Laparoscopic versus open donor nephrectomy. An appraisal on surgical outcome and post-operative course

Laparoscopic living donor nephrectomy (LLDN) is supposed to be safe and effective and it ensures an excellent allograft function in the recipient. The use of laparoscopic technique is rapidly spreading in most transplant programs since it offers advantages over the open procedure. Aim of our study is to evaluate both surgical outcome and post-operative course in the LLDN group comparing with an historical series of open donor nephrectomies (ODN).

From January 1992 to August 2008, 37 living donor nephrectomies were performed in our center. 23 nephrectomies were carried out, laparoscopically and 14 by open technique. Donors characteristics were comparable in both groups.

All laparoscopic nephrectomies were performed successfully without conversion. No significant differences were observed between the two groups for both surgical complication and graft and patient survival rates. Mean warm ischemia time (p < 0.04), resumption of oral intake (p < 0.03) and length of hospital stay (p < 0.0001) were shorter in the LLDN group. Mean operative time (p < 0.036) was longer in the LLDN group, whereas time to return to work and daily activities were similar (p < 0.52).

Laparoscopic nephrectomy provides some post-operative advantages over the open technique without additional surgical risk ensuring comparable graft and patient outcomes. Therefore, LLDN has become the standard approach in our transplant center. However, the laparoscopic procedure should be performed only by experienced surgical staff in order to prevent serious complications in the donors.