Enhanced Recovery Open Versus Laparoscopic Donor Nephrectomy

The MEnROL trial is a phase III randomized controlled trial of Open versus Laparoscopic donor nephrectomy within a standardized enhanced recovery program. Eligible donors were randomized in a 1:1 ratio.

Laparoscopic procedures are performed by a single surgeon (AMM) while Open donor nephrectomies (ODN) were performed by an experienced team that included the laparoscopic surgeon. ODN were performed via a supracostal incision above the 11th rib and an extra-pleural extra-peritoneal approach was adopted. Laparoscopic donor nephrectomy (LDN) was performed via a standard 4-port distribution. Control of the hilar vessels was performed using extra-large Hem-o-Lok clips (Weck- Covidien, Research Triangle Park, NC) and graft extraction was performed via a pre-prepared Pfannenstiel incision.

Donors are enrolled in our enhanced recovery program for donor nephrectomy. The program was compliant with the Enhanced Recovery After Surgery Group (ERAS) guidelines. All donors receive epidural analgesia and are maintained on non-narcotic postoperative analgesics. Criteria for hospital discharge include ambulation, adequate pain control with oral analgesics, and sustained intake of solid food.

Inclusion criteria

• Donor aged 18 years or more.
• Donors who have the ability to understand information and materials provided.
• Donors who didn't express a preference for either open or laparoscopic surgery.
• Donors who are fit for both open and laparoscopic intervention
• Donors in whom evaluation revealed left kidney with single renal artery suitable for donation.
• Donors able to give signed written informed consent.

Exclusion criteria

• Donors who had a preference for either open or laparoscopic surgery.
• Donors in whom the right kidney was chosen for donation.
• Donors with double renal arteries in kidneys chosen for donation.
• Donors who didn't sign consent.