Acessibilidade / Reportar erro

Comparison of laparoendoscopic single-site donor nephrectomy and conventional laparoscopic donor nephrectomy: donor and recipient outcomes

UROLOGICAL SURVEY

ENDOUROLOGY & LAPAROSCOPY

Comparison of laparoendoscopic single-site donor nephrectomy and conventional laparoscopic donor nephrectomy: donor and recipient outcomes

Afaneh C; Aull MJ; Gimenez E; Wang G; Charlton M; Leeser DB; Kapur S; Del Pizzo JJ

Department of Surgery, Division of Transplantation Surgery, New York Presbyterian Weill Cornell Medical College, New York, New York

Urology. 2011; 78: 1332-7

OBJECTIVE: To present a comparison of perioperative donor outcomes and recipient graft function in a series of patients undergoing laparoendoscopic single-site donor nephrectomy (LESS-DN) versus conventional laparoscopic donor nephrectomy (LDN).

METHODS: Data were collected for 50 consecutive LESS-DN patients and a matched cohort of 50 LDN patients.

The donor outcomes analyzed included operative time, estimated blood loss, complications, visual analog pain scores, and recovery time. The recipient outcomes analyzed included serum creatinine at discharge and follow-up and the incidence of delayed graft function.

RESULTS: The mean total operative time was shorter in the LDN group than in the LESS-DN group (P< 0.0001). Linear regression analysis of the LESS-DN operative times relative to case number showed a significant decrease in the operative time with increasing case number (r(2) = 0.19, P = 0.002). No statistically significant differences were found in estimated blood loss, warm ischemia time, length of stay, or visual analog pain scores between the 2 groups. However, the surgical incision was significantly smaller in the LESS-DN group (P < 0.0001). After discharge, the patient-reported time to complete recovery was faster in the LESSDN group (P = 0.01). The incidence of complications was similar in both groups; however, major complications only occurred in the LDN group. No differences were found in the recipient serum creatinine values or the incidence of delayed graft function.

CONCLUSION: Our initial experience with LESS-DN is encouraging. This retrospective matched-pair comparison between LESS-DN and LDN suggests that the single-port approach might be associated with quicker convalescence. Longer operative times in the LESS-DN group could simply represent the learning curve of a novel procedure.

Editorial Comment

Laparoscopic live donor nephrectomy (LDN) has become the standard of care at most major academic centers. The benefits of laparoscopic over open donor nephrectomy have extensively been demonstrated since the first report by Kavoussi et al. Recently, the LESS Urological procedures are gaining popularity. The authors studied 50 consecutive LESS-DN patients versus a matched cohort of 50 LDN patients.

They demonstrated that LESS-DN patients recovered faster and complications were comparable with equal graft function and warm ischemia time. This report is valuable since convalescence and recovery is pivotal variables that may influence the decision to become a kidney donor increasing the pool of donors for the current high demand. The Gelport was used in this study that may also facilitate the learning curve compared to other single ports.

Dr. Fernando J. Kim

Chief of Urology, Denver Health Med. Ctr.

Associate Professor, Univ. Colorado Health Sci. Ctr.

Director of Minimally Invasive Urol. Oncology, UCHSC

Denver, Colorado, USA

E-mail: fernando.kim@dhha.org

Publication Dates

  • Publication in this collection
    16 Feb 2012
  • Date of issue
    Dec 2011
Sociedade Brasileira de Urologia Rua Bambina, 153, 22251-050 Rio de Janeiro RJ Brazil, Tel. +55 21 2539-6787, Fax: +55 21 2246-4088 - Rio de Janeiro - RJ - Brazil
E-mail: brazjurol@brazjurol.com.br