Minimal incision living donor nephrectomy compared to the hand-assisted laparoscopic living donor nephrectomy.

BACKGROUND: There has been a surge of minimally invasive procedures for living donor nephrectomy. We compared our minimal incision living donor (MILD) nephrectomy to hand-assisted laparoscopic (HAL) living donor nephrectomy METHODS: We conducted a Medline search and compared our first 45 MILD nephrectomies to the data from the University of Michigan (UM), Tulane University (TU), and the University of Chicago (UC). RESULTS: The MILD incision was smaller than the cumulative incisions in the UM and UC groups (8.6, 11 and 10.4 cm, respectively). The operating times were similar in the UM and UC groups (209, 246, and 215 min, respectively). The UM and TU lengths of hospital stay (1.8 and 2.2 days) were shorter than those of the MILD and UC groups (2.5 and 2.8 days). CONCLUSIONS: MILD nephrectomy has results similar to those of HAL living donor nephrectomy. It allows the surgeon with a traditionally trained background to perform a safe, minimally invasive operation without laparoscopic technology.

Minimal incision living donor nephrectomy: improvement in patient outcome.

OBJECTIVES: To analyze the minimal incision living donor (MILD) nephrectomy and compare it with the standard open donor (SOD) nephrectomy with respect to incision size, operative time, complication rate, length of hospital stay, and recipient creatinine. METHODS: Forty-five consecutive patients who underwent MILD nephrectomy were compared with 13 patients who had previously undergone SOD nephrectomy. The MILD nephrectomy was performed through a minimally invasive incision using a modified, anterolateral, retroperitoneal approach without a rib resection. The incision length, operative time, complication rates, length of hospital stay, and recipient creatinine were analyzed. RESULTS: The average incision length in the MILD group was 8.6 cm compared with 21.8 cm in the SOD group (P >0.005.) The operative times (209 minutes in the MILD group versus 191 minutes in the SOD group) were not significantly different. Four postoperative complications were encountered in the SOD group and seven in the MILD group. The average hospital stay for the MILD patients was 2.5 days compared with 4.6 days in the SOD group, and as the procedure was refined, the length of stay was reduced to 1 day in 3 patients. The recipient creatinine at 1 and 6 months was 1.39 and 1.4 mg/dL in the MILD group, respectively. CONCLUSIONS: The MILD nephrectomy allows the patient to undergo a less morbid procedure with a more aesthetic incision. Patients have fewer complications, minimal anesthesia exposure, and short hospital stays.