Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Jan 6, 2017; 6(1): 45-52
Published online Jan 6, 2017. doi: 10.5527/wjn.v6.i1.45
Laparoscopic vs open donor nephrectomy: Lessons learnt from single academic center experience
Georgios Tsoulfas, Polyxeni Agorastou, Dicken S C Ko, Martin Hertl, Nahel Elias, AB Cosimi, Tatsuo Kawai
Georgios Tsoulfas, Polyxeni Agorastou, Department of Surgery, Aristotle University of Thessaloniki, 54622 Thessaloniki, Greece
Dicken S C Ko, Martin Hertl, Nahel Elias, AB Cosimi, Tatsuo Kawai, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114-2696, United States
Author contributions: Tsoulfas G, Agorastou P and Kawai T contributed equally to thiswork; Tsoulfas G and Agorastou P collected and analyzed the data, and drafted the manuscript; Kawai T provided analytical oversight; Kawai T designed and supervised the study; Ko DSC, Hertl M, Elias N and Cosimi AB revised the manuscript for important intellectual content; Ko DSC, Hertl M, Elias N and Kawai T offered the technical or material support; Tsoulfas G, Agorastou P and Kawai T provided administrative support; all authors have read and approved the final version to be published.
Institutional review board statement: The study was reviewed and approved by the Massachusetts General Hospital - Partners Human Research Institutional Review Board. Protocol #: 2015P001576/MGH.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors report no conflict of interest.
Data sharing statement: Technical appendix, statistical code and data set available from the corresponding author at tsoulfasg@gmail.com. Consent was not obtained but the obtained data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Georgios Tsoulfas, MD, PhD, Assistant Professor of Surgery, Department of Surgery, Aristotle University of Thessaloniki, 66 Tsimiski Street, 54622 Thessaloniki, Greece. tsoulfasg@gmail.com
Telephone: +30-697-1895190 Fax: +30-231-0332022
Received: June 17, 2016
Peer-review started: June 17, 2016
First decision: July 4, 2016
Revised: September 23, 2016
Accepted: October 25, 2016
Article in press: October 27, 2016
Published online: January 6, 2017
Processing time: 194 Days and 14.1 Hours
Abstract
AIM

To compare laparoscopic and open living donor nephrectomy, based on the results from a single center during a decade.

METHODS

This is a retrospective review of all living donor nephrectomies performed at the Massachusetts General Hospital, Harvard Medical School, Boston, between 1/1998 - 12/2009. Overall there were 490 living donors, with 279 undergoing laparoscopic living donor nephrectomy (LLDN) and 211 undergoing open donor nephrectomy (OLDN). Demographic data, operating room time, the effect of the learning curve, the number of conversions from laparoscopic to open surgery, donor preoperative glomerular filtration rate and creatinine (Cr), donor and recipient postoperative Cr, delayed graft function and donor complications were analyzed. Statistical analysis was performed.

RESULTS

Overall there was no statistically significant difference between the LLDN and the OLDN groups regarding operating time, donor preoperative renal function, donor and recipient postoperative kidney function, delayed graft function or the incidence of major complications. When the last 100 laparoscopic cases were analyzed, there was a statistically significant difference regarding operating time in favor of the LLDN, pointing out the importance of the learning curve. Furthermore, another significant difference between the two groups was the decreased length of stay for the LLDN (2.87 d for LLDN vs 3.6 d for OLDN).

CONCLUSION

Recognizing the importance of the learning curve, this paper provides evidence that LLDN has a safety profile comparable to OLDN and decreased length of stay for the donor.

Keywords: Laparoscopic donor nephrectomy; Open donor nephrectomy; Living donor renal transplantation; Complications; Surgical technique; Renal graft function

Core tip: The experience of the Massachusetts General Hospital was reviewed to compare laparoscopic vs open donor nephrectomy in a 10-year period. A review of the results of operating room time and conversions to open made the importance of the learning curve apparent. Although there was no difference in the recipient kidney function, the length of hospital stay was significantly shorter for the laparoscopic procedure. Overall, the laparoscopic donor nephrectomy appears to be the preferred surgical approach, considering the importance of the learning curve.