2.1.1 Kidneys from live donors are considered more likely to be successful in treating endstage renal disease than those from cadaver donors.
2.1.2 The standard technique for retrieving kidneys from live donors is by open surgery. The aim of laparoscopic nephrectomy is to reduce donor morbidity and make the process more appealing to potential donors. It can be performed via a transperitoneal or retroperitoneal approach. The transperitoneal approach is preferred because it allows more laparoscopic working space, it makes it easier to remove the kidney and the incision is less painful.
2.2.1 The procedure involves the insertion of laparoscopic instruments through the abdominal wall via small incisions, insufflation of carbon dioxide and removal of a kidney.
2.3.1 One systematic review and several non-randomised comparative studies were identified. The systematic review found no statistically significant difference between the laparoscopic and open procedures for graft function, graft survival and recipient survival, although there was a lack of long-term follow-up data. One study found recipient acute rejection in the first month to be 30% (33/110) for the laparoscopic procedure and 31% (15/48) for the open procedure. Donor hospital stay was generally shorter for the laparoscopic procedure; means ranged from 1.3 to 3.2 days for the laparoscopic procedure and 4.1 to 4.4 days for the open procedure. Laparoscopic donors generally returned to work earlier than donors undergoing the open procedure; means ranged from 2.1 to 3.9 weeks for the laparoscopic procedure and 4.1 to 7.4 weeks for the open procedure. For more details, refer to the sources of evidence (see below).
2.3.2 The Specialist Advisors did not raise any concerns regarding the efficacy of this procedure.
2.4.1 The risks of laparoscopic live donor simple nephrectomy appeared similar to those of open live donor nephrectomy. In a systematic review, donor complication rates were reported to be between 0% (0/20) and 35% (23/65) for open procedures, and between 5% (1/19) and 20% (6/30) for laparoscopic procedures; some studies did not report their open nephrectomy results for comparison. Recipient complications also appeared to be similar for both open and laparoscopic procedures, but these were reported even less often than the donor complications. In a systematic review, recipient ureteric complication rates were reported to be 3–6% for open procedures and 3–10% for laparoscopic procedures. For more details, refer to the sources of evidence (see below).
2.4.2 The Specialist Advisors considered the main safety concerns to be bleeding, injury to nearby organs and conversion to open surgery.