title: Single-port donor nephrectomy provides improved patient satisfaction and equivalent outcomes.
abstract: OBJECTIVE
  Minimally invasive techniques have expanded the donor pool for living kidney donation. We changed our approach to single-port donor nephrectomy in 2009 and have compared outcomes with traditional multiple-port laparoscopic donor nephrectomy.
  
  
  BACKGROUND
  The development of minimally invasive surgical techniques to procure kidneys from living donors has allowed expansion of living donor renal transplantation to account for one third of all renal transplants. Recent technical advancement allows for the entire surgical procedure to be done through a single incision contained within the umbilicus.
  
  
  METHODS
  We compared outcomes from 135 single-port donor nephrectomies with an immediately preceding cohort of 100 multiple-port laparoscopic donor nephrectomies. Survey data were collected from both groups to compare outcomes. Additional comparisons were made to total center experience with 1300 laparoscopic donor nephrectomies.
  
  
  RESULTS
  A total of 135 patients completed successful single-port donor nephrectomy without major complication or open conversion. Another 16 patients required additional port placement because of excessive intra-abdominal fat or limited abdominal domain. Compared with multiple-port donor nephrectomy, single-port patients had similar operative times to cross clamp (2.8 vs 2.6 hours; P = 0.11) that normalized after a learning curve of approximately 50 cases. Recipient creatinine levels were similar at 1 week and 1 month posttransplant. Although 36-Item Short Form Health Surveys demonstrated no significant differences, additional survey data revealed that single-port patients were more satisfied with cosmetic outcomes (P < 0.01) and the overall donation process (P = 0.01). Single-port approach had similar outcomes compared with all previous laparoscopic donor nephrectomies.
  
  
  CONCLUSIONS
  Single-port donor nephrectomy can be integrated as a standardized approach for renal donation without additional donor risk, and with benefits of improved patient satisfaction with cosmetic and overall outcomes. Although the primary benefit is cosmetic, (a single incision predominantly contained within the umbilicus) outcomes justify application for kidney donors in experienced centers and may motivate additional living kidney donation.
authors.affiliation: Division of Transplantation, University of Maryland School of Medicine, Baltimore, MD 21201, USA. rbarth@smail.umaryland.edu
authors.forename: Rolf N
authors.initials: RN
authors.lastname: Barth
authors.forename: Michael W
authors.initials: MW
authors.lastname: Phelan
authors.forename: Lauren
authors.initials: L
authors.lastname: Goldschen
authors.forename: Raghava B
authors.initials: RB
authors.lastname: Munivenkatappa
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Jacobs
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Bartlett
authors.forename: Benjamin
authors.initials: B
authors.lastname: Philosophe
mesh_terms: D000328:Adult; D004867:Equipment Design; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D019520:Living Donors; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D017060:Patient Satisfaction; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000295:instrumentation*