Prospective, case matched comparison of hand assisted laparoscopic and open surgical live donor nephrectomy

Purpose: The technical difficulty of standard laparoscopic live donor nephr ectomy has limited its application. Hand assistance, which takes advantage of the incision necessary for organ removal, facilitates laparoscopy withou t significant impact on patient recovery. We prospectively compared open su rgical and hand assisted laparoscopic donor nephrectomy. Materials and Methods: Our first 10 laparoscopic live donor nephrectomies w ere matched with 40 open donor nephrectomies by gender, age and body mass i ndex. Data were obtained by pain scales, SF-12 survey instruments, question naires and chart abstraction. Results: Operative time was longer for the laparoscopic approach (mean 95 v ersus 215 minutes). However, laparoscopic group patients had a shorter hosp ital stay compared to tl lose undergoing open surgery (mean 2.9 versus 1.8 days), returned sooner to nonstrenuous activity (mean 19.0 versus 9.9 days) and reported less pain 6 weeks postoperatively (mean 2.3 versus 0.6) (p le ss than or equal to 0.03 for all). There were no differences between groups in terms of donor complications, allograft function and ureteral complicat ions. Mean hospital cost was 23% greater in the laparoscopic group (p = 0.0 05) but global cost, which accounted for estimated loss of income from work during the recovery period, was only 15% greater (p = 0.10). Mean operativ e time was significantly improved for our second compared to our first 5 la paroscopic group patients (177 versus 254 minutes). Conclusions: Laparoscopic live donor nephrectomy appears to be a safe and e ffective alternative to open donor nephrectomy. Indexes of patient recovery suggest patient morbidity similar to that reported following standard lapa roscopic donor nephrectomy and significantly less than after open nephrecto my. Improvement in operative time in the first 10 cases suggests that hand assistance "shortens" the learning curve, which might encourage more surgeo ns to offer laparoscopic live donor nephrectomy.