Cost-effectiveness of four living-donor nephrectomy techniques from a hospital perspective.

BACKGROUND: In Europe, transplantation centres use different nephrectomy techniques: open surgery, and standard, hand-assisted and robot-assisted laparoscopies. Few studies have analysed the disparity in costs and clinical outcomes between techniques. Since donors are healthy patients expecting minimum pain and fast recovery, this study aimed to compare the cost-effectiveness of four nephrectomy techniques focusing on early surgical outcomes, an essential in the donation act. METHODS: A micro-costing approach was used to estimate the cost of implementation from a hospital perspective. Estimates took into account sterilization costs for multiple-use equipment, costs for purchasing single-use equipment, staff and analgesics. The study recruited donors in 20 centres in France. Quality of life by EuroQol-5D was assessed preoperatively, and 4 and 90 days post-operatively. Two effectiveness indicators were built: quality-of-life recovery and post-operative pain days averted (PPDA). The study was registered at ClinicalTrials.gov NCT02830568, on 10 June 2010. RESULTS: A total of 264 donors were included; they underwent open surgery (n = 65), and standard (n = 65), hand-assisted (n = 65) and robot-assisted laparoscopies (n = 69). Use of the nephrectomy techniques differed greatly in cost of implementation and immediate post-operative outcomes but not in clinical outcomes at 90 days. At 4 days, hand-assisted laparoscopy provided the lowest cost per quality-of-life recovery unit of effectiveness (%) and PPDA (days) (€2056/40.1%/2.3 days, respectively). Robot-assisted laparoscopy was associated with the best post-operative outcomes but with the highest cost (€3430/59.1%/2.6 days). CONCLUSION: Hand-assisted, standard and robot-assisted laparoscopies are cost-effective techniques compared with open surgery. Hand-assisted surgery is the most cost-effective procedure. Robot-assisted surgery requires more healthcare resource use but enables the best clinical outcome.

Efficacy of Follow-up Care System of Living Kidney Donors in Monitoring of Residual Kidney Function.

BACKGROUND: The possibility of an increased risk of end-stage renal disease is a major concern associated with living kidney donation. Therefore, monitoring of residual kidney function becomes most essential. METHODS: A data analysis of 156 living kidney donors (LKDs) was conducted. The efficacy of the long-term care system with regard to monitoring residual kidney function was evaluated. RESULTS: The analyzed group consisted of 102 (65.4%) women. The mean follow-up period was 5.44 years. The rise in value of mean serum creatinine concentration after donation was observed, but it was within the range of normal during the observation period. Despite its initial decline after nephrectomy, mean glomerular filtration rate (GFR) remained >60 mL/min/1.73 m2. A MDRD (Modification of Diet in Renal Disease) GFR in the range of 45-60 mL/min/1.73 m2 was observed in 53 donors (33.97%). It was found to be <45.0 mL/min/1.73 m2 in 15 cases (9.6%). No patient developed end-stage renal disease. Only 25.0% of those analyzed had their CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) GFR estimated on 45-60 mL/min/1.73 m2 and 4.49% were found to have levels of <45 mL/min/1.73 m2 (down to 33.7 mL/min/1.73 m2). Mean postdonation CKD-EPI GFR was estimated at 69.99% of its predonation value. CONCLUSION: A reliable qualification process could minimize the probability of kidney donation by someone with an increased risk of chronic kidney failure. The CKD-EPI formula seems to be more precise than the MDRD for estimatation of LKDs' GFR, as their loss of GFR is a result of nephrectomy and not kidney or systemic disease. Using the MDRD formula may lead to inappropriate diagnosis of CKD in some cases.

Evaluation of the enhanced recovery after surgery protocol in living liver donors.

BACKGROUND: Enhanced recovery after surgery (ERAS) protocol has proven to be effective in many surgery fields in controlling pain and promoting early recovery. Application of the (ERAS) protocol in living donor liver patients is a new step to promote early recovery. METHODS: We analyzed outcomes in two groups. Group A included the living donors who had the ERAS protocol applied (n = 30), and Group B included donors who had their surgery before the ERAS protocol (n = 30). All donors had the same incision. The ERAS protocol involved a multimodality methods. This included intravenous ketamine and lidocaine intraoperatively with single dose intrathecal morphine and local injection of long-acting bupivacaine. The postoperative regimen included intravenous ketamine, lidocaine, ketorolac, and narcotics as PRN. RESULTS: Pain on the first three postoperative days was significantly lower in Group A (P < 0.05). Narcotics were also significantly lower in Group A (P < 0.01). Return of bowel function occurred earlier by 1 day in Group A (P < 0.003). Group A patients could tolerate a regular diet by postoperative day (POD) three vs four in Group B patients (P = 0.0057). Mean length of stay was lower in Group A, but not statistically significant. CONCLUSIONS: Enhanced recovery after surgery protocol was effective in minimizing postoperative pain and helped to decrease the postoperative narcotics and helped early recovery.

Notch-mediated Sox9+ cell activation contributes to kidney repair after partial nephrectomy.

AIMS: Partial nephrectomy is a surgical technique as an alternative for traditional radical nephrectomy. The advantage of partial nephrectomy technique is nephron-sparing, however, whether the remaining kidney tissue could regenerate the lost nephron is still unknown. The current work is to investigate the kidney tissue repair process and the related cellular and molecular mechanism. MAIN METHODS: We used a novel unilateral partial nephrectomy mouse model to study kidney repair, and focused on a population of Sox9+ progenitor cells to study their pivotal role in the regenerative process. Kidney function after nephrectomy was measured using creatinine and urea nitrogen assay kit. Wound healing was assessed by Masson Trichrome Staining. Tissue regeneration was tested by Sox9+ cells immunofluorescence staining. The differentiation potential of Sox9+ cells were assessed by immunoanalysis with various tubular cell markers. Notch activation was determined by qPCR and Western blotting. KEY FINDINGS: After partial nephrectomy, we found that massive Sox9+ cells emerged one day after the surgery and lasted for up to 20days. The Sox9+ cells had proliferative capacity and could give rise to epithelial cells of proximal tubule, Henle's loop, distal tubule, collecting duct, and the parietal layer of glomerulus. We also found that the activation of Sox9+ cells was mediated by Notch signaling pathway. SIGNIFICANCE: The current study reveals that Notch-mediated Sox9+ cell activation can contribute to kidney tubule regeneration after unilateral partial nephrectomy in mice.

Mesenchymal stem cell-derived extracellular vesicles for kidney repair: current status and looming challenges.

Novel therapies are urgently needed to address the rising incidence and prevalence of acute kidney injury (AKI) and chronic kidney disease (CKD). Mesenchymal stem/stromal cells (MSCs) have shown promising results in experimental AKI and CKD, and have been used in the clinic for more than a decade with an excellent safety profile. The regenerative effects of MSCs do not rely on their differentiation and ability to replace damaged tissues, but are primarily mediated by the paracrine release of factors, including extracellular vesicles (EVs), composed of microvesicles and exosomes. MSC-derived EVs contain genetic and protein material that upon transferring to recipient cells can activate several repair mechanisms to ameliorate renal injury. Recent studies have shown that MSC-derived EV therapy improved renal outcomes in several animal models of AKI and CKD, including ischemia-reperfusion injury, drug/toxin-induced nephropathy, renovascular disease, ureteral obstruction, and subtotal nephrectomy. However, data about the renoprotective effects of EV therapy in patients with renal failure are scarce. This review summarizes current knowledge of MSC-derived EV therapy in experimental AKI and CKD, and discusses the challenges that need to be addressed in order to consider MSC-derived EVs as a realistic clinical tool to treat patients with these conditions.

Evaluation of renal function in a specific population of living kidney donors.

BACKGROUND: The increase in candidates for kidney transplant has led to growth in the number of living donor transplants. Therefore, studies that adequately evaluate the possible long-term consequences of elective transplant nephrectomy are needed. OBJECTIVE: To evaluate the possible long-term adverse effects of transplant nephrectomy on the renal function of living kidney donors. DESIGN: A cross-sectional study. PARTICIPANTS: Thirty-three living kidney donors registered in the transplant programme of a centre in Alagoas, Brazil. MEASUREMENTS: Demographic characteristics, anthropometric measures, clinical data and biomarkers (creatinine, eGFR, microalbuminuria, cholesterol and triglycerides) were measured. Creatinine clearance was calculated using the Cockcroft-Gault and Modification of Diet in Renal Disease formulae. RESULTS: Of the 33 individuals, 63.63% were female, and the median age was 45 years. Additionally, 24.24% of these individuals had altered blood pressure, 39.39% had altered abdominal circumference (AC) and 36.36% were obese, with a body mass index ≥30. Furthermore, 33.33% of these individuals had elevated triglyceride levels. The average eGFR was 97.33 (33.03-175.9) ml/min/1.73 m2 (CG) and 84.14 (29.4-131) ml/min/1.73 m2 (MDRD). The microalbuminuria level was altered in 12.12% patients. CONCLUSION: Kidney donation is unquestionably a safe procedure. However, a better understanding of the long-term consequences of living donor kidney transplantation is still needed. This knowledge may have important implications for the follow-up of these patients. Our study has demonstrated a non-negligible presence of an early marker of glomerular injury and a decrease in the GFR of some patients, thereby reinforcing the proposal for long-term follow-up of living kidney donors.

Effectiveness of Epidural Analgesia, Continuous Surgical Site Analgesia, and Patient-Controlled Analgesic Morphine for Postoperative Pain Management and Hyperalgesia, Rehabilitation, and Health-Related Quality of Life After Open Nephrectomy: A Prospective, Randomized, Controlled Study.

BACKGROUND: There is no widely recognized effective technique to optimally reduce pain scores and prevent persistent postoperative pain after nephrectomy. We compared continuous surgical site analgesia (CSSA), epidural analgesia (EA), and a control group (patient-controlled analgesic morphine) in patients undergoing open nephrectomy. METHODS: Sixty consecutive patients were randomized to be part of EA, CSSA, or control groups postoperatively for 72 hours. All patients received patient-controlled analgesic morphine, if needed. Hyperalgesia was assessed on the first, second, and third postoperative days. Chronic pain characteristics and quality of life were analyzed at 1 and 3 months. The primary outcome was the pain score at 24 hours. Secondary outcomes were morphine consumption, postoperative rehabilitation, hyperalgesia, chronic pain incidence, and quality-of-life parameters. RESULTS: At 24 hours, mean ± standard deviation pain values at rest (2.4 ± 1.7, 2.2 ± 1.2, and 4.2 ± 1.2, respectively, in EA, CSSA, and control groups, P <.001) and during coughing was lower in the EA and CSSA groups. Total morphine consumption was higher in the control group. Rehabilitation parameters improved sooner in the EA and CSSA groups. Median values of area of hyperalgesia differed at 48 hours between the EA group and the control group (36.4 cm) and (52 cm) (P = .01) and at 72 hours among the EA group, CSSA group, and the control group (40 cm, 39.5 cm, and 59 cm, respectively; P = .002). CSSA reduced the severity of pain and hyperalgesia at 1 month and optimized quality of life 3 months after surgery (role physical scores, P = .005). CONCLUSIONS: CSSA and EA significantly improve postoperative analgesia, reduce postoperative morphine consumption, area of wound hyperalgesia, and accelerate patient rehabilitation after open nephrectomy. CSSA significantly reduces the severity of residual pain 1 month after surgery and optimizes quality-of-life parameters 3 months after surgery.

