title: A randomized clinical trial of living donor nephrectomy: a plea for a differentiated appraisal of mini-open muscle splitting incision and hand-assisted laparoscopic donor nephrectomy.
abstract: A randomized controlled trial was designed to compare various outcome variables of the retroperitoneal mini-open muscle splitting incision (MSI) technique and the transperitoneal hand-assisted laparoscopic technique (HAL) in performing living donor nephrectomies. Fifty living kidney donors were randomized to MSI or HAL. Primary endpoint was pain experience scored on a visual analogue scale (VAS). After MSI living donors indicated lower median (range) VAS scores at rest than HAL living donors on postoperative day 2.5 [10 (0-44) vs. 15 (0-70), P = 0.043] and day 3 [7 (0-28) vs. 10 (0-91), P = 0.023] and lower VAS scores while coughing on postoperative day 3 [20 (0-73) vs. 42 (6-86), P = 0.001], day 7 [8 (0-66) vs. 33 (3-76), P < 0.001] and day 14 [2 (0-17) vs. 12 (0-51), P = 0.009]. The MSI technique also resulted in reduced morphine requirement, better scores on three domains of the RAND-36, reduced costs and reduced CRP and IL-6 levels. The HAL technique was superior in operating time and postoperative decrease of hemoglobin level. The MSI technique is superior to the HAL technique in performing living donor nephrectomies with regard to postoperative pain experience. This study reopens the discussion of the way to go in performing the living donor nephrectomy.
authors: Departments of Surgery, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700RB Groningen, The Netherlands. h.s.hofker@umcg.nl
authors: Hendrik S
authors: HS
authors: Hofker
authors: Willemijn N
authors: WN
authors: Nijboer
authors: Jan
authors: J
authors: Niesing
authors: Christina
authors: C
authors: Krikke
authors: Marc A
authors: MA
authors: Seelen
authors: Willem J
authors: WJ
authors: van Son
authors: Marten
authors: M
authors: van Wijhe
authors: Henk
authors: H
authors: Groen
authors: Jaap J Homan
authors: JJ
authors: Vd Heide
authors: Rutger J
authors: RJ
authors: Ploeg
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007249:Inflammation; D016030:Kidney Transplantation / Q000379:methods* / Q000523:psychology; D010535:Laparoscopy / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000473:pathology* / Q000601:surgery; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods* / Q000523:psychology; D010146:Pain; D011788:Quality of Life; D013997:Time Factors; D020858:Tissue and Organ Harvesting; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins