Comparison of laparoscopic live donor nephrectomy versus the traditional open technique

Laparoscopic live donor nephrectomy (LDN) is a minimally invasive technique for kidney procurement that may decrease the donor disincentives. In addition, recent studies have demonstrated that LDN has equal graft and recipient survival when compared to the standard open approach. We report our experience with LDN and compare the results with the most recent open donor nephrectomy (ODN) group performed at our institutions.

The records of 70 consecutives left sided LDN performed between October 1998 and March 2001 were retrospectively reviewed and compared to 40 ODN performed between April 1996 and January 2000.

Average blood loss (127 ml vs. 317 ml; p < 0.001), time to PO intake (25 hrs vs. 34.6 hrs; p < 0.001), and hospital stay (2.7 d vs. 4.2 d; p < 0.001) were statistically significant better for the LDN group when compared to ODN group. The average warm ischemia time in the LDN group was 138 seconds (range 55 - 360). The major complication rate in both laparoscopic (4 cases) and open (2 cases) donor groups was similar (5.7% and 5%, respectively). The average post-operative day (POD) 90 recipient creatinine was similar for both groups (1.5+/-0.9 vs. 1.5+/-0.8 ng/dL; p= 0.799). Similar rates of recipient ureteral complications occurred in the LDN and ODN groups: 1.4% (1 case) and 2.5% (1 case), respectively. Likewise, acute rejection was also similar at 22.8% (16 cases) and 27.5% (11 cases) in the LDN and ODN respectively.

At our institutions, LDN was superior to ODN with regards to donor operative blood loss, time to PO intake, and length of hospital stay. In addition, similar complication rates, and 3-month recipient kidney function were demonstrated.