A randomised controlled trial of conventional open versus laparoscopic-assisted live donor nephrectomy for renal transplantation.
journal contributionposted on 19.11.2015, 08:50 by Gareth Richard Rankin. Lewis
The use of live donors in renal transplantation is an area of rapidly expanding interest. This interest has been driven by the continuing fall in available cadaveric organs for transplantation. Live donor renal transplants accounting for twenty six percent of renal transplants in 2003, contrasting with an eight percent rate some ten years previously. Traditionally kidneys have been harvested from donors via a loin incision with partial resection of the tip of the twelfth rib, which placed a considerable burden on the donors in terms of post-operative pain, absence from work, and morbidity. A new minimally invasive laparoscopic technique was developed in 1995, which promised to lessen this burden placed upon the donor. Several non-randomised comparative studies have shown this new technique to hold promise in terms of less pain, and faster inpatient and outpatient recovery, with no apparent loss in quality of the graft harvested. Both pure laparoscopic and hand-assisted laparoscopic techniques are described, and two randomised trials have been published comparing a hand-assisted technique to the more traditional open technique. No study to date has compared a pure laparoscopic technique versus an open technique without resection of the twelfth rib. Our study showed a significantly shorter hospitalisation following the laparoscopic technique, associated with less pain on day one after the procedure. There were other favourable trends demonstrated with the laparoscopic technique, but larger trial numbers would be required to render these significant. No increase in donor morbidity, or difference in graft morphology, and graft function in the recipient was demonstrated. In conclusion, we have demonstrated that in the correct hands, laparoscopic live donor nephrectomy is a potentially superior donor procedure, with provision of equivalent quality allograft when compared to the traditional open procedure.