Laparo-endoscopic single site (LESS) versus standard laparoscopic left donor nephrectomy: matched-pair comparison.
BACKGROUND
Laparo-endoscopic single site (LESS) surgery is a recent development in minimally invasive surgery. Presented herein is the initial comparison of LESS donor nephrectomy (LESS-DN) and standard laparoscopic living donor nephrectomy (LLDN).


OBJECTIVE
To determine whether LESS-DN provides any measurable benefit over LLDN during the perioperative period and subsequent convalescence.


METHODS
Between November 2007 and November 2008, 18 consecutive patients underwent LESS-DN (17 left DN, 1 right DN). A contemporary matched-pair cohort of 17 patients undergoing standard LLDN was selected for retrospective comparison.


METHODS
LESS-DN was performed through an intraumbilical novel multichannel port. The kidney was extracted through a slightly extended umbilical incision.


METHODS
All data were prospectively accrued in an institutional review board-approved database. Convalescence data included visual analog pain scores and questionnaires containing patient-reported time to recovery end points.


CONCLUSIONS
One right-sided donor was converted to standard laparoscopy and excluded from analysis. Baseline demographics, operating time, blood loss, and hospital stay were comparable between groups. Compared to LLDN, patients undergoing LESS-DN had similar in-hospital analgesic requirements and mean visual analog scores at discharge. After discharge, patient-reported convalescence was faster in the LESS-DN group, including days on oral pain medication (20 vs 6; p=0.01), days off work (46 vs 18; p=0.0009), and days to 100% physical recovery (83 vs 29; p=0.03). Mean warm ischemia time was longer in the LESS-DN group (3 vs 6.1 min; p<0.0001); however, allograft function was immediate and comparable between groups. One allograft in the LESS-DN group thrombosed postoperatively. Regardless of laparoscopic approach, patients' global satisfaction with kidney donation and willingness to recommend their procedure to others were favorable and equivalent between groups.


CONCLUSIONS
This retrospective matched-pair comparison between LESS-DN and LLDN suggests that the single-port approach may be associated with quicker convalescence. In this initial series, LESS-DN had longer ischemia time, yet early allograft outcomes were comparable.
Canes
David
D
Department of Urology, Lahey Clinic, Burlington, MA, USA.
Berger
Andre
A
Aron
Monish
M
Brandina
Ricardo
R
Goldfarb
David A
DA
Shoskes
Daniel
D
Desai
Mihir M
MM
Gill
Inderbir S
IS
D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D003289:Convalescence; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D019520:Living Donors; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology; D017060:Patient Satisfaction; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D052096:Warm Ischemia; D055815:Young Adult
D000700:Analgesics