Randomized controlled trial comparing hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy.

Abstract

BACKGROUND:

Laparoscopic donor nephrectomy (LDN) has become the gold standard for live-donor nephrectomy, as it results in a short convalescence time and increased quality of life. However, intraoperative safety has been debated, as severe complications occur incidentally. Hand-assisted retroperitoneoscopic donor nephrectomy (HARP) is an alternative approach, combining the safety of hand-guided surgery with the benefits of endoscopic techniques and retroperitoneal access. We assessed the best approach to optimize donors' quality of life and safety.

METHODS:

In two tertiary referral centers, donors undergoing left-sided nephrectomy were randomly assigned to HARP or LDN. Primary endpoint was physical function, one of the dimensions of the Short Form-36 questionnaire on quality of life, at 1 month postoperatively. Secondary endpoints included intraoperative events and operation times. Follow-up was 1 year.

RESULTS:

In total, 190 donors were randomized. Physical function at 1 month follow-up did not significantly differ between groups (estimated difference, 1.79; 95% confidence interval, -4.1 to 7.68; P=0.55). HARP resulted in significantly shorter skin-to-skin time (mean, 159 vs. 188 min; P<0.001), shorter warm ischemia time (2 vs. 5 min; P<0.001) and a lower intraoperative event rate (5% vs. 11%, P=0.117). Length of stay (both 3 days; P=0.135) and postoperative complication rate (8% vs. 8%; P=1.00) were not significantly different. Potential graft-related complications did not significantly differ (6% vs. 13%; P=0.137).

CONCLUSIONS:

Compared with LDN, left-sided HARP leads to similar quality of life, shorter operating time, and warm ischemia time. Therefore, we recommend HARP as a valuable alternative to the laparoscopic approach for left-sided donor nephrectomy.

• Authors: Leonienke F C Dols, Niels F M Kok, Frank C H d'Ancona, Karel W J Klop, T C Khe Tran, Johan F Langenhuijsen, Türkan Terkivatan, Frank J M F Dor, Willem Weimar, Ine M Dooper, Jan N M Ijzermans
• Journal: Transplantation (Transplantation) Vol. 97 Issue 2 Pg. 161-7 (Jan 27 2014) ISSN: 1534-6080 [Electronic] United States
• PMID: 24092379 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Endoscopy (methods)
• Female
• Humans
• Kidney Transplantation
• Laparoscopy (methods)
• Living Donors
• Male
• Middle Aged
• Nephrectomy (methods)
• Quality of Life
• Retroperitoneal Space
• Warm Ischemia