A randomized, prospective study of laparoendoscopic single-site plus one-port versus mini laparoscopic technique for live donor nephrectomy
To compare the clinical outcomes of laparoendoscopic single-site plus one-port donor nephrectomy (LESSOP-DN) and mini laparoscopic donor nephrectomy (MLDN).
A prospective randomized controlled trial was conducted from December 2014 to February 2016 in donors scheduled for left donor nephrectomy. Donor and recipient demographics and clinical outcomes including pain scores and questionnaires (BIQ: body image questionnaire, SF-36, patient-reported overall convalescence) were also compared.
A total of 121 eligible donors were recruited, of which 99 donors who were scheduled to undergo an operation on their left side were randomized into LESSOP-DN (n = 50) and MLDN (n = 49) groups. There were no significant demographic differences between the two groups. The renal extraction time in the LESS-DN group was shorter than that in the MLDN group (75.89 ± 13.01 vs. 87.31 ± 11.38 min, p < 0.001). Other perioperative parameters and complication rates were comparable between the two groups. The LESSOP-DN group had a smaller incision length than the MLDN group (4.89 ± 0.68 vs. 6.21 ± 1.11 cm, p < 0.001), but cosmetic scores and body image scores were similar in the two groups (p = 0.905, 0.217). Donor quality of life (SF-36) and recovery and satisfaction data were comparable between the two groups. Delayed graft function (DGF) occurred in one recipient undergoing MLDN procedure (2.1%) and progressed to graft failure.
There were no differences in cosmetic satisfaction between groups despite the smaller incision size of LESSOP-DN. Safety parameters and subjective measures of postoperative morbidity were similar between the two groups.
KeywordsKidney transplantation Laparoscopy Minimally invasive surgery
Laparoendoscopic single-site plus one-port donor nephrectomy
Mini laparoscopic donor nephrectomy
Body image questionnaire
Delayed graft function
RAND 36-item short-form health survey questionnaire
Quality of life
Warm ischemia time
Estimated blood loss
Length of stay
Hand-assisted laparoscopic donor nephrectomy
KWL: data collection and analysis, manuscript writing. SWC: protocol development, data collection. YHP: data collection. WJB: data collection. YSC: data management. UH: data management. SH: data analysis. JYL: manuscript editing. SWK: manuscript editing. HJC: protocol and project development, manuscript editing
Compliance with ethical standards
Conflict of interest
Kyu Won Lee, Sae Woong Choi, Yong Hyun Park, Woong Jin Bae, Yong Sun Choi, U-Syn Ha, Sung-Hoo Hong, Ji Youl Lee, Sae Woong Kim and Hyuk Jin Cho have no conflicts of interests or financial ties to disclose.
All human studies have been approved by the appropriate ethics committee and have, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. This study has been approved by our institutional review board (KC15EISI0015).
Informed consent was obtained from all individual participants included in the study.
- 1.Abecassis M, Bartlett ST, Collins AJ, Davis CL, Delmonico FL, Friedewald JJ, Hays R, Howard A, Jones E, Leichtman AB, Merion RM, Metzger RA, Pradel F, Schweitzer EJ, Velez RL, Gaston RS (2008) Kidney transplantation as primary therapy for end-stage renal disease: a National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (NKF/KDOQITM) conference. Clin J Am Soc Nephrol 3:471–480. https://doi.org/10.2215/cjn.05021107 CrossRefPubMedPubMedCentralGoogle Scholar
- 2.Cecka JM (2001) The UNOS renal transplant registry. Clin Transpl 1–18Google Scholar
- 4.Park YH, Min SK, Lee JN, Lee HH, Jung WK, Lee JS, Lee JH, Lee YD (2004) Comparison of survival probabilities for living-unrelated versus cadaveric renal transplant recipients. Transplant Proc 36:2020–2022. https://doi.org/10.1016/j.transproceed.2004.08.122 CrossRefPubMedGoogle Scholar
- 9.Kaouk JH, Autorino R, Kim FJ, Han DH, Lee SW, Yinghao S, Cadeddu JA, Derweesh IH, Richstone L, Cindolo L, Branco A, Greco F, Allaf M, Sotelo R, Liatsikos E, Stolzenburg JU, Rane A, White WM, Han WK, Haber GP, White MA, Molina WR, Jeong BC, Lee JY, Linhui W, Best S, Stroup SP, Rais-Bahrami S, Schips L, Fornara P, Pierorazio P, Giedelman C, Lee JW, Stein RJ, Rha KH (2011) Laparoendoscopic single-site surgery in urology: worldwide multi-institutional analysis of 1076 cases. Eur Urol 60:998–1005. https://doi.org/10.1016/j.eururo.2011.06.002 CrossRefPubMedGoogle Scholar
- 10.Autorino R, Brandao LF, Sankari B, Zargar H, Laydner H, Akça O, De Sio M, Mirone V, Chueh SC, Kaouk JH (2015) Laparoendoscopic single-site (LESS) vs laparoscopic living-donor nephrectomy: a systematic review and meta-analysis. BJU Int 115:206–215. https://doi.org/10.1111/bju.12724 CrossRefPubMedGoogle Scholar
- 15.Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2 CrossRefPubMedGoogle Scholar
- 20.Kurien A, Rajapurkar S, Sinha L, Mishra S, Ganpule A, Muthu V, Sabnis R, Desai M (2011) First prize: standard laparoscopic donor nephrectomy versus laparoendoscopic single-site donor nephrectomy: a randomized comparative study. J Endourol 25:365–370. https://doi.org/10.1089/end.2010.0250 CrossRefPubMedGoogle Scholar
- 21.Richstone L, Rais-Bahrami S, Waingankar N, Hillelsohn JH, Andonian S, Schwartz MJ, Kavoussi LR (2013) Pfannenstiel laparoendoscopic single-site (LESS) vs conventional multiport laparoscopic live donor nephrectomy: a prospective randomized controlled trial. BJU Int 112:616–622. https://doi.org/10.1111/bju.12202 CrossRefPubMedGoogle Scholar
- 22.Aull MJ, Afaneh C, Charlton M, Serur D, Douglas M, Christos PJ, Kapur S, Del Pizzo JJ (2014) A randomized, prospective, parallel group study of laparoscopic versus laparoendoscopic single site donor nephrectomy for kidney donation. Am J Transplant 14:1630–1637. https://doi.org/10.1111/ajt.12735 CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Dols LF, Ijzermans JN, Wentink N, Tran TC, Zuidema WC, Dooper IM, Weimar W, Kok NF (2010) Long-term follow-up of a randomized trial comparing laparoscopic and mini-incision open live donor nephrectomy. Am J Transplant 10:2481–2487. https://doi.org/10.1111/j.1600-6143.2010.03281.x CrossRefPubMedGoogle Scholar
- 24.Wang PH, Liu WM, Fuh JL, Chao HT, Yuan CC, Chao KC (2009) Comparison of ultraminilaparotomy for myomectomy through midline vertical incision or modified Pfannenstiel incision—a prospective short-term follow-up. Fertil Steril 91:1945–1950. https://doi.org/10.1016/j.fertnstert.2008.02.134 CrossRefPubMedGoogle Scholar
- 25.Saito M, Tsuchiya N, Maita S, Numakura K, Obara T, Tsuruta H, Kumazawa T, Inoue T, Narita S, Horikawa Y, Yuasa T, Satoh S, Habuchi T (2011) What is the most preferred wound site for laparoscopic donor nephrectomy?: a questionnaire assessment. J Laparoendosc Adv Surg Tech A 21:511–515. https://doi.org/10.1089/lap.2010.0457 CrossRefPubMedGoogle Scholar