Retroperitoneal Single Port Versus Transperitoneal Multiport Donor Nephrectomy: A Prospective Randomized Control Trial

Background: Laparoscopic donor nephrectomy (LDN) converted a retroperitoneal (RP) procedure into a transperitoneal (TP) operation with reports of bowel and solid organ injuries leading to mortality in occasional cases. Laparoscopic RP donor nephrectomy can reduce these risks but never became popular because of the muscle cutting approach. Lumbotomy incision can be used to approach retroperitoneum by incising fascial planes, eliminating disadvantages of the RP approach. This report compares the outcomes of the standard multiport TP LDN with translumbar laparoendoscopic single-site donor nephrectomy (LESS-DN). Methods: Between January 2016 and June 2017, 50 voluntary kidney donors out of 267 donors were randomized to undergo LESS-DN vs LDN. Donors with body mass index 30kg/m(2), multiple renal arteries, and right-sided nephrectomy were excluded from the study. Postoperative pain, duration of surgery, length of graft vessels and ureter, warm ischemia time, intraoperative blood loss, incision length, convalescence period, duration of hospital stay, and recipients' creatinine at discharge were compared among both the groups. Pain assessment was done using visual analogue scale (VAS). Results: The RP group experienced lesser pain (VAS score 0.30.3 vs 1.1 +/- 0.0, p=0.000), lesser analgesic requirement (186 +/- 51.07mg vs 254 +/- 62.7mg, p=0.000), and faster convalescence (7.0 +/- 3.0 days vs 10.7 +/- 3.3 days, p=0.00) related to smaller cumulative incision (7.8 +/- 0.8cm vs12.4 +/- 2.0cm, p=0.00), and had reduced operative time (142 +/- 26.2 minutes vs 170.8 +/- 34.75 minutes, p=0.001) and blood loss. Other recorded parameters were similar in both the groups. Conclusions: The single port RP approach significantly reduced postoperative pain and hastened recovery when compared with the TP approach. Converting to a RP approach presents an opportunity for surgeons to further reduce morbidity associated with the donor nephrectomy.