Body mass index and comorbidity are associated with postoperative renal function after nephrectomy.

PURPOSE: To explore the association of body mass index (BMI) and comorbidity with renal function after nephrectomy. MATERIALS AND METHODS: We retrospectively analyzed 263 patients submitted to partial or radical nephrectomy from 2000-2013. Variables assessed included BMI, Charlson Comorbidity Index (CCI), race, tobacco use, tumor histology, surgical approach, Fuhrman nuclear grade, and tumor (T) classification. Glomerular filtration rate (GFR) was estimated using the Cockroft-Gault equation, adjusted for gender. Logistic regression was performed and included all interaction terms. RESULTS: Median follow-up was 19.6 months (IQR 5.2, 53.7). Median preoperative GFR was 86.2 mL/min/1.73 m2 and median postoperative GFR was 68.4 mL/min/1.73 m2. BMI (OR 1.07, 95%CI 1.02-1.11), CCI (OR 1.19, 95%CI 1.04-1.37), and radical nephrectomy (OR 3.09, 95%CI 1.51-6.33) were significantly associated with a decline in renal function of ≥ 25%. CONCLUSION: BMI and CCI are associated with postoperative decline in renal function after nephrectomy. Additionally, radical nephrectomy is significantly associated with decreasing renal function compared to partial nephrectomy. These findings highlight the importance of assessing patient comorbidity in the decision making process for patients presenting with a renal mass.

Body mass index and comorbidity are associated with postoperative renal function after nephrectomy

ABSTRACTPurpose:To explore the association of body mass index (BMI) and comorbidity with renal function after nephrectomy.Materials and Methods:We retrospectively analyzed 263 patients submitted to partial or radical nephrectomy from 2000-2013. Variables assessed included BMI, Charlson Comorbidity Index (CCI), race, tobacco use, tumor histology, surgical approach, Fuhrman nuclear grade, and tumor (T) classification. Glomerular filtration rate (GFR) was estimated using the Cockroft-Gault equation, adjusted for gender. Logistic regression was performed and included all interaction terms.Results:Median follow-up was 19.6 months (IQR 5.2, 53.7). Median preoperative GFR was 86.2mL/min/1.73m2 and median postoperative GFR was 68.4mL/min/1.73m2. BMI (OR 1.07, 95%CI 1.02-1.11), CCI (OR 1.19, 95%CI 1.04-1.37), and radical nephrectomy (OR 3.09, 95%CI 1.51-6.33) were significantly associated with a decline in renal function of ≥25%.Conclusion:BMI and CCI are associated with postoperative decline in renal function after nephrectomy. Additionally, radical nephrectomy is significantly associated with decreasing renal function compared to partial nephrectomy. These findings highlight the importance of assessing patient comorbidity in the decision making process for patients presenting with a renal mass.

Predictors of health-related quality of life recovery following laparoscopic simple, radical and donor nephrectomy.

