title: Back-to-back comparison of mini-open vs. laparoscopic technique for living kidney donation.
abstract: BACKGROUND
  Laparoscopic living donor nephrectomy is the standard of care at high-volume renal transplant centres, with benefits over the open approach well-documented in the literature. Herein, we present a retrospective analysis of our single-institution donor nephrectomy series comparing the mini-open donor nephrectomy (mini-ODN) to the laparoscopic donor nephrectomy (LDN) with regards to operative, donor, and recipient outcomes.
  
  
  METHODS
  From 2007-2011, there were 89 cases of mini-ODN, at which point our centre transitioned to LDN; 94 cases were performed from 2011-2014. In total, 366 patients were reviewed, including donor and recipient pairs. Donor and recipient demographics, intraoperative data, postoperative donor recovery, recipient graft outcomes, and financial cost were assessed comparing the surgical approaches.
  
  
  RESULTS
  We demonstrate a reduced estimated blood loss (347.83 vs. 90.3 cc), lower intraoperative complication rate (4 vs. 11) and shorter length of hospital stay (2.4 vs. 3.3 days) for patients in the LDN group. Operative time was significantly longer for the LDN group (108.4 vs. 165.9 minutes), although this did not translate to a longer warm ischemia time (mean 2.0 minutes for each group). The rate of delayed graft function and recipient 12-month creatinine were comparable for ODN and LND. Overall cost of LDN was $684 higher for an uncomplicated admission.
  
  
  CONCLUSIONS
  Despite a longer surgical time and higher upfront cost, our study supports that LDN yields several advantages over the mini-ODN, with a lower estimated blood loss, fewer intraoperative complications, and shorter length of hospital stay, all while maintaining excellent renal allograft outcomes.
authors.affiliation: College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: Christie
authors.initials: C
authors.lastname: Rampersad
authors.affiliation: Section of Urology, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: Premal
authors.initials: P
authors.lastname: Patel
authors.affiliation: Section of Vascular Surgery, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: Joshua
authors.initials: J
authors.lastname: Koulack
authors.affiliation: Section of Urology, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: McGregor