Forty-eight healthy voluntary renal donors between 18 and 60 years of age with BMI less than 30 who were planned for laparoscopic left side donor nephrectomy were enrolled. After randomization 25 donors (group A) underwent a laparoscopic donor nephrectomy with a kidney retrieval via Pfannenstiel incision whereas in 23 donors (group B) the kidney was extracted via a midline extension of the transumbilical port.

Both groups of recipients were comparable in terms of basic renal disease and received CNI, MMF and steroid. There were no operative complications in both groups.

Mean duration of surgery and warm ischemia time were comparable (227.12 min/ 263 seconds in group A versus 228.91 min/ 283 seconds in group B). Estimated blood loss was similar in both groups (165.6 ml in group A versus 151.3 ml in group B).

Weight of the kidneys (128.2 gm in group A vs. 120.4 gm in group B), length of renal artery (2.37 cm in group A vs. 2.30 cm in group B) and length of renal vein (2.58 cm in group A vs. 2.67 cm in group B) were statistically similar in both groups.

Length of ureter (8.7 cm in group A vs. 10.17 cm in group B) and length of extraction site incision (7.95 cm in group A vs. 10.17 cm in group B) showed statistically significant difference.

Pain scores noted by numerical rating scale on day 1 (8 in group A vs. 6 in group B) and 3 (6 in group A vs. 3 in group B) after surgery and at time of discharge (5 in group A vs. 3 in group B) showed statistically significant difference. Both groups of donors rated pain at 0 at 1 month following surgery. Day of discharge was similar in both groups with median 3 days post operative stay.

Serum creatinine of recipients on day 1 (2.57 vs. 2.99 mg/dl in groups A and B respectively) and 3 (1.74 vs. 2.15 mg/dl in groups A and B respectively) after surgery were comparable while mean serum creatinine on post operative day 7 (1.74 vs. 2.15 mg/dl in groups A and B respectively) was significantly higher in recipients of group B. Serum creatinine of recipients at 1 month post transplantation was similar in both groups (1.11 vs. 1.18 mg/dl in groups A and B respectively). The higher creatinine at day 7 may be explained by two patients in group B who had delayed graft function due to calcineurin inhibitor toxicity.

In conclusion the lower pain scores and shorter incision length with similar outcomes suggests that a transumbilical route may be a more acceptable route for kidney retrieval.

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