Risk reduction strategies in laparoscopic donor nephrectomy: A comparative study

OBJECTIVES: As the advancements, modifications and standardization of laparoscopy are taking place, there is a need for the reduction in morbidity associated with laparoscopic live donor nephrectomy. This study was performed to determine and reconfirm the advantages of laparoscopic donor nephrectomy over its open counterpart. MATERIALS AND METHODS: Two hundred open live donor nephrectomy (ODN) cases were compared to 264 cases of laparoscopic live donor nephrectomy (LDN). Pretransplant functional and radiological evaluation was done routinely by excretory urogram and renal arteriography. In case of vascular variations, CT angiography was preferred. Open cases were done by conventional method and laparoscopic group underwent certain technical and surgical modifications, including meticulous planning for the port placement. Operative time, analgesia requirement, start of the orals, hospital stay, blood loss, late allograft function, incidence of rejection, complications and technical problems were analyzed. RESULTS: Operative time was 135.8 +/- 43 and 165 +/- 44.4 min (P<0.0001), requirement of analgesia was 60.5 +/- 40 and 320 +/- 120 mg (P<0.0001), hospital stay was 4 +/- 0.04 and 5.7 +/- 2.03 days (P<0.0001), warm ischemia time was 6.1 +/- 2.0 and 4.1 +/- 0.80 min (P<0.0001) and time taken for the serum creatinine to stabilize in the recipient was 4.1 +/- 1.6 and 4.32 +/- 1.40 days (P=0.06) for LDN and ODN groups respectively. There was a significant reduction in the blood loss in LDN group (P=0.0005). Overall complications were 6.81 and 14.5% and ureteric injury was seen in 0.37 and 1% in LDN and ODN respectively. CONCLUSION: Laparoscopic live donor nephrectomy can now be performed with low morbidity and mortality to both donors and recipients and is proving to be the preferred operation to open donor nephrectomy. Our continued innovations in technical modifications have made this novel operation successful.