title: Pfannenstiel laparoendoscopic single-site (LESS) vs conventional multiport laparoscopic live donor nephrectomy: a prospective randomized controlled trial.
abstract: OBJECTIVE
  To present outcomes of a randomized, patient-blinded controlled trial on Pfannenstiel laparoendoscopic single-site (LESS) vs conventional multiport laparoscopic live donor nephrectomy.
  
  
  METHODS
  Patients presenting as left kidney donors between January 2009 and November 2011 were randomized to LESS donor nephrectomy (LESS-DN: n = 15) or conventional laparoscopic donor nephrectomy (LDN: n = 14). Patients were blinded to the surgical approach preoperatively and attempts to continue patient blinding postoperatively were made by applying dressings consistent with multiple conventional laparoscopic incisions for all patients. De-identified data related to the operation, peri-operative course and postoperative follow-up were prospectively collected and compared between the two groups with an intention-to-treat analysis.
  
  
  RESULTS
  There were no significant differences between the groups when comparing operating time, estimated blood loss (EBL), i.v. fluid administration, renal allograft warm ischaemia time (WIT), length of hospital stay (LOS) and total inpatient analgesic requirements. Quantitative pain assessment was not significantly different on postoperative day (POD) #0, however, it was significantly lower in the LESS-DN group, beginning on POD #1 (P < 0.05). The changes in haematocrit and serum creatinine in the two groups were not significantly different, and there were no blood transfusions in either group, nor was there a decline in estimated glomerular filtration rate to <60 mL/min per 1.73 m² of body surface area in any patients. Two patients in the LESS-DN group were converted to conventional LDN, both because of failure to progress effectively. All allografts were functional at the time of transplantation and revascularization, with no cases of hyperacute rejection.
  
  
  CONCLUSIONS
  Peri-operative variables including EBL, WIT and LOS were equivalent when comparing Pfannenstiel LESS-DN with conventional LDN. Patient-reported visual analogue pain scale scores were significantly lower in the LESS-DN group beginning on the first postoperative day.
authors.affiliation: Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Richstone
authors.forename: Soroush
authors.initials: S
authors.lastname: Rais-Bahrami
authors.forename: Nikhil
authors.initials: N
authors.lastname: Waingankar
authors.forename: Joel H
authors.initials: JH
authors.lastname: Hillelsohn
authors.forename: Sero
authors.initials: S
authors.lastname: Andonian
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Schwartz
authors.forename: Louis R
authors.initials: LR
authors.lastname: Kavoussi
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods / Q000639:trends; D010535:Laparoscopy / Q000379:methods / Q000639:trends; D007902:Length of Stay; D019520:Living Donors; D008297:Male; D009392:Nephrectomy / Q000379:methods* / Q000639:trends; D061646:Operative Time; D010149:Postoperative Pain; D011446:Prospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods* / Q000639:trends; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D052096:Warm Ischemia
keywords: NOTES; allograft; kidney transplantation; natural orifice transluminal endoscopic surgery; warm ischaemia