title: Laparoscopic versus open live donor nephrectomy: outcomes analysis of 266 consecutive patients.
abstract: BACKGROUND
  Minimally invasive surgical techniques have become the preferred method for live donor nephrectomy (DN) in many centers. We compared our experience with laparoscopic and open DN in a single institution.
  
  
  METHODS
  Data for 266 consecutive live DNs were collected. Demographic, intraoperative, and postoperative data were compared.
  
  
  RESULTS
  A total of 199 hand-assisted laparoscopic (HAL) DNs, 18 totally laparoscopic (TL), and 49 open DNs were performed. Laparoscopic DN was associated with a shorter operative time (p < 0.013), less blood loss (p < 0.0001), and shorter hospital stay (p < 0.0001) than open DN. Warm ischemia time was less for HAL versus TL DN (59.9 vs. 90.0 seconds; p < 0.0001). Compared with open DN, laparoscopic patients had fewer complications (p < 0.03), fewer wound infections (p < 0.004), less wound paresthesias (p < 0.0009), and fewer complaints of chronic incisional pain (p < 0.0001). Delayed graft function during the first 24 h postoperatively was significantly less for the laparoscopic DN versus the open cases (12.9% vs. 30.4%; p = 0.003), but the need for hemodialysis for the recipient was similar between groups (6.9% vs. 5%; p = not significant).
  
  
  CONCLUSIONS
  Laparoscopic DN resulted in less blood loss, reduced operative time, and shorter hospital stay than open DN. Hand-assisted laparoscopic DN has the potential to decrease warm ischemia time for renal allografts. Donors managed laparoscopically had fewer complications, significantly less wound-related morbidity, and less delayed graft function than patients who underwent open DN.
authors.affiliation: Department of Surgery, Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, NC, USA. charles.dolce@carolinashealthcare.org
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Dolce
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Keller
authors.forename: K Christian
authors.initials: KC
authors.lastname: Walters
authors.forename: Daniel
authors.initials: D
authors.lastname: Griffin
authors.forename: H James
authors.initials: HJ
authors.lastname: Norton
authors.forename: B Todd
authors.initials: BT
authors.lastname: Heniford
authors.forename: Kent W
authors.initials: KW
authors.lastname: Kercher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D051799:Delayed Graft Function / Q000453:epidemiology; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult