title: Comparison of complications of laparoscopic versus laparoendoscopic single site donor nephrectomy using the modified Clavien grading system.
abstract: OBJECTIVE
  We compared postoperative complications of laparoendoscopic single site and standard laparoscopic living donor nephrectomy using a standardized complication reporting system.
  
  
  METHODS
  We retrospectively analyzed the records of consecutive patients who underwent a total of 663 laparoscopic living donor nephrectomies and 101 laparoendoscopic single site donor nephrectomies. All data were recorded retrospectively. The 30-day complication rate was compiled and graded using the modified Clavien complication scale. Multivariate binary logistic regression was used to determine independent predictors of complications.
  
  
  RESULTS
  Baseline demographics were comparable between the groups. Compared to those with laparoscopic living donor nephrectomy patients who underwent laparoendoscopic single site donor nephrectomy had a shorter hospital stay and less estimated blood loss but longer operative time (p <0.05) as well as higher oral but lower intravenous in hospital analgesic requirements (p <0.05). Mean warm ischemia time was marginally lower in the laparoendoscopic single site donor nephrectomy group (3.9 vs 4 minutes, p = 0.03). At 30 days there was no difference in the overall complication rate between the laparoscopic living and laparoendoscopic single site donor nephrectomy groups (7.1% vs 7.9%, p >0.05). There were 8 major complications (grade 3 to 5) in the laparoscopic living donor nephrectomy group but only 1 in the laparoendoscopic single site group. Multivariate binary logistic regression analysis revealed that estimated blood loss was a predictor of fewer complications at 30 days.
  
  
  CONCLUSIONS
  With appropriate patient selection and operative experience laparoendoscopic single site donor nephrectomy may be a safe procedure associated with postoperative outcomes similar to those of laparoscopic living donor nephrectomy as well as low morbidity. Using a standardized complication system can aid in counseling potential donors in the future.
authors.affiliation: Department of Urology, New York-Presbyterian Hospital, New York, New York, USA.
authors.forename: Ranjith
authors.initials: R
authors.lastname: Ramasamy
authors.forename: Cheguevara
authors.initials: C
authors.lastname: Afaneh
authors.forename: Matthew
authors.initials: M
authors.lastname: Katz
authors.forename: Xueying
authors.initials: X
authors.lastname: Chen
authors.forename: Meredith J
authors.initials: MJ
authors.lastname: Aull
authors.forename: David B
authors.initials: DB
authors.lastname: Leeser
authors.forename: Sandip
authors.initials: S
authors.lastname: Kapur
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Del Pizzo
mesh_terms: D000328:Adult; D000368:Aged; D004724:Endoscopy; D005260:Female; D006801:Humans; 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; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult