Hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy

Transplantation is the only treatment offering long-term benefit to patients with chronic kidney failure. As the number of patients suffering end stage renal disease increases, the recruitment of more kidney donors is important. Live kidney donation is the most realistic option to reduce donor shortage. Increasing the number of donors may reduce patient’s mortality and decrease the transplantation waiting list.
Implementation of live donation offers the possibility to transplant before the kidney disease reaches it’s terminal phase necessitating dialysis. Thus, this so called pre-emptive transplantation may prevent unnecessary surgical intervention to establish dialysis (including costs and mortality). To date the number of non-related live kidney donations is rising.

Living kidney donor nephrectomy is performed on healthy individuals who receive no direct therapeutic benefit of the procedure themselves. In order to guarantee donor’s safety, it is important to optimise the surgical approach. Recently we demonstrated the benefit of laparoscopic nephrectomy to the donor. However, this method is characterized by high costs, long operation times and requires a well-trained surgeon. Especially on the left side we experience more intra-operative complications. An alternative to the fully laparoscopic approach may be the hand-assisted retroperitoneoscopic technique.
The peritoneum remains intact and the risk of visceral injuries is reduced. Due to the hand-assistance the procedure is fast and the time on the operation table may be reduced significantly. The feasibility of this method has been demonstrated recently , but as to date there are no data available advocating the use of one technique above the other. This randomised controlled trial compares the hand-assisted retroperitoneal approach to the current standard, the transabdominal laparoscopic technique, to define the most optimal approach for left-sided donor nephrectomy.

To determine the best approach for left-sided live donor nephrectomy to optimise donor’s safety and comfort while reducing donation related costs, with equal or better quality of life for the HARP-technique.

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This trial randomizes donors for either laparoscopic or hand-assisted retroperitoneoscopic (HARP) donor nephrectomy to assess the role of HARP for kidney donation.