Mini-incisions by lombotomy or subcostal access in living kidney donors: a randomized trial comparing pain, safety, and quality of life.
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.
Aguiar
Wilson Ferreira
WF
Department of Urology, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil. wfaguiar@hotmail.com
Passerotti
Carlo Camargo
CC
Claro
Joaquim Francisco de Almeida
JF
Almeida
Claudio Jose Ramos
CJ
Gattas
Nelson
N
Cedenho
Agnaldo Pereira
AP
Pestana
Jose Osmar Medina
JO
Ortiz
Valdemar
V
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