S Praveena, Krishnamoorthy Venkatesh, Tyagaraj Krishnaprasad
Department of Urology, NU Hospitals, Bengaluru, India.
Curr Urol. 2025 May;19(3):218-223. doi: 10.1097/CU9.0000000000000220. Epub 2023 Sep 12.
Laparoscopic transperitoneal donor nephrectomy (LTDN) is currently the standard procedure for renal donation from living donors. Only a handful of clinical studies have compared the outcomes of retroperitoneoscopic donor nephrectomy (RDN) and LTDN. More robust data and systematic comparative analyses of the outcomes and complications of these 2 techniques are needed. This study aimed to elucidate the noninferiority of RDN to LTDN.
All live renal donors who underwent either RDN or LTDN at our institution during the period of January 2015 to March 2021 were considered subjects, excluding those who refused to participate in the study. This was a bidirectional cohort study. Demographic and clinical data were collected and analyzed using standard statistical methods. Statistical significance was set at < 0.05.
Our study included 89 subjects: 40 in the LTDN group and 49 in the RDN group. The RDN group had significantly shorter warm ischemia time (2.85 vs. 6.04 minutes), a lower fall in hemoglobin on postoperative day (POD)-1 (1.73 vs. 2.24 g/dL), lower estimated blood loss (601.93 vs. 797.27 mL), and lower pain on POD-1 (0.78 vs. 1.28). The improvement in recipient's estimated glomerular filtration rate on POD-30 was significantly higher in the RDN group (79.98 vs. 63.73 mL/min/1.73 m). There was a significantly higher fall in estimated glomerular filtration rate of donor after nephrectomy in RDN group on POD-30 (35.53 vs. 30.60 mL/min/1.73 m). However, there were no significant differences in other parameters.
Our study, conducted in India, showed that the majority of RDN outcomes were better than those of LTDN. Hence, RDN is clearly non-inferior to the gold standard LTDN. A well-designed randomized controlled study is required to elucidate the statistical superiority of one approach over another.
腹腔镜经腹腔供体肾切除术（LTDN）目前是活体供体肾脏捐献的标准术式。仅有少数临床研究比较了后腹腔镜供体肾切除术（RDN）和LTDN的手术效果。需要更有力的数据以及对这两种技术的手术效果和并发症进行系统的对比分析。本研究旨在阐明RDN不劣于LTDN。
将2015年1月至2021年3月期间在本机构接受RDN或LTDN的所有活体肾供体视为研究对象，排除拒绝参与研究的患者。这是一项双向队列研究。采用标准统计方法收集和分析人口统计学及临床数据。设定统计学显著性水平为<0.05。
我们的研究纳入了89名受试者：LTDN组40例，RDN组49例。RDN组的热缺血时间明显更短（2.85分钟对6.04分钟），术后第1天（POD-1）血红蛋白下降幅度更低（1.73 g/dL对2.24 g/dL），估计失血量更低（601.93 mL对797.27 mL），POD-1时疼痛程度更低（0.78对1.28）。RDN组术后第30天受者估计肾小球滤过率的改善明显更高（79.98 mL/min/1.73 m对63.73 mL/min/1.73 m）。RDN组术后第30天供体肾切除术后估计肾小球滤过率下降幅度明显更高（35.53 mL/min/1.73 m对30.60 mL/min/1.73 m）。然而，其他参数无显著差异。
我们在印度进行的研究表明大多数RDN的手术效果优于LTDN。因此，RDN明显不劣于金标准LTDN。需要开展精心设计的随机对照研究以阐明一种方法相对于另一种方法的统计学优势。
