A randomized, prospective, parallel group study of laparoscopic versus laparoendoscopic single site donor nephrectomy for kidney donation.
Aull M J, Afaneh C, et al.American Journal of Transplantation. 2014; 14(7): 1630-1637.
Aims
To compare laparoendoscopic single site donor nephrectomy (LESS-DN) and laparoscopic donor nephrectomy (LDN) in terms of satisfaction and donor recovery in living donor nephrectomy patients.
Interventions
Patients were randomised to receive LDN or LESS-DN. LDN patients underwent laparoscopic nephrectomy in the lateral decubitus position and abdominal access was achieved using a Veress needle. For LESS-DN procedures, donors were placed in a modified flank position and following a vertical periumbical incision a GelPoint device was inserted into the abdomen and pneumoperitoneum.
Participants
100 kidney transplant donors scheduled to undergo donor nephrectomy.
Outcomes
The primary outcome was patient self-reported “return to 100%†measured by the number of days post-surgery that the patient reported a return to 100% functioning capacity. The secondary outcomes included operative data, post-operative data (within 30 days), donor subjective questionnaire results, long term follow-up (30 days to 5 years) and kidney transplant recipient outcomes. Kidney transplant recipient outcomes included assessment of ureteral complications or delayed graft function, patient and graft survival and graft function.
Follow-up
One month to 5 years.
CET Conclusions
This study of LESS donor nephrectomy versus standard laparoscopic donor nephrectomy found no difference in the key outcomes reported. LESS-DN was safe but did not have much of an impact on patient reported outcomes. Unfortunately the authors did not use a validated tool to assess donor recovery and there was also a low response rate of 75%. In particular, there was no difference in the primary outcome, days to self-reported full recovery, which was just over 7 weeks in both groups. Analgesia use, hospital stay and return to normal activities were all the same. Warm ischaemic time and operative complications were similar. The only difference found was in the proportion of donors who reported full recovery by 2 months, 80% LDN versus 97% LESS-DN. Interestingly the authors describe a much longer time to donor-reported recovery when patients respond by post, suggesting that when donors are asked face-to-face they may feel pressure to respond more positively.
Data analysis
Per protocol analysis
Trial registration
ClinicalTrials.gov – NCT01236326