OBJECTIVES: To objectively quantify the recovery of health-related quality of life (HRQL) in patients undergoing laparoscopic nephrectomy. To determine which factors are predictive of a more expedited recovery. MATERIALS AND METHODS: Patient recovery was prospectively measured among patients undergoing laparoscopic simple (n= 12), radical (n= 42) and donor (n= 95) nephrectomy. All procedures were performed using a 3- or 4-trocar, transperitoneal fully-laparoscopic technique with intact specimen extraction using impermeable sacs for simple and radical nephrectomy, and hand extraction for donor nephrectomy. Postoperative recovery and quality of life were measured using the Postoperative Recovery Scale (PRS) administered preoperatively, immediately postoperatively and as an outpatient at 4, 8, 12, and 16 weeks postoperatively. ANOVA and Pearson's χ² tests were performed on demographic data. Multivariate logistic regression analysis was used to calculate odds ratios for factors predictive of recovery. RESULTS: Statistically significant differences were found at baseline for age (P = 0.02), gender (P < 0.01), body mass index (BMI; P = 0.03), surgical side (P < 0.01) and activity-based lifestyle (P = 0.04) across the three groups. Minimal adverse events were seen. Factors predictive of expedited recovery include age < 50 years (OR: 2.1, P < 0.01), body-mass index (BMI) < 30 kg/m² (OR: 1.7, P < 0.01), active lifestyles (OR: 1.3, P < 0.01) and those patients undergoing nephrectomy for benign or malignant indications rather than for organ donation (OR: 1.4, P < 0.01). There was a significant delay in the donor group vs the non-donor group with respect to the median number of days both groups took to recover 75% and 90% of their baseline PRS scores (11 days, P = 0.02; 20 days, P = 0.02, respectively). CONCLUSIONS: Predictive factors of recovery from laparoscopic nephrectomy include age, BMI, lifestyle and surgical indication. Differences between HRQL recovery following donor vs non-donor laparoscopic nephrectomy are significant, and suggest the possible interplay of underlying psychological factors.

Tumor renal maligno: análise das características clínicas, anatomatológicas e sobrevida dos pacientes nefrectomizados / Malignant renal tumor: analyze of clinical characteristics, anatomopathological and survival of nephrectomized patients

Analisar as características dos pacientes nefrectomizados por tumor renal maligno, para avaliar possibilidade de implantação do nomograma desenvolvido pelo Hospital Memorial Sloan-Kettering Cancer Center. Análise dos pacientes nefrectomizados por tumor pelos grupos de Urologia e Oncologia do Hospital Universitário de Taubabé e Hospital Regional do Vale do Paraíba, no período de 1998 a 2003, por análise de prontuário e contato telefônico. Na comparação de percentagens entre o estado atual dos pacientes (83,33 por cento) e a média da sobrevida estimada pelo nomograma (77,18 por cento) não houve significância estatística (p = 1). O nomograma pode ser aplicado para esta população.

In order to analyze the characteristics of the patients with malignant renal tumor submitted the nephrectomy surgery, and evaluate the possibility implantation of the nomogram developed by the Memorial Sloan-Kettering Cancer Center. The analysis of patients who were submitted to surgery for tumor by the group of Urology in Taubaté University Hospital and Vale do Paraíba's Regional Hospital from 1998 to 2003, for handbooks and telephonic contact. There was not significant diference (p = 1) between the actual condition of the patients (83.33 per cent) and the average of survivors estimated by the nomogram (77.18 per cent). The nomogram is applied for this population of this study.

Cost effectiveness of laparoscopic versus mini-incision open donor nephrectomy: a randomized study.

BACKGROUND: Cost-effectiveness remains an issue surrounding the introduction of laparoscopic donor nephrectomy (LDN). METHODS: In a randomized controlled trial the cost-effectiveness of LDN versus mini-incision open donor nephrectomy (ODN) was determined. Fifty donors were included in each group. All in-hospital costs were documented. Postoperatively, case record forms were sent to the donors during 1-year follow-up to record return-to-work and societal costs. To offset costs against quality of life, the Euroqol-5D questionnaire was administered preoperatively and 3, 7, 14, 28, 90, 180, and 365 days postoperatively. RESULTS: Mean total costs were euro6,090 (US$7,308) after LDN and euro4,818 ($5,782) after ODN (P<0.001). Disposables influenced the cost difference most. Mean productivity loss was 68 and 75 days after LDN and ODN respectively, corresponding to euro783 ($940) gained per donor after LDN. The main gain in quality of life in the LDN group was realized within 4 weeks postoperatively. LDN resulted in a mean gain of 0.03 quality-adjusted life years at mean costs of euro1,271 ($1,525) and euro488 ($586) from a healthcare perspective and a societal perspective, respectively. This implies that one additional Quality-Adjusted Life Year after LDN costs about euro16,000 ($19,200) from a societal point of view and about euro41,000 ($49,200) from a health-care perspective. Activities other than work were resumed significantly earlier after LDN (66 vs. 91 days, P=0.01). CONCLUSION: In addition to a clinically relevant donor-experienced benefit from LDN, this technique appeared, given a societal perspective, a cost-efficient procedure mainly due to less productivity losses.

