How safe is hand-assisted laparoscopic donor nephrectomy?--results of 200 live donor nephrectomies by two different techniques.
BACKGROUND
Despite the rapid introduction of laparoscopic living donor nephrectomy, doubts exist about safety compared with open surgery. Early series have often reported on selective donor groups. We present a consecutive, prospective analysis of morbidity following hand-assisted laparoscopic donor nephrectomy (HALDN) compared with historical controls undergoing open donation (ODN) in a total of 200 living donors at a single UK centre.


METHODS
The results of 144 consecutively performed HALDN donors were compared to 56 preceding ODN patients. Patients with multiple arteries, right-sided nephrectomies and obesity were included. Data on recovery and complications were collected prospectively and consecutively.


RESULTS
There were two (1.4%) major complications in the HALDN group and one in the ODN group (1.8%, P = 0.629). Additionally, there were 24 minor complications in 23 HADLN patients (16.7%), compared with 21 in 21 ODN patients (37.5%, P = 0.003). Time taken to return to normal activity and mean post-operative stay was significantly shorter for the HALDN group. There was no mortality in either group.


CONCLUSIONS
Contrary to concerns, we report a safe experience with HALDN with a low rate of major complications. Furthermore, our patients spend less time in hospital with an earlier return to normal activity compared with open donation.
Chandak
Pankaj
P
Department of Transplant Surgery, Renal Unit, Guy's Hospital, Guy's and St Thomas' NHS Trust, London, UK.
Kessaris
Nicos
N
Challacombe
Ben
B
Olsburgh
Jonathan
J
Calder
Francis
F
Mamode
Nizam
N
D000328:Adult; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D020858:Tissue and Organ Harvesting / Q000009:adverse effects* / Q000379:methods*