Author(s): Canes D, Berger A, Aron M, Brandina R, Goldfarb DA
BACKGROUND: Laparo-endoscopic single site (LESS) surgery is a recent development in minimally invasive surgery. Presented herein is the initial comparison of LESS donor nephrectomy (LESS-DN) and standard laparoscopic living donor nephrectomy (LLDN).
OBJECTIVE: To determine whether LESS-DN provides any measurable benefit over LLDN during the perioperative period and subsequent convalescence. DESIGN, SETTING, AND PARTICIPANTS: Between November 2007 and November 2008, 18 consecutive patients underwent LESS-DN (17 left DN, 1 right DN). A contemporary matched-pair cohort of 17 patients undergoing standard LLDN was selected for retrospective comparison.
INTERVENTIONS: LESS-DN was performed through an intraumbilical novel multichannel port. The kidney was extracted through a slightly extended umbilical incision.
MEASUREMENTS: All data were prospectively accrued in an institutional review board-approved database. Convalescence data included visual analog pain scores and questionnaires containing patient-reported time to recovery end points.
RESULTS AND LIMITATIONS: One right-sided donor was converted to standard laparoscopy and excluded from analysis. Baseline demographics, operating time, blood loss, and hospital stay were comparable between groups. Compared to LLDN, patients undergoing LESS-DN had similar in-hospital analgesic requirements and mean visual analog scores at discharge. After discharge, patient-reported convalescence was faster in the LESS-DN group, including days on oral pain medication (20 vs 6; p=0.01), days off work (46 vs 18; p=0.0009), and days to 100% physical recovery (83 vs 29; p=0.03). Mean warm ischemia time was longer in the LESS-DN group (3 vs 6.1 min; p<0.0001); however, allograft function was immediate and comparable between groups. One allograft in the LESS-DN group thrombosed postoperatively. Regardless of laparoscopic approach, patients' global satisfaction with kidney donation and willingness to recommend their procedure to others were favorable and equivalent between groups.
CONCLUSIONS: This retrospective matched-pair comparison between LESS-DN and LLDN suggests that the single-port approach may be associated with quicker convalescence. In this initial series, LESS-DN had longer ischemia time, yet early allograft outcomes were comparable.Medical & Surgical Urology