < 0.001), less blood loss (100 v 240 ml, P < 0.001), and a similar number of complications (intraoperatively 12% v 6%, P = 0.49, postoperatively both 6%). After laparoscopic nephrectomy, donors required less morphine (16 v 25 mg, P = 0.005) and shorter hospital stay (3 v 4 days, P = 0.003). During one year's follow-up mean physical fatigue was less (difference - 1.3, 95% confidence interval - 2.4 to - 0.1) and physical function was better (difference 6.2, 2.0 to 10.3) after laparoscopic nephrectomy. Function of the graft and graft survival rate of the recipient at one year censored for death did not differ (100% after laparoscopic nephrectomy and 98% after open nephrectomy).


CONCLUSIONS
Laparoscopic donor nephrectomy results in a better quality of life compared with mini incision open donor nephrectomy but equal safety and graft function.
Kok
Niels F M
NF
Department of Surgery, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands.
Lind
May Y
MY
Hansson
Birgitta M E
BM
Pilzecker
Desiree
D
Mertens zur Borg
Ingrid R A M
IR
Knipscheer
Ben C
BC
Hazebroek
Eric J
EJ
Dooper
Ine M
IM
Weimar
Willem
W
Hop
Wim C J
WC
Adang
Eddy M M
EM
van der Wilt
Gert Jan
GJ
Bonjer
Hendrik J
HJ
van der Vliet
Jordanus A
JA
IJzermans
Jan N M
JN
D000328:Adult; D000368:Aged; D005221:Fatigue / Q000209:etiology; D005260:Female; D006085:Graft Survival; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D011788:Quality of Life; D016037:Single-Blind Method