Robotic assisted laparoscopic donor nephrectomy versus standard laparoscopic donor nephrectomy: A prospective randomised comparative study.
Bhattu AS, Ganpule A, et al.J Endourol 2015 [record in progress].
Aims
To compare the outcomes of living donor nephrectomy (LDN) and robotic assisted laparoscopic donor nephrectomy (RDN)
Interventions
Patients were randomized to receive either robotic approach (Da Vinci Si TM-Intuitive surgical®, Sunnyvale, CA, USA) or laparoscopic approach for donor nephrectomy.
Participants
45 live related kidney donors
Outcomes
The primary outcomes measured were the postoperative visual analogue pain scores (VAS), analgesic requirement in first 48 hours and hospital stays of the donors. Secondary outcomes measured were haemoglobin drop, preserved graft arterial and venous length, total operative time (TOT), retrieval time (RT) , warm ischemia time (WIT), number of ports, donor creatinine at 1 month follow up, intraoperative and post-operative complications, estimated glomerular filtration rate (eGFR), graft related complications and graft loss. Surgeon difficulty scores for different steps of surgery were also analys
Follow-up
1 year
CET Conclusions
This interesting manuscript reports the first published randomised comparison of laparoscopic (LDN) versus robotic (RDN) donor nephrectomy. Donors were randomised 2:1 to LDN or RDN. The authors report lower visual-analogue pain scores in the RDN group, with shorter hospital stay and less analgesic requirements. There was however, a longer retrieval time and longer warm ischaemic time in the RDN group. Both procedures appeared safe with no major complications experienced. There are a few points worth noting about this study. First, the method of randomisation and patient selection is not clear. Secondly, the study is not blinded, so the subjective primary endpoint (VAS pain score) is likely to be biased. The patient group is unusual in that there is a predominance of right-sided donors (left side is preferred in most centres) and the reason for this is not clear. Donors with multiple vessels were excluded, as were those with a BMI higher than 35. Finally, the two surgeons performing the procedures were experienced robotic surgeons – it is unclear what the learning curve for the procedure is and where on this curve the participating surgeons fall.
Data analysis
Strict intention-to-treat analysis
Trial registration
None