Randomized controlled trial comparing hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy.
Dols LF, Kok NF, et al.Transplantation 2014 Jan 27;97(2):161-7
Aims
To assess the best approach to optimize donors’ quality of life and safety by comparing hand assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy.
Interventions
Participants were randomized to receive either hand assisted retroperitoneoscopic or standard laparoscopic donor nephrectomy.
Participants
190 kidney transplant donors.
Outcomes
Intraoperative outcomes included skin-to-skin time, warm ischemia time, blood loss, complications, incision pfannenstiel and graft related complications. Post operative outcomes included complications, reoperation, length of hospital stay, morphine requirement, recipient survival, death censored graft survival and post operative pain.
Follow-up
1 year.
CET Conclusions
This is a report of a very good randomised study comparing hand assisted retroperitoneoscopic donor nephrectomy (HARP) on the left side with traditional laparascopic donor nephrectomy. The results in 190 donors who were randomised showed no difference in physical function at one month, but the hand assisted retroperitoneoscopic nephrectomy resulted in significantly shorter operating time, a shorted warm ischemia time and a lower intraoperative event rate. The length of hospital stay and the post-operative complication rate were the same in both groups. The authors consider HARP as a valuable alternative to the laparascopic approach for left sided donor nephrectomy and in addition it is easier as a learning technique for units developing a laparascopic approach for left sided donor nephrectomy. It is not appropriate on the right side.
Data analysis
Available case analysis
Trial registration
Dutch trial registry - NTR1433