Enhanced Recovery Open vs Laparoscopic Left Donor Nephrectomy: A Randomized Controlled Trial.

Autor: Mansour AM; Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt; Department of Urology, University of Texas Health Science Center San Antonio, San Antonio, TX. Electronic address: Ahmedmansour1st@hotmail.com., El-Nahas AR; Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt., Ali-El-Dein B; Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt., Denewar AA; Department of Nephrology, Urology and Nephrology Center, Mansoura, Egypt., Abbas MA; Department of Nephrology, Urology and Nephrology Center, Mansoura, Egypt., Abdel-Rahman A; Department of Nephrology, Urology and Nephrology Center, Mansoura, Egypt., Eraky I; Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt., Shokeir AA; Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Jazyk: angličtina
Zdroj: Urology [Urology] 2017 Dec; Vol. 110, pp. 98-103. Date of Electronic Publication: 2017 Sep 08.
DOI: 10.1016/j.urology.2017.08.047
Abstrakt: Objective: To compare recovery outcomes between laparoscopic donor nephrectomy (LDN) and open donor nephrectomy within a specified enhanced recovery program (ERP) for left kidney donations.
Patients and Methods: A phase III randomized trial was conducted between January 2013 and June 2015; eligible left-side donors were randomized to laparoscopic or open donor nephrectomy in a 1:1 ratio with recovery optimized within a standardized ERP. The primary outcome was patient-reported measure of physical fatigue, as measured by the physical fatigue domain of the translated Multidimensional Fatigue Inventory 20. Secondary outcomes included other donor recovery outcomes, postoperative pain scores, hospital stay, perioperative complications, and graft outcomes.
Results: A total of 224 donors (laparoscopy, n = 113; open surgery, n = 111) were randomly allocated. Six weeks postoperatively, physical fatigue domain scores in Multidimensional Fatigue Inventory 20 were significantly lower in the LDN group (mean: laparoscopy, 8.2 ± 3.2 vs open surgery, 13.05 ± 2.9) (P = .007). Median total hospital stay was also significantly shorter in the LDN group (median: laparoscopy, 2; interquartile range, 1-5 vs open surgery, 4; interquartile range, 2-9 days) (P = .002). LDN was associated with less pain scores and less non-opioid analgesic requirements. Warm ischemia times were not significantly different in both groups (mean: laparoscopy, 2.5 ± 0.8 vs open surgery, 2.2 ± 0.6) (P = .431).
Conclusion: Even when optimized within an ERP, LDN was associated with less general and physical fatigue and better physical function at 6 weeks postoperatively when compared with open surgery for left kidney donations.
(Copyright © 2017 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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