title: Mini-incisions by lombotomy or subcostal access in living kidney donors: a randomized trial comparing pain, safety, and quality of life.
abstract: OBJECTIVE
  The aim of this study was to compare two mini-incision techniques and judge the impact on the quality of life, pain, and safety of living kidney donors.
  
  
  METHODS
  From March through September 2003, a prospective randomized study with 60 donors had nephrectomy performed - 30 through a lombotomy and another 30 patients underwent subcostal mini-incisions. The same anesthetic procedure was used for both groups. All patients were evaluated from baseline (T0) to day 90 after surgery. Pain evaluation included visual analog scale (VAS) and drug usage. To assess quality of life (QOL), the questionnaire SF-36 was used and surgical outcomes were also checked.
  
  
  RESULTS
  Sixty patients (41.6 +/- 8.9 yr old) were included in the protocol. Regarding incision length and blood loss, no statistical difference was observed. However, irrespective to the site of the mini-incision, patients with body mass index (BMI) higher than 25 kg/m(2) had significantly longer incision length as well as higher blood loss. There were no complications. No significant difference in tramadol or in pain perception was observed between groups. QOL was also not different between groups, however, there was a significant loss with subsequent return to baseline levels.
  
  
  CONCLUSIONS
  The position of the mini-incision (lombotomy or subcostal) has no significant impact on surgical outcomes, pain perception, and QOL of living kidney donors. Mini-incision techniques represent fast and safe approaches to perform nephrectomy in the healthy population. Special care must be taken in obese patients in order to minimize surgical complications.
authors.affiliation: Department of Urology, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil. wfaguiar@hotmail.com
authors.forename: Wilson Ferreira
authors.initials: WF
authors.lastname: Aguiar
authors.forename: Carlo Camargo
authors.initials: CC
authors.lastname: Passerotti
authors.forename: Joaquim Francisco de Almeida
authors.initials: JF
authors.lastname: Claro
authors.forename: Claudio Jose Ramos
authors.initials: CJ
authors.lastname: Almeida
authors.forename: Nelson
authors.initials: N
authors.lastname: Gattas
authors.forename: Agnaldo Pereira
authors.initials: AP
authors.lastname: Cedenho
authors.forename: Jose Osmar Medina
authors.initials: JO
authors.lastname: Pestana
authors.forename: Valdemar
authors.initials: V
authors.lastname: Ortiz
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology*; D011788:Quality of Life; D016896:Treatment Outcome