Nefrectomía laparoscópica versus nefrectomía abierta. Experiencia en la Fundación Valle del Lili / Comparison between laparoscopic and nephrectomy at a colombia hospital

Objetivo: Comparar los resultados clínicos entre nefrectomía laparoscópica versus nefrectomía abierta en un hospital de Colombia. Métodos: Diseño: Cohorte retrospectiva. Lugar: Servicio de urología, Fundación Valle del Lili. Se incluyeron todos los pacientes que fueron llevados a nefrectomía laparoscópica o abierta entre 1995-2005. Se recolecto la información demográfica y clínica del procedimiento, hasta el egreso hospitalario. Los datos se analizaron en STATA v.8.0Resultados: Se incluyeron 143 pacientes. De ellos, 54 fueron tratados laparoscópicamente (laparoscopia total en 40, mano-asistida en 14) y con nefrectomía abierta en 89. El total de riñones extraídos fue de 161; 64 de ellos por laparoscopia. Los pacientes llevados a laparoscopia fueron más jóvenes (36 y 22 vs 48,5 y 19 años, p<0,05), pero con mucha más morbilidad (insuficiencia renal crónica). Hubo cuatro conversiones en los pacientes llevados a laparoscopia, todas por dificultades técnicas: una por salida de material purulento abundante, una por tumor de gran tamaño, y dos por adherencias...

Un caso de nefrectomía / A case of nephrectomy

El alejamiento casi absoluto del ejercicio profesional no me permite presentar a la Sociedad observaciones dignas de ser tenidas en consideración, y es sólo por cumplir con la obligación que impone la honrosa designación que se me ha hecho por lo que voy a relatar a ustedes una nefrectomía practicada por mí en asocio del doctor Zea Uribe hace quince años en el Hospital. Cristina Penagos, de treinta años de edad, soltera, sin hijos y de escasas facultades intelectuales, me consultó en agosto de 1900 para unos dolores en la región lumbar con irradiaciones hacia la ingle y el abdomen; en época anterior había tenido una hematuria. A la palpación bimanual, en decúbito dorsal, encontré en el flanco derecho un cuerpo globuloso, duro, sensible a la presión que, debajo del hígado seguía los movimientos del diafragma. Las paredes abdominales, sumamente flojas, hacían fácil la exploración. No había líquido intraperitoneal. La región lumbar no estaba deprimida; había ligero edema

Efficacy and safety of fast-track recovery strategy for patients undergoing laparoscopic nephrectomy.

BACKGROUND AND PURPOSE: Factors that adversely affect early recovery after major laparoscopic procedures include ileus, pain, nausea, emesis, and fatigue. The objective of this randomized controlled study was to evaluate the impact of a multimodal fast-track (FT) rehabilitation program on recovery and length of hospital stay after laparoscopic nephrectomy. PATIENTS AND METHODS: Thirty patients undergoing laparoscopic nephrectomy received either conventional care (control) or an FT recovery program. All patients received a standardized anesthetic technique and patient- controlled analgesia (morphine) for postoperative pain control. In the FT group, patients received premedication with rofecoxib and ranitidine, local anesthesia was administered at the ports and renal fosa during surgery, and postoperative non-opioid analgesic and gastrokinetic drugs were administered as part of an early enteral nutrition and mobilization program. During the postoperative period, pain and nausea were assessed at specific time intervals. In addition, recovery room and hospital discharge times, the need for rescue analgesics and antiemetics, patient satisfaction with pain management and quality of recovery, and side effects were recorded daily for 3 days after surgery. Patients were discharged home when they met previously defined discharge criteria. RESULTS: The FT group was discharged earlier from the recovery room (74+/-23 v 103+/-47 minutes) and the hospital (41+/-11 v 59+/-11 hours). Pain and nausea scores were consistently lower in the FT group during the first 48 hours after surgery. In addition, the requirement for antiemetic rescue therapy during the first 24 hours was reduced in the FT group (15% v 58%). The FT group also received less morphine during the first 2 postoperative days (14+/-16 v 40+/-24 mg). Finally, patient satisfaction with postoperative pain control was significantly higher in the FT group. CONCLUSIONS: A multimodal approach to minimizing postoperative side effects led to a reduced recovery room and hospital stay, as well as better pain control and patient satisfaction after laparoscopic nephrectomy.

