LAPAROSCOPIC ASSISTED LIVE DONOR NEPHRECTOMY - A COMPARISON WITH THE OPEN APPROACH

Live donor renal transplantation provides significant advantages when compared with cadaveric donor renal transplantation in terms of improv ed patient and graft survival, a lower incidence of delayed function, and a shorter waiting time. Yet despite these advantages, live donors continue to be an under utilized source of kidneys for transplantation . Disincentives to live donation include the length of hospitalization , postoperative pain, cosmetic concerns, and the prolonged convalescen ce associated with the donor operation. In many instances minimally in vasive video-assisted techniques have proven more efficacious than sta ndard open procedures in terms of patient discomfort, length of hospit al stay, cost, and length of time until the patient can return to full activity, Laparoscopic live donor nephrectomies are being performed a t our institution in an attempt to make live donation more attractive to the potential donor, The purpose of this study was to retrospective ly review the results of laparoscopic live donor nephrectomy (LapNx) a nd to compare them with those obtained using the standard open approac h (OpenNx), Ten consecutive LapNx were performed from February 1995 th rough April 1996, The control group consisted of the 20 consecutive Op enNx performed at the same institution from January 1991 through Janua ry 1995 immediately before the initiation of the LapNx program. Live d onors were considered candidates for LapNx if they possessed at least one kidney with normal renal anatomy with single renal vessels and a s ingle ureter. LapNx was safely performed in all cases, No patients req uired open conversion or blood transfusions, The allograft warm ischem ic time for the laparoscopic cases was 4.2+/-1.3 min, All kidneys harv ested laparoscopically produced urine on the table immediately upon re vascularization, Presently nine of the ten recipients have functioning allografts. At three months posttransplant the calculated recipient c reatinine clearances were 67.0+/-11.5 ml/min and 64.8+/-21.4 ml/min fo r the LapNx and OpenNx groups, respectively (P=NS), The LapNx donors h ad a significantly decreased estimated blood loss, shorter time until resumption of oral intake, decreased postoperative pain (in terms of d ecreased analgesic requirements), shorter hospitalization and a shorte r interval until the resumption of full activities (P<0.05 for all), I n addition, the LapNx group donors returned to work sooner than the Op enNx group (3.9+/-1.6 wk vs, 6.4+/-3.1 wk, respectively) (P=0.024). Fo ur individuals agreed to donate a kidney only after learning of the av ailability of the laparoscopic approach, We conclude that laparoscopic live donor nephrectomy is technically feasible. In addition, it may o ffer significant advantages over the standard open approach in terms o f patient comfort and convenience, These advantages may make live dono r renal transplantation more attractive to prospective donors. The pot ential decrease in hospitalization and convalescence may also prove to be financially advantageous, We believe that further careful study of this procedure is warranted.