NIV Congres

Nowadays laparoscopic donor nephrectomy (LDN) has become the gold standard to procure live donor kidneys. As the relationship between donor and recipient loosens, it becomes of even greater importance to optimize safety and comfort of the surgical procedure. Low pressure pneumoperitoneum has been shown to reduce pain scores after laparoscopic cholecystectomy. Live kidney donors may also benefit from the use of low pressure during LDN. To evaluate feasibility and efficacy to reduce postoperative pain, we performed a randomized double blind study. Twenty donors were randomly assigned to standard (14 mmHg) or low (7 mmHg) pressure during LDN. One conversion from low to standard pressure was indicated by protocol due to lack of progression. Intention-to-treat analysis showed that low pressure resulted in a significantly longer skin-to-skin time (149±86 versus 111±19 minutes), higher urine output during pneumoperitoneum (23±35 versus 11±20 mL/hr), lower cumulative overall pain score after 72 hours (9.4±3.2 versus 13.5±4.5) and a lower cumulative overall referred pain score (1.8±1.9 versus 4.2±3). Donor serum creatinine levels, complications and quality of life dimensions were not significantly different. Our data show that low pressure pneumoperitoneum during LDN is feasible and may contribute to increase live donors’ comfort during the early postoperative phase.