Fast-track open transperitoneal nephrectomy.

OBJECTIVE: Hospital stay after open transperitoneal nephrectomy is usually 5-10 days, the limiting factors being pain, ileus, stress-induced organ dysfunction and fatigue. Recent studies have shown that aggressive multimodal rehabilitation may improve recovery and shorten hospitalization after other abdominal procedures. We therefore studied the effect of a multimodal rehabilitation regimen in patients undergoing open transperitoneal nephrectomy. MATERIAL AND METHODS: A total of 25 consecutive patients scheduled for elective transperitoneal nephrectomy were studied after the introduction of a multimodal rehabilitation regimen (continuous epidural analgesia, enforced mobilization and oral nutrition and revision of the transurethral catheterization and drain regimen) and compared with 50 consecutive patients treated before the introduction of this regimen. RESULTS: The multimodal rehabilitation regimen decreased hospital stay from 8 to 4 days (p < 0.001) with mobilization for approximately 6 h on the first postoperative day and 8 h on the second and third days. Use of a drain was shorter with the multimodal regimen (1 vs 4 days; p < 0.001), as was transurethral catheterization (1 vs 5 days; p < 0.001). "Medical" 30-day morbidity was low (6-8%) in both groups. CONCLUSION: Our results suggest that a multimodal rehabilitation regimen with optimized pain relief, enforced mobilization, early oral nutrition and short-term transurethral catheterization and drain placement may reduce hospital stay after open transperitoneal nephrectomy.

Living kidney donation: a comparison of laparoscopic and conventional open operations.

Laparoscopic donor nephrectomy has the potential to lessen the burden placed on live kidney donors. This study describes the first British comparison of donor morbidity and recovery following conventional open donor nephrectomy (ODN) and laparoscopic donor nephrectomy (LDN). An initial series of LDN (n=20) was compared to a historical control group of ODN (n=34). Laparoscopic operations were performed via a transperitoneal approach, the kidney being removed through a 6--12 cm Pfannensteil incision. Open operations were performed using a retroperitoneal flank approach with resection of the 12th rib. Postoperatively, donors were managed with a patient controlled analgesia system. LDN was associated with shorter mean (SD) inpatient stay (6 (2) v 4 (1) days; p=0.0001) and lower parenteral narcotic requirements (morphine 179 (108) v 67 (54) mg; p=0.0001). Laparoscopic donors started driving their cars sooner (2 (1.5) v 6 (4) weeks; p=0.0001) and returned to work more quickly (5 (3) v 12 (6) weeks; p=0.0001) than open nephrectomy donors. There were no differences in recipient serum creatinine levels at three months post-transplant but two recipients of transplant kidneys retrieved laparoscopically (10%) developed ureteric obstruction, whereas this complication did not occur after ODN (p=0.13). LDN is associated with less postoperative pain and a substantial improvement in donor recovery times. It is not yet clear whether or not the outcome of the recipient kidney transplants are the same after ODN and LDN and much more experience is required before the place of this new technique can be defined.