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Randomized Controlled Trial
. 2006 Jul 29;333(7561):221.
doi: 10.1136/bmj.38886.618947.7C. Epub 2006 Jul 17.

Comparison of laparoscopic and mini incision open donor nephrectomy: single blind, randomised controlled clinical trial

Niels F M Kok  1 , May Y Lind, Birgitta M E Hansson, Desiree Pilzecker, Ingrid R A M Mertens zur Borg, Ben C Knipscheer, Eric J Hazebroek, Ine M Dooper, Willem Weimar, Wim C J Hop, Eddy M M Adang, Gert Jan van der Wilt, Hendrik J Bonjer, Jordanus A van der Vliet, Jan N M IJzermans
Affiliations
Randomized Controlled Trial

Comparison of laparoscopic and mini incision open donor nephrectomy: single blind, randomised controlled clinical trial

Niels F M Kok et al. BMJ. .

Abstract

Objectives: To determine the best approach for live donor nephrectomy to minimise discomfort to the donor and to provide good graft function.

Design: Single blind, randomised controlled trial.

Setting: Two university medical centres, the Netherlands.

Participants: 100 living kidney donors.

Interventions: Participants were randomly assigned to either laparoscopic donor nephrectomy or to mini incision muscle splitting open donor nephrectomy.

Main outcome measures: The primary outcome was physical fatigue using the multidimensional fatigue inventory 20 (MFI-20). Secondary outcomes were physical function using the SF-36, hospital stay after surgery, pain, operating times, recipient graft function, and graft survival.

Results: Conversions did not occur. Compared with mini incision open donor nephrectomy, laparoscopic donor nephrectomy resulted in longer skin to skin time (median 221 v 164 minutes, P < 0.001), longer warm ischaemia time (6 v 3 minutes, P < 0.001), less blood loss (100 v 240 ml, P < 0.001), and a similar number of complications (intraoperatively 12% v 6%, P = 0.49, postoperatively both 6%). After laparoscopic nephrectomy, donors required less morphine (16 v 25 mg, P = 0.005) and shorter hospital stay (3 v 4 days, P = 0.003). During one year's follow-up mean physical fatigue was less (difference - 1.3, 95% confidence interval - 2.4 to - 0.1) and physical function was better (difference 6.2, 2.0 to 10.3) after laparoscopic nephrectomy. Function of the graft and graft survival rate of the recipient at one year censored for death did not differ (100% after laparoscopic nephrectomy and 98% after open nephrectomy).

Conclusions: Laparoscopic donor nephrectomy results in a better quality of life compared with mini incision open donor nephrectomy but equal safety and graft function.

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Figures

Fig 1
Fig 1
Flow of patients
Fig 2
Fig 2
Physical function and physical fatigue (means with 95% confidence intervals) during follow-up of living kidney donors after laparoscopic nephrectomy or mini incision open donor nephrectomy. Numbers refer to donors evaluated at each time point
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References

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