Subcostal versus transcostal mini donor nephrectomy: is rib resection responsible for pain related donor morbidity

Conventional donor nephrectomy is associated with significant postoperative morbidity. Whether this morbidity is associated with rib resection or a long incision is not clear. We designed a prospective randomized study of subcostal and transcostal mini incision donor nephrectomy and compared the results.

We performed 82 donor nephrectomies in the study period of December 2000 to July 2001. Open donor nephrectomies were randomized to subcostal (25) or transcostal (24) mini incision techniques. Results were compared and analyzed using the independent t test.

The subcostal and transcostal groups were comparable in terms of patient age, body mass index, nephrectomy side, number of renal vessels and incision length (9.32 vs 9.72 cm). Patients in the subcostal group had a lesser postoperative analgesic requirement (304 +/- 49.8 vs 487 +/- 74.1 mg, p = 0.0001), shorter hospital stay (2.36 +/- 0.7 vs 3.71 +/- 0.81 days, p = 0.0001) and early convalescence (26.56 +/- 4.06 vs 37.46 +/- 6.05 days) compared with the transcostal group. Warm ischemia time and recipient outcome were similar in the groups.

Rib sparing, subcostal mini incision donor nephrectomy has significantly less morbidity and a shorter hospital stay compared with the rib resection transcostal technique.