A PROSPECTIVE STUDY COMPARING OUTCOMES AND QUALITY OF LIFE AFTER LAPAROSCOPIC DONOR NEPHRECTOMY VERSUS OPEN DONOR NEPHRECTOMY

Renal transplant is the accepted standard of care in patients with end stage renal disease. Its superiority over dialysis has been already proved. Grafts obtained from live donors have a significantly longer life than those obtained from cadaveric donors. However, live donor nephrectomy places an individual through a major operation done for some other individual’s benefit. For this reason, it has always been a major concern to reduce the perioperative morbidity and mortality to the donor while still achieving a favorable graft outcome. There are several approaches to retrieve the kidney, like flank approach, subcostal approach and the latest laparoscopic organ retrieval. However major concerns exist over the merits and demerits of each approach, especially laparoscopic organ retrieval. With the advent of laparoscopy, a minimally invasive method is available to reduce the perioperative morbidity to the patient. Studies have shown laparoscopic donor nephrectomy to be equally safe and efficacious as the traditional open approach. It provides all the advantages of minimally invasive surgery, such as less pain, decreased blood loss, fewer wound complications, shorter hospital stay and faster recovery. However, laparoscopic donor nephrectomy is an advanced minimally invasive procedure which requires high level of laparoscopic skills. Large prospective studies comparing open versus laparoscopic donor nephrectomy are lacking in number, especially in the Indian scenario and further studies are required to compare the two modalities. Quality of life and cosmesis are important aspects after any operative intervention; however, they are especially important in donor nephrectomy, because the individual undergoes a major procedure for some other individual’s benefit. His/her post operative quality of life should be, if not, equal to his preoperative quality of life. However, there is a lacuna in the literature about the quality of life following open/laparoscopic donor nephrectomy, especially in the Indian scenario. Hence, this study proposes to prospectively compare laparoscopic donor nephrectomy with open donor nephrectomy with respect to perioperative morbidity and mortality to the donor and the recipient’s graft function and to assess and compare the quality of life of patient’s pre and post renal transplant by using WHO QOL-BREF protocol and the Hospital Anxiety and Depression Scale; to compare the cosmetic outcomes of the two procedures using the Body Image Questionnaire and to assess the overall patient satisfaction with the procedure using the Verbal Rating Scale.