Efficacy of Laparoscopic versus Open Donor Nephrectomy in the Living Kidney Donor: A Retrospective Cohort Study

Introduction: Renal transplantation is the optimal treatment for End-stage Renal Disease (ESRD), with living donor nephrectomy providing significant advantages over deceased donor renal transplantation. The present study compares the safety and efficacy of Laparoscopic Donor Nephrectomy (LDN) versus Open Donor Nephrectomy (ODN) in living kidney donors. Aim: To evaluate the efficacy of laparoscopic versus ODN. Materials and Methods: This retrospective cohort study was conducted in the Department of Urology at D.Y. Patil Medical College, Pune, Maharashtra, India, over a period of two years, from May 2022 to May 2024 involved 60 living kidney donors who underwent either LDN (30 patients) or ODN (30 patients). Data were collected from medical records, including demographic information, surgical details, and postoperative outcomes. Primary outcomes assessed included mean operative time, warm ischaemia time, amount of intraoperative blood loss, conversion rates to open surgery, and intra- as well as postoperative complications and difficulties encountered. Secondary outcomes included length of hospital stay, postoperative pain, recipient graft function, and donor renal function at the time of discharge. Quality of life was measured using a validated questionnaire at six months post- surgery. Data were analysed using the Student's t-test and Chisquare test with Statistical Packages of Social Sciences (SPSS) version 22.0, considering p<0.05 as statistically significant. Results: The mean age of the LDN and ODN patients was 50.10 +/- 10.69 years 50.17 +/- 7.88 years, respectively. Most patients were aged 51-60 years (40%) and predominantly female (65%). The ODN had a shorter mean operative time (186.50 +/- 27.04 vs. 256.23 +/- 25.53 minutes, p<0.001) and lower warm ischaemia time (3.30 +/- 1.36 vs. 9.10 +/- 3.82 minutes, p<0.001) compared to LDN. However, ODN resulted in greater blood loss (89.67 +/- 36.99 vs. 61.16 +/- 15.68 mL, p<0.001) and longer hospital stays (4.60 +/- 0.77 vs. 3.50 +/- 0.63 days, p<0.001). Peri- and postoperative complications were more frequent in ODN (n=8 Grade 1; n=1 Grade 3 complication). At six months, LDN donors reported better quality of life scores in physical function (85.0 vs. 78.0, p=0.02), vitality (78.0 vs. 70.0, p<0.05), social functioning (82.0 vs. 75.0, p=0.012), and mental health (80.0 vs. 73.0, p=0.006). Conclusion: The LDN offers superior surgical outcomes and quality of life for living kidney donors, promoting its continued use in renal transplantation. However, additional studies are necessary to validate these findings across various populations and clinical environments, especially in novice surgical centres.