Comparison of Clinical Outcomes of Hand-Assisted Retroperitoneoscopic with the Hand-Assisted Laparoscopic Donor Nephrectomy in Healthy Kidney Donors

Objective: To compare the outcomes of hand-assisted laparoscopic (HALS) and hand-assisted retroperitoneoscopic (HARS) donor nephrectomy procedures. Study Design: Descriptive study. Place and Duration of the Study: Pakistan Kidney and Liver Institute and Research Centre (PKLI & RC), Lahore, Pakistan, from May 2018 to December 2022. Methodology: Data from 358 donors were analysed for pre- and postoperative outcomes of HALS and HARS donor nephrectomies, considering techniques based on clinical judgement and donor characteristics, covering demographics, pre-and postoperative complications under multidisciplinary oversight. Results: In a group of 358 donors, the median age was 36 years, with an interquartile range (IQR) of 29-44 years, and the median (IQR) body mass index (BMI) was 25.82 (22.57-28.53). Most donors were female (58.7%) and had blood type O (47.8%). A majority had no prior surgeries (86.0%). HALS donor nephrectomies were performed in 36.3% and HARS donor nephrectomies in 63.7%, with left kidneys predominantly procured (98.3%). The median warm ischaemia time (WIT) was 88.00 seconds (IQR: 17.25). No complications were reported in 95.5% of cases. Pain scores at 12 hours (p <0.001), 24 hours (p <0.001), 48 hours (p <0.001), and 10 days (p = 0.028), along with the length of hospital stay (LOS) (p <0.001), displayed significant differences in their distributions across procedures. HARS donor nephrectomies showed better pain management, while both techniques had similar outcomes for early bowel movement within 48 hours. Conclusion: The study results emphasise tailored surgical approaches and meticulous postoperative care in live kidney donation surgeries. HARS technique offers advantages in postoperative pain management, contributing to optimising donor outcomes and surgical techniques.