Laparoscopic donors experienced less discomfort than mini-incision donors, and graft survival outcomes were equivalent.
Along with larger numbers of living kidney donors have come better techniques for reducing donor discomfort and improving donor recovery. Two popular techniques are laparoscopic nephrectomy and muscle-sparing mini-incision without rib resection. Dutch investigators compared these approaches from 2001 to 2004.
One hundred living kidney donors were assigned randomly to undergo either laparoscopic nephrectomy or mini-incision nephrectomy. Laparoscopic donors had significantly longer mean skin-to-skin time (221 vs. 164 minutes), longer warm ischemic time (6 vs. 3 minutes), less blood loss (100 vs. 240 mL), shorter hospital stay (3 vs. 4 days), and lower use of morphine (16 vs. 25 mg) than did mini-incision donors. Intraoperative complication rates were similar (12% for laparoscopy [bleeding in 3, lesions of the spleen, colon, and bladder in 1 each] and 6% for mini-incision [bleeding in 3]). At 1 year, mean physical fatigue was significantly less and physical function was better in the laparoscopic group than in the mini-incision group (based on scores from the Multidimensional Fatigue Inventory 20 and the SF-36). Graft survival was the same with either technique.
Comment: Laparoscopic donors experienced less discomfort than mini-incision donors, and transplant outcomes were equivalent in the groups. Why significant differences should be found in fatigue scores a year after surgery is unclear and is not discussed by the authors, but this might be important for people who are considering this altruistic procedure. On the other hand, the greater number of intraoperative complications in the laparoscopic group (albeit nonsignificant in this small study) raises some concern, especially because three or four port sites, which might lead to additional complications, were required for the laparoscopic procedures. At the time of publication, the full text of the original article was available free of charge.
— Keith I. Marton, MD
Published in Journal Watch September 14, 2006
Citation(s):
Kok NFM et al. Comparison of laparoscopic and mini incision open donor nephrectomy: Single blind, randomised controlled clinical trial. BMJ 2006 Jul 29; 333:221-4.