title: Can right-sided hand-assisted retroperitoneoscopic donor nephrectomy be advocated above standard laparoscopic donor nephrectomy: a randomized pilot study.
abstract: Endoscopic techniques have contributed to early recovery and increased quality of life (QOL) of live kidney donors. However, laparoscopic donor nephrectomy (LDN) may have its limitations, and hand-assisted retroperitoneoscopic donor nephrectomy (HARP) has been introduced, mainly as a potentially safer alternative. In a randomized fashion, we explored the feasibility and potential benefits of HARP for right-sided donor nephrectomy in a referral center with longstanding expertise on the standard laparoscopic approach. Forty donors were randomly assigned to either LDN or HARP. Primary outcome was operating time, and secondary outcomes included QOL, complications, pain, morphine requirement, blood loss, warm ischemia time, and hospital stay. Follow-up time was 1 year. Skin-to-skin time did not significantly differ between both groups (162 vs. 158 min, P = 0.98). As compared to LDN, HARP resulted in a shorter warm ischemia time (2.8 vs. 3.9 min, P < 0.001) and increased blood loss (187 vs. 50 ml, P < 0.001). QOL, complication rate, pain, or hospital stay was not significantly different between the groups. Right-sided HARP is feasible but does not confer clear benefits over standard right-sided LDN yet. Further studies should explore the value of HARP in difficult cases such as the obese donor and the value of HARP for transplantation centers starting a live kidney donation program (Dutch Trial Register number: NTR3096). Nevertheless, HARP is a valuable addition to the surgical armamentarium in live donor surgery.
authors.affiliation: Division of Transplant Surgery, Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Karel W J
authors.initials: KW
authors.lastname: Klop
authors.forename: Niels F M
authors.initials: NF
authors.lastname: Kok
authors.forename: Leonienke F C
authors.initials: LF
authors.lastname: Dols
authors.forename: Frank J M F
authors.initials: FJ
authors.lastname: Dor
authors.forename: Khe T C
authors.initials: KT
authors.lastname: Tran
authors.forename: Türkan
authors.initials: T
authors.lastname: Terkivatan
authors.forename: Willem
authors.initials: W
authors.lastname: Weimar
authors.forename: Jan N M
authors.initials: JN
authors.lastname: Ijzermans
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006085:Graft Survival; D006225:Hand; D006801:Humans; D016030:Kidney Transplantation / Q000295:instrumentation / Q000379:methods*; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D007902:Length of Stay; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000295:instrumentation / Q000379:methods*; D010146:Pain; D010865:Pilot Projects; D011788:Quality of Life; D013514:Surgical Procedures, Operative / Q000379:methods; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome; D052096:Warm Ischemia; D055815:Young Adult
keywords: hand-assisted donor nephrectomy; kidney transplantation; laparoscopic donor nephrectomy; living donors; surgical technique