Clinical Science: First Prize Standard Laparoscopic Donor Nephrectomy Versus Laparoendoscopic Single-Site Donor Nephrectomy: A Randomized Comparative Study Abraham Kurien, M.S., D.N.B. (Urol), 1 Sujata Rajapurkar, M.A., Ph.D., 2 Lokesh Sinha, M.S., 1 Shashikant Mishra, M.S., D.N.B. (Urol), 1 Arvind Ganpule, M.S., D.N.B. (Urol), 1 Veeramani Muthu, M.S., M.Ch. (Urol), 1 Ravindra Sabnis, M.S., M.Ch. (Urol), 1 and Mahesh Desai, M.S., FRCS (Eng), FRCS (Edin) 1 Abstract Introduction: The purpose of this study was to compare in a randomized fashion the clinical outcomes following standard laparoscopic and laparoendoscopic single-site (LESS) donor nephrectomies. Materials and Methods: Fifty voluntary renal donors who met the inclusion and exclusion criteria were ran- domized to standard laparoscopic (group A) and LESS (group B) donor nephrectomies. The primary end point of the study was patients’ postoperative pain. The clinical outcomes, patient’s quality of life, body image, and cosmetic scores on follow-up were also compared. Results: The operating times were similar in both groups (175.83  47.57 vs. 172.20  38.33 minutes, p ¼ 0.38). The surgeon’s difficulty as measured using a visual analog scale was significantly more in group B in 4 of 10 defined steps. The postoperative patient pain scores were similar till 48 hours following surgery (3.84  1.68 vs. 3.68  0.75, p ¼ 0.33), but following which the patients in group B had improved pain scores (2.08  0.91 vs. 1.24  0.72, p ¼ 0.0004). Analgesic requirements were similar in both groups ( p ¼ 0.47). The warm ischemia times in group B (5.11  1.01 vs. 7.15  1.84 minutes, p < 0.0001) were longer but the total ischemia times in both groups were similar (62.55  9.46 vs. 62.71  12.14 minutes, p ¼ 0.48). All grafts had on-table urine output in the recipient. Intraoperative (8% vs. 16%, p ¼ 0.2) and postoperative complications (20% vs. 16%, p ¼ 0.99) in both groups were comparable. The patients in group B had shorter hospital stay (4.56  0.82 vs. 3.92  0.76 days, p ¼ 0.003). There was no graft loss in either group except for one recipient in group A who sustained sudden cardiac death. The estimated glomerular filtration rates of recipients at 1 year were comparable for both groups (80.87  22.12 vs. 81.51  29.01 mL=minute, p ¼ 0.46). The donor’s quality of life, body image, and cosmetic scores were comparable for both groups. Conclusion: In this select group of donors, LESS donor nephrectomy, although challenging to the surgeon with longer warm ischemic times, gave early pain relief with shorter hospital stay and comparable graft function. Introduction I n 1994, Gill et al successfully performed laparoscopic donor nephrectomy in a porcine model. 1 Subsequently, Ratner and associates 2 were the first to clinically develop a technique for laparoscopic live donor nephrectomy in a 40- year-old man in February 1995. Laparoscopic donor ne- phrectomy has been now accepted worldwide. Comparative studies with open donor nephrectomy have shown that lap- aroscopic donor nephrectomy removes some of the disin- centives to live donation with shorter hospital stay and faster return to work, without compromising the outcome of the recipient graft function. 3,4 It also results in a better quality of life compared with the open one. 5 Efforts are constantly being made to further decrease the morbidity to the donor. The initial reports on laparoendoscopic single-site (LESS) donor nephrectomy showed that it is feasible. 6–9 The purpose of this study was to compare the clinical outcome between standard laparoscopic and LESS donor nephrectomies. Materials and Methods This randomized comparative study was approved by our institutional review board. The study period was from 1 Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India. 2 Medical Social Work and Transplant Coordination, Muljibhai Patel Urological Hospital, Nadiad, India. JOURNAL OF ENDOUROLOGY Volume 25, Number 3, March 2011 ª Mary Ann Liebert, Inc. Pp. 365–370 DOI: 10.1089=end.2010.0250 365