Randomized controlled trial of hand-assisted laparoscopic versus open surgical live donor nephrectomy

Background. Laparoscopic live donor nephrectomy for renal transplantation i s being performed in increasing numbers with the goals of broadening organ supply while minimizing pain and duration of convalescence for donors. Rela tive advantages in terms of recovery provided by laparoscopy over standard open surgery have not been rigorously assessed. We hypothesized that laparo scopic as compared with open surgical live donor nephrectomy provides brief er, less intense, and more complete convalescence. Methods. Of 105 volunteer, adult, potential living-renal donors interested in the laparoscopic approach, 70 were randomly assigned to undergo either h and-assisted laparoscopic or open surgical live donor nephrectomy at a sing le referral center. Objective data and subjective recovery information obta ined with telephone interviews and validated questionnaires administered 2 weeks, 6 weeks, and 6-12 months postoperatively were compared between the 2 3 laparoscopic and 27 open surgical patients. Results. There was 47% less analgesic use (P=0.004), 35% shorter hospital s tay (P=0.0001), 33% more rapid return to nonstrenuous activity (P=0.006),23 % sooner return to work (P=0.037), and 73% less pain 6 weeks postoperativel y (P=0.004) in the laparoscopy group. Laparoscopic patients experienced com plete recovery sooner (P=0.032) and had fewer long-term residual effects (P =0.0015). Conclusions. Laparoscopic donor nephrectomy is associated with a briefer, l ess intense, and more complete convalescence compared with the open surgica l approach.