Laparoscopic Donor Nephrectomy Has Better Outcomes Than Open Donor Nephrectomy

Ahmet Keles, MD

Credit: ResearchGate

Laparoscopic donor nephrectomy has better outcomes than open door nephrectomy in terms of hospital stay length, urinary catheterization duration, operating time, and blood loss, according to a new study.¹

Ever since Llyod E. Ratner, MD, introduced laparoscopic donor nephrectomy in 1955, donor transplants have become more successful. In 1994, there were 3004 live donor kidney transplants.² Seven years later, once surgeons implemented the laparoscopic donor nephrectomy technique, the yearly rate of live donor kidney transplants increased to 5949 cases. Nephrectomy stands apart from other surgical procedures because the surgery transfers the organs of a healthy individual to someone with organ failure.¹

“Living-donor nephrectomy is considered the most stressful intervention in urology because, by definition, it involves an altruistic organ donation by healthy individuals,” investigators of the new study wrote. “Donor nephrectomy is a unique operation in that it exposes a person in complete health to the potential complications of major surgery for the benefit of the recipient.”

The investigators continued by adding that since a healthy individual willingly heads into surgery and risks unexpected complications, surgeons should keep donor safety a priority in kidney transplantation.

The retrospective study, led by Ahmet Keles, MD, from the department of urology at Istanbul Medeniyet University in Uskudar, Turkey, sought to compare preoperative and postoperative outcomes of kidney donors who went through transperitoneal laparoscopic nephrectomy or open nephrectomy.

In the study, kidney donors were broken into two groups. In group 1, donors (n = 55) underwent open nephrectomy (n = 21), and in group 2 donors underwent transperitoneal laparoscopic nephrectomy (n = 34).

Compared to donors who underwent open nephrectomy, donors who underwent transperitoneal laparoscopic nephrectomy had significantly shorter postoperative hospital stays (2.3 ± 0.2 versus 3.8 ± 0.8 days, P = .003), urinary catheterization duration (1.2 ± 0.8 days versus 2.0 ± 0.7 days, P = .0001), operating times (210 ± 27 minutes versus 185 ± 24 minutes, P = .02), and less blood loss (86 ml versus 142 ml, P = .048).

Donors from both groups 1 and 2 had comparable serum creatinine levels for the preoperative week, first postoperative week, and 1-month postoperative week. Both groups also did not have statistically significant differences regarding the estimated blood transfusion and warm ischemia time. Previous studies reported a warm ischemia time of around 2.6 minutes. In the new study, however, the warm ischemia time was 2.7 minutes. Although the time was below 3 minutes—which is the time the warm ischemia should not exceed—it was still longer than earlier studies. Reducing the warm ischemia time is important to avoid renal injury.

“In general, the warm ischemia time is expected to be shorter in minimally invasive donor nephrectomy than in open donor nephrectomy,” the investigators wrote. “However, in our study, we observed a longer warm ischemia time in the open donor nephrectomy group than that reported in the literature.”

While recipients might view the 2 transplant surgeries similarly, as both techniques receive comparable outcomes, the investigators and donors had a positive viewpoint of laparoscopic nephrectomy.

“Based on the transperitoneal laparoscopic nephrectomy experience gained during this study, we adopted a point of view that seemed promising in terms of minimizing the morbidity associated with the learning curve,” the investigators wrote. “From the donors’ standpoint, the transperitoneal laparoscopic nephrectomy results were superior to those of the open approach.”

^References

1. ^{Keleş A, Kaya C. A comparison of pre- and post-operative outcomes in living donors undergoing transperitoneal laparoscopic nephrectomy and open nephrectomy: a retrospective single-center study. Sao Paulo Med J. 2023;142(3):e2022488. Published 2023 Dec 8. doi:10.1590/1516-3180.2022.0488.R1.070723}
2. ^{Bartlett ST. Laparoscopic donor nephrectomy after seven years. Am J Transplant. 2002;2(10):896-897. doi:10.1034/j.1600-6143.2002.21004.x}