Andersen MH et al. (2006) Postoperative pain and convalescence in living kidney donors—laparoscopic versus open donor nephrectomy: a randomized study. Am J Transplant 6: 1438–1443

Kidney transplant donors who undergo laparoscopic surgery have significantly less postoperative pain and more-rapid convalescence than those who undergo traditional open surgery, according to the results of a single-center, prospective, controlled trial in Norway. A few previous studies have had similar findings, but the larger sample size of the present investigation could make it the most accurate to date.

The donors were randomized to laparoscopic (n = 63) or open (n = 59) donor nephrectomy. On the second postoperative day, self-reported pain scores were not significantly different between the two groups, but 1 month after donation, mean pain scores measured on numeric rating scales were significantly lower in the laparoscopy group than in the open-surgery group (P = 0.002). At 1 month post-donation, more open-surgery donors than laparoscopic donors had used pain medication in the previous 24 h (24.6% vs 11.3%; P = 0.048). In addition, in multiple regression analyses, donors who underwent laparoscopic surgery had a shorter period of sick leave than those who underwent open surgery (P = 0.011). Major postoperative complications, including jejunal perforation, occurred in five patients in the laparoscopic group. There were no major complications in patients in the open-surgery group.

Laparoscopy involves creating a small incision through which the kidney is removed, minimizing tissue damage; the donor should, therefore, recover faster and return to work sooner than after open surgery. As postoperative pain and disruption to life are disincentives to potential living donors, offering the laparoscopic option might increase donation rates.