A controlled sequential evaluation of laparoscopic donor nephrectomy versus open donor nephrectomy: an update

In this study, we compared laparoscopic (lap Nx) to open donor nephrectomy (open Nx) with specific emphasis on outcomes in the donor and recipient.

This single-center sequential analysis recruited 100 consecutive donor-recipient pairs operated on from 1997 until 2003. The open Nx (n = 30), were performed between 1997 and 2000; the lap Nx (n = 70) were performed between 2000 and 2003. Prospective records included operative data, anatomic details of the graft, hospital stay, and donor recovery.

Donor characteristics and renal function were similar for open Nx and lap Nx. Operative parameters were similar except for the longer warm ischemia time in lap Nx versus open Nx (3.14 +/- 2.10 vs 1.5 +/- 0.5 minute, P < .001). Donor complications were equivalent in number, but differed in spectrum with a trend toward more intraoperative complications with lap Nx versus more postoperative complications for open Nx. Donor recovery, hospital stay, and return to work were improved in lap Nx versus open Nx (P < .001). Renal function of grafts after lap Nx were similar to open Nx: 2-year serum creatinine values of 1.26 +/- 0.21 versus 1.31 +/- 0.40, respectively. Graft survivals were similar.

Compared to open Nx lap Nx offers major advantages to the donor, and yields similarly favorable results in graft outcomes. However, it is more surgically demanding. Consequently, lap Nx should be adopted as the procedure of choice for living kidney retrieval.