Enhanced Recovery Open Versus Laparoscopic Left Donor Nephrectomy: a Randomized Controlled Trial.
Mansour AM, El-Nahas AR, et al.Urology 2017 [record in progress].
Aims
To evaluate the postoperative outcomes between laparoscopic donor nephrectomy (LDN) and open donor nephrectomy (ODN) within a specified Enhanced Recovery Program (ERP) for left kidney donations.
Interventions
Participants were randomized to LDN or ODN with recovery optimized within an ERP. ODN was performed via a 12-15 cm supracostal incision above the 11th rib and an extra-pleural extra peritoneal approach was adopted. LDN was performed via a standard 4-port distribution.
Participants
224 left side donors who did not express a preference for either ODN or LDN.
Outcomes
The primary outcome measured was donor recovery as evaluated by the physical fatigue domain of the Multidimensional Fatigue Inventory 20 (MFI-20). Other measured outcomes included the other domains within the MFI-20, scores of Short Form-36 health survey, pain scores, analgesic requirements, length of hospital stay, return to work, daily activities, perioperative complications and graft outcome measures.
Follow-up
6 weeks
CET Conclusions
This single-centre study from Egypt investigates the effect of an Enhanced Recovery Protocol (ERP) on laparoscopic and open left donor nephrectomy. Donors were randomised 1:1 to laparoscopic or open nephrectomy, and all donors underwent an enhanced recovery plan. Unfortunately, the details of the ERP are given in supplementary digital content, which is not currently available on the journal website. The authors demonstrate a significant advantage to laparoscopic nephrectomy even in the setting of ERP, with reduced physical fatigue, shorter hospital stay less pain and reduced opioid use. Warm ischaemic time did not differ between the groups. The study appears well conducted, with appropriate randomisation, although not blinded. Analysis is per protocol, excluding 2 patients who withdrew consent and underwent open nephrectomy. The results are perhaps not too surprising, given the existing evidence of the benefits of the laparoscopic approach. Without detail of the ERP used, it is not clear what the potential benefits could be – hopefully this will be added to the journal site upon full publication.
Data analysis
Per protocol analysis
Trial registration
ClinicalTrials.gov - NCT02699489