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A cost-effective technique for pure laparoscopic live donor nephrectomy
Tiberio M Siqueira1, Anuar I Mitre, Fabiano A Simoes
1Kidney Transplantation Center General Hospital, Federal University of Pernambuco, Recife, Pernambuco, Brazil. tiberiojr@uol.com.br
Summary
Laparoscopic live donor nephrectomy (LDN) techniques were compared. Center A’s manual specimen retrieval was cheaper and safe, despite a longer learning curve, showing no adverse donor or recipient outcomes.
Area of Science:
- Nephrology
- Surgical Innovation
- Transplantation Medicine
Background:
- Laparoscopic live donor nephrectomy (LDN) is a standard procedure in kidney transplantation.
- Comparing different surgical techniques is crucial for optimizing outcomes and costs.
Purpose of the Study:
- To compare two distinct laparoscopic live donor nephrectomy (LDN) techniques.
- To evaluate operative costs and the learning curve associated with each technique.
Main Methods:
- A comparative study of 61 patients undergoing pure transperitoneal LDN across two centers (Center A: n=11, Center B: n=50).
- Center A utilized Hem-O-Lok clips and manual specimen retrieval; Center B used endo-GIA appliers and endobags.
- Data collected included operative time, warm ischemia time, blood loss, complications, and costs.
Main Results:
- Center B demonstrated statistically better operative time, warm ischemia time, and blood loss (p < 0.000, p = 0.002, p = 0.02 respectively).
- Discharge times were similar; major complications and donor outcomes were comparable, with one donor death in Center B (2%) and one open conversion in Center A (9.1%).
- Center A achieved a cost saving of US$1,440 per procedure.
Conclusions:
- The technique used at Center A, despite a learning curve, yielded no adverse donor or recipient outcomes compared to Center B.
- Center A's approach proved more cost-effective, presenting an attractive alternative for LDN, particularly in resource-limited settings.