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Research

Comparison of laparoscopic and mini incision open donor nephrectomy: single blind, randomised controlled clinical trial

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.38886.618947.7C (Published 27 July 2006) Cite this as: BMJ 2006;333:221
  1. Niels F M Kok, research fellow1,
  2. May Y Lind, surgical resident1,
  3. Birgitta M E Hansson, consultant2,
  4. Desiree Pilzecker, research fellow3,
  5. Ingrid R A M Mertens zur Borg, consultant4,
  6. Ben C Knipscheer, consultant5,
  7. Eric J Hazebroek, surgical resident1,
  8. Ine M Dooper, consultant3,
  9. Willem Weimar, professor of transplantation6,
  10. Wim C J Hop, statistician7,
  11. Eddy M M Adang, deputy head8,
  12. Gert Jan van der Wilt, head of department8,
  13. Hendrik J Bonjer, professor1,
  14. Jordanus A van der Vliet, consultant2,
  15. Jan N M IJzermans (j.ijzermans{at}erasmusmc.nl), professor of transplantation surgery1
  1. 1 Department of Surgery, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, Netherlands
  2. 2 Department of Surgery, Radboud University Medical Centre, Nijmegen, Netherlands
  3. 3 Department of Nephrology, Radboud University Medical Centre
  4. 4 Department of Anaesthesiology, Erasmus MC
  5. 5 Department of Urology, Radboud University Medical Centre
  6. 6 Department of Nephrology, Erasmus MC
  7. 7 Department of Epidemiology and Biostatistics, Erasmus MC
  8. 8 Department of Medical Technology Assessment, Radboud University Medical Centre
  1. Correspondence to: J N M IJzermans
  • Accepted 25 May 2006

Abstract

Objectives To determine the best approach for live donor nephrectomy to minimise discomfort to the donor and to provide good graft function.

Design Single blind, randomised controlled trial.

Setting Two university medical centres, the Netherlands.

Participants 100 living kidney donors.

Interventions Participants were randomly assigned to either laparoscopic donor nephrectomy or to mini incision muscle splitting open donor nephrectomy.

Main outcome measures The primary outcome was physical fatigue using the multidimensional fatigue inventory 20 (MFI-20). Secondary outcomes were physical function using the SF-36, hospital stay after surgery, pain, operating times, recipient graft function, and graft survival.

Results Conversions did not occur. Compared with mini incision open donor nephrectomy, laparoscopic donor nephrectomy resulted in longer skin to skin time (median 221 v 164 minutes, P < 0.001), longer warm ischaemia time (6 v 3 minutes, P < 0.001), less blood loss (100 v 240 ml, P < 0.001), and a similar number of complications (intraoperatively 12% v 6%, P = 0.49, postoperatively both 6%). After laparoscopic nephrectomy, donors required less morphine (16 v 25 mg, P = 0.005) and shorter hospital stay (3 v 4 days, P = 0.003). During one year's follow-up mean physical fatigue was less (difference - 1.3, 95% confidence interval - 2.4 to - 0.1) and physical function was better (difference 6.2, 2.0 to 10.3) after laparoscopic nephrectomy. Function of the graft and graft survival rate of the recipient at one year censored for death did not differ (100% after laparoscopic nephrectomy and 98% after open nephrectomy).

Conclusions Laparoscopic donor nephrectomy results in a better quality of life compared with mini incision open donor nephrectomy but equal safety and graft function.

Footnotes

  • Embedded Image Table with data for additional dimensions is on bmj.com

    We thank J G van Duuren-van Pelt, data manager, and I P J Alwayn, surgeon, for their contributions to this study.

  • Contributors WW, BMEH, GJvdW, EJH, IRAMMzB, HJB, JAvdV, and JNMI contributed to the design and initial planning of this study. BMEH, BCK, HJB, and JNMIJ attended all operations and controlled the carrying out of the surgical technique. NFMK, MYL, EJH, and DP collected the donors' data. WW and IMD collected the recipients' data. WCJH was the trial statistician. NFMK, EMMA, and GJvdW were responsible for collecting, analysing, interpreting, and writing up the quality of life data. IRAMMzB supervised and controlled the anaesthesiology protocol. NFMK, WW, JNMI, and EMMA coordinated the writing and drafting of the article. JNMI is guarantor.

  • Funding This study was supported by unrestricted grants from the Society of American Gastrointestinal Endoscopic Surgeons and the Dutch Kidney Foundation.

  • Competing interest None declared.

  • Ethical approval This study was approved by the medical ethics committees of the university medical centres at Rotterdam and Nijmegen.

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