Comparison of laparoscopic and mini incision open donor nephrectomy: single blind, randomised controlled clinical trial

• Published in: BMJ Vol. 333; no. 7561; pp. 221 - 224
• Main Authors: Kok, Niels F M, Lind, May Y, Hansson, Birgitta M E, Pilzecker, Desiree, Mertens zur Borg, Ingrid R A M, Knipscheer, Ben C, Hazebroek, Eric J, Dooper, Ine M, Weimar, Willem, Hop, Wim C J, Adang, Eddy M M, van der Wilt, Gert Jan, Bonjer, Hendrik J, van der Vliet, Jordanus A, IJzermans, Jan N M
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 29-07-2006; British Medical Association; BMJ Publishing Group LTD; BMJ Publishing Group; BMJ Publishing Group Ltd
• Edition: International edition
• Subjects: Abdomen; Adult; Aged; Biological and medical sciences; Blood & organ donations; Blood donation; Cholecystectomy; Clinical trials; Digestive system. Abdomen; Endoscopy; Fatigue; Fatigue - etiology; Female; General aspects; Graft Survival; Hospitals; Humans; Investigative techniques, diagnostic techniques (general aspects); Kidneys; Laparoscopy; Laparoscopy - methods; Length of Stay; Living Donors; Male; Medical imaging; Medical sciences; Middle Aged; Nephrectomy; Nephrectomy - methods; Nephrology; Organ donation; Pain; Patient safety; Patients; Postoperative complications; Postoperative Complications - etiology; Quality of Life; Self image; Single-Blind Method; Skin; Statistical median; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tissue grafting; Transplants & implants; Universities; Veins & arteries; Netherlands; Human; Incision; Medicine; Treatment; Donor; Nephrectomy; Surgery; Randomised controlled trial; Clinical trial; Laparoscopy; Endoscopy; Comparative study
• ISSN: 0959-8138; 0959-8146; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.38886.618947.7C

Abstract Objectives To determine the best approach for live donor nephrectomy to minimise discomfort to the donor and to provide good graft function. Design Single blind, randomised controlled trial. Setting Two university medical centres, the Netherlands. Participants 100 living kidney donors. Interventions Participants were randomly assigned to either laparoscopic donor nephrectomy or to mini incision muscle splitting open donor nephrectomy. Main outcome measures The primary outcome was physical fatigue using the multidimensional fatigue inventory 20 (MFI-20). Secondary outcomes were physical function using the SF-36, hospital stay after surgery, pain, operating times, recipient graft function, and graft survival. Results Conversions did not occur. Compared with mini incision open donor nephrectomy, laparoscopic donor nephrectomy resulted in longer skin to skin time (median 221 v 164 minutes, P < 0.001), longer warm ischaemia time (6 v 3 minutes, P < 0.001), less blood loss (100 v 240 ml, P < 0.001), and a similar number of complications (intraoperatively 12% v 6%, P = 0.49, postoperatively both 6%). After laparoscopic nephrectomy, donors required less morphine (16 v 25 mg, P = 0.005) and shorter hospital stay (3 v 4 days, P = 0.003). During one year's follow-up mean physical fatigue was less (difference - 1.3, 95% confidence interval - 2.4 to - 0.1) and physical function was better (difference 6.2, 2.0 to 10.3) after laparoscopic nephrectomy. Function of the graft and graft survival rate of the recipient at one year censored for death did not differ (100% after laparoscopic nephrectomy and 98% after open nephrectomy). Conclusions Laparoscopic donor nephrectomy results in a better quality of life compared with mini incision open donor nephrectomy but equal safety and graft function.