title: Laparoscopic live-donor nephrectomy: a comparison with the open technique and how to reach quality standards: a single-center experience in Thailand.
abstract: OBJECTIVE
  We report our experience with laparoscopic donor nephrectomy (LDN) compared with open donor nephrectomy (ODN). Prognostic factors associated with adverse outcomes in LDN were identified.
  
  
  METHODS
  From January 2000 to December 2009, 243 consecutive live-donor nephrectomies were performed, including 129 LDNs and 114 ODNs. We compared patient demographics, perioperative outcomes, and recipient graft function in each group. Prognostic factors for adverse outcomes in LDN were investigated using uni- and multivariate analyses.
  
  
  RESULTS
  Patient demographics, except mean donor age (P=.032), were similar between groups. Mean operative time (219 vs 163 minutes; P<.001) and warm ischemia time (WIT; 3.1 vs 1.7 minutes; P<.001) were significantly longer in LDN. Conversely, mean analgesic requirement (9.2 vs 14.7 mg morphine; P<.001) and postoperative hospital stay (6.5 vs 7.1 days; P=.003) were significantly lower with LDN. Mean estimated blood loss (EBL) was slightly lower in LDN (P=.15). There were 7 conversions from LDN to ODN. Complication rates were similar between the groups (P=.38). Delayed graft function (10.9% vs 1.7%; P=.016) and mean serum creatinine level at 1 month (1.47 vs 1.3 mg/dL; P=.04) were higher for LDN. However, 5-year allograft survival was not inferior among LDN (90% vs 85%; P=.42). Mean operative time (268 to 175 minutes; P<.001), EBL (316 to 66 mL; P<.001), and complication incidence (8 to 0 cases; P<.002) gradually decreased from the initial 43 cases to the last 43 cases of LDNs. Among surgeons who had performed-30 LDNs, the mean operative time and WIT were 197 mL and 2.8 minutes, respectively.
  
  
  CONCLUSIONS
  Based on our evidence, LDN was a feasible and safe surgical option for live-donor nephrectomy, even in a small volume center. Better results can be achieved after a learning curve of experience for both the surgeon and the institution.
authors.affiliation: Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. sittm@mahidol.ac.th
authors.forename: T
authors.initials: T
authors.lastname: Taweemonkongsap
authors.forename: C
authors.initials: C
authors.lastname: Nualyong
authors.forename: T
authors.initials: T
authors.lastname: Amornvesukit
authors.forename: S
authors.initials: S
authors.lastname: Srinualnad
authors.forename: S
authors.initials: S
authors.lastname: Jitpraphai
authors.forename: N
authors.initials: N
authors.lastname: Premasathian
authors.forename: P
authors.initials: P
authors.lastname: Sujijantararat
authors.forename: A
authors.initials: A
authors.lastname: Tantiwong
authors.forename: S
authors.initials: S
authors.lastname: Soontrapa
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D016009:Chi-Square Distribution; D002983:Clinical Competence; D051799:Delayed Graft Function / Q000209:etiology; D005240:Feasibility Studies; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000592:standards*; D010535:Laparoscopy / Q000009:adverse effects / Q000592:standards*; D059032:Learning Curve; D007902:Length of Stay; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D059039:Standard of Care; D013785:Thailand; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000700:Analgesics