Laparo-Endoscopic Single Site (LESS) versus Standard Laparoscopic Left Donor Nephrectomy: Matched-pair Comparison

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. (C) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.