title: Comparative and prospective analysis of three different approaches for live-donor nephrectomy.
abstract: OBJECTIVE
  Living donor nephrectomy is usually performed by a retroperitoneal flank incision. Due to the significant morbidity and long recovery time for a flank incision, anterior extra peritoneal sub-costal and transperitoneal video-laparoscopic methods have been described for donor nephrectomy. We prospectively compare the long-term results of donors as well as functional recipients submitted to these three approaches.
  
  
  METHODS
  A total of 107 live donor renal transplantations were prospectively evaluated from May 2001 to January 2004. Donors were compared with regard to operative and warm ischemia time, postoperative pain, analgesic requirements, and complications. Recipients were compared with regard to graft function, acute cellular rejection, surgical complications, and graft and recipient survival.
  
  
  RESULTS
  The mean operative and warm ischemia times were longer in the video-laparoscopic group (p<0.001), whereas patients of the flank incision group presented more postoperative pain (p=0.035), required more analgesics (p<0.001), had longer hospital stays (p<0.001), and suffered more pain on the 90th day after surgery (p=0.006). In the sub-costal and flank incision groups, there was a larger number of paraesthesias and abdominal wall asymmetries (p<0.001). Recipient groups were demographically comparable and presented similar acute tubular necrosis incidence and delayed graft function. The incidence of acute cellular rejection was higher in the video-laparoscopic and flank incision groups (p=0.013). There was no difference in serum creatinine levels, surgical complications, or recipient or graft survival between groups.
  
  
  CONCLUSIONS
  The video-laparoscopic and sub-costal approaches proved to be safe, and to provide donor advantages relative to the flank incision approach. Among recipients, the complication rate, graft survival, and recipient survival were similar in all groups.
authors.affiliation: Department of Urology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil. anuar@mitre.com.br
authors.forename: Anuar Ibrahim
authors.initials: AI
authors.lastname: Mitre
authors.forename: Francisco T
authors.initials: FT
authors.lastname: Dénes
authors.forename: William Carlos
authors.initials: WC
authors.lastname: Nahas
authors.forename: Fabiano A
authors.initials: FA
authors.lastname: Simões
authors.forename: José Roberto
authors.initials: JR
authors.lastname: Colombo
authors.forename: Affonso C
authors.initials: AC
authors.lastname: Piovesan
authors.forename: José L
authors.initials: JL
authors.lastname: Chambô
authors.forename: Sami
authors.initials: S
authors.lastname: Arap
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D000328:Adult; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000379:methods*; D010535:Laparoscopy; D007902:Length of Stay; D019520:Living Donors; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D010149:Postoperative Pain; D011446:Prospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods*
chemical_list: D003404:Creatinine