A bidirectional cohort study to compare the outcomes of transperitoneal and retroperitoneal approaches in subjects undergoing laparoscopic live donor nephrectomy
{"title":"A bidirectional cohort study to compare the outcomes of transperitoneal and retroperitoneal approaches in subjects undergoing laparoscopic live donor nephrectomy","authors":"Praveena S., Venkatesh Krishnamoorthy, Krishnaprasad Tyagaraj","doi":"10.1097/cu9.0000000000000220","DOIUrl":null,"url":null,"abstract":"Abstract Background Laparoscopic transperitoneal donor nephrectomy (LDN) 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 (RLDN) and LDN. 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 RLDN to LDN. Materials and methods All live renal donors who underwent either RLDN or LDN 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 p < 0.05. Results Our study included 89 subjects: 40 in the LDN group and 49 in the RLDN group. The RLDN 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 RLDN group (79.98 vs. 63.73 mL/min/1.73 m 2 ). There was a significantly higher fall in estimated glomerular filtration rate of donor after nephrectomy in RLDN group on POD-30 (35.53 vs. 30.60 mL/min/1.73 m 2 ). However, there were no significant differences in other parameters. Conclusions Our study, conducted in India, showed that the majority of RLDN outcomes were better than those of LDN. Hence, RLDN is clearly non-inferior to the gold standard LDN. A well-designed randomized controlled study is required to elucidate the statistical superiority of one approach over another.","PeriodicalId":39147,"journal":{"name":"Current Urology","volume":"1 1","pages":"0"},"PeriodicalIF":0.9000,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Current Urology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/cu9.0000000000000220","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Abstract Background Laparoscopic transperitoneal donor nephrectomy (LDN) 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 (RLDN) and LDN. 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 RLDN to LDN. Materials and methods All live renal donors who underwent either RLDN or LDN 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 p < 0.05. Results Our study included 89 subjects: 40 in the LDN group and 49 in the RLDN group. The RLDN 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 RLDN group (79.98 vs. 63.73 mL/min/1.73 m 2 ). There was a significantly higher fall in estimated glomerular filtration rate of donor after nephrectomy in RLDN group on POD-30 (35.53 vs. 30.60 mL/min/1.73 m 2 ). However, there were no significant differences in other parameters. Conclusions Our study, conducted in India, showed that the majority of RLDN outcomes were better than those of LDN. Hence, RLDN is clearly non-inferior to the gold standard LDN. A well-designed randomized controlled study is required to elucidate the statistical superiority of one approach over another.
背景腹腔镜经腹膜供者肾切除术(LDN)是目前活体供者肾捐赠的标准程序。只有少数临床研究比较了后腹膜镜下供体肾切除术(RLDN)和LDN的结果。需要对这两种技术的结果和并发症进行更可靠的数据和系统的比较分析。本研究旨在阐明RLDN对LDN的非劣效性。材料和方法2015年1月至2021年3月期间在我机构接受RLDN或LDN的所有活体肾供者均被视为受试者,拒绝参加研究的患者除外。这是一项双向队列研究。收集人口学和临床资料,采用标准统计方法进行分析。p <0.05. 结果本研究共纳入89例受试者:LDN组40例,RLDN组49例。RLDN组热缺血时间明显缩短(2.85 vs. 6.04分钟),术后1天血红蛋白(POD)-1下降较低(1.73 vs. 2.24 g/dL),估计失血量较低(601.93 vs. 797.27 mL), POD-1疼痛较低(0.78 vs. 1.28)。RLDN组受者在POD-30上估计肾小球滤过率的改善明显更高(79.98 vs. 63.73 mL/min/1.73 m2)。在POD-30上,RLDN组肾切除术后供者肾小球滤过率的估计下降明显更高(35.53 vs. 30.60 mL/min/1.73 m2)。但其他参数差异无统计学意义。我们在印度进行的研究表明,大多数RLDN的结果优于LDN。因此,RLDN显然不逊于黄金标准LDN。需要精心设计的随机对照研究来阐明一种方法相对于另一种方法的统计优越性。