Laparoscopic or open surgery for living donor nephrectomy

Background. The anterior extraperitoneal approach for living donor nephrect omy has been used in mol-e than 700 living cases in the unit and proved to be safe for the donor. In 1998, laparoscopic nephrectomy was introduced as an option when technically feasable. We found it essential to investigate t he consequences of the new technique. Subjects and methods. One hundred living donor kidney transplantations were performed from 1998 to June 2000, 45 with laparoscopic, 55 with open nephr ectomy. The donors took part in a structured interview 4 weeks after the do nation and their responses were categorized in three classes. Results, In each group, one recipient had delayed initial function. The ser um creatinine levels after 3 and 7 days or the GFR Values after 6 months di d not differ. One graft has been lost following laparoscopic nephrectomy an d four after open surgery. For the laparoscopy donors, the median number of post-operative days in hospital was 5.0 days (range 2-9), vs 6.0 (4-8) aft er open surgery (NS). The requirement of opoid analgesics post-operatively was 5.0 closes (1-22) vs 6.0 (1 38) (P = 0.02); and after 4 weeks, 23 Of 45 laparoscopic donors were free of pain vs eight of 55 open nephrectomy dono rs (P = 0.0004). Approximately one-third of all donors felt some restrictio n of physical activity and the majority complained of impaired physical ene rgy, There were no differences between the groups. The duration of sick-lea ve after laparoscopic surgery was median 6 (2-19) weeks vs 7 (1-16) (NS). Conclusions, Laparoscopic nephrectomy is safe. Less post-operative pain is a definite advantage for the donor.