Mansour Ahmed M, El-Nahas Ahmed R, Ali-El-Dein Bedeir, Denewar Ahmed A, Abbas Mohammed A, Abdel-Rahman Ahmed, Eraky Ibrahim, Shokeir Ahmed A
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.
Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Urology. 2017 Dec;110:98-103. doi: 10.1016/j.urology.2017.08.047. Epub 2017 Sep 8.
To compare recovery outcomes between laparoscopic donor nephrectomy (LDN) and open donor nephrectomy within a specified enhanced recovery program (ERP) for left kidney donations.
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.
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).
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.
比较在特定的增强康复计划（ERP）下，腹腔镜供肾切除术（LDN）与开放性供肾切除术用于左肾捐献的恢复结果。
2013年1月至2015年6月进行了一项III期随机试验；符合条件的左侧供体按1:1比例随机分为腹腔镜或开放性供肾切除术，并在标准化ERP内优化恢复情况。主要结局是患者报告的身体疲劳程度，通过翻译后的多维疲劳量表20的身体疲劳领域进行测量。次要结局包括其他供体恢复结果、术后疼痛评分、住院时间、围手术期并发症和移植结果。
共随机分配了224名供体（腹腔镜组，n = 113；开放手术组，n = 111）。术后6周，LDN组多维疲劳量表20的身体疲劳领域得分显著更低（平均值：腹腔镜组，8.2±3.2 vs开放手术组，13.05±2.9）（P = 0.007）。LDN组的中位总住院时间也显著更短（中位数：腹腔镜组，2天；四分位间距，1 - 5天 vs开放手术组，4天；四分位间距，2 - 9天）（P = 0.002）。LDN与更低的疼痛评分和更少的非阿片类镇痛药需求相关。两组的热缺血时间无显著差异（平均值：腹腔镜组，2.5±0.8 vs开放手术组，2.2±0.6）（P = 0.431）。
即使在ERP内进行优化，与左肾捐献的开放性手术相比，LDN在术后6周时与更少的全身和身体疲劳以及更好的身体功能相关。
