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Introduction: In this multicenter, randomized controlled trial, endovenous laser ablation (EVLA) is compared with conventional surgery for the treatment of varicose veins based on incompetence of the small saphenous vein and the saphenopopliteal junction (SPJ)., Methods: In two Dutch hospitals, 189 patients were enrolled and randomized to receive EVLA (810-nm laser) or ligation of the SPJ. End points were success rate measured with duplex ultrasound (6 weeks post-treatment), perioperative pain, quality of life, duration of surgery, difficulty of surgery, complications, cosmetic results, and number of days to resume work and normal activities. Pain was measured on a visual analog scale (VAS). Quality of life was assessed using the Aberdeen Varicose Vein Questionnaire (AVVQ) and Euro Qol-5D. The follow-up duration in this article is 6 weeks., Results: One hundred seventy-five patients have been treated and analyzed. One hundred eighteen patients (67%) underwent EVLA, and 57 patients (33%) underwent ligation of the SPJ. The patient characteristics were similar in both groups. In the surgery group, 21% residual incompetence of the SPJ was seen after 6 weeks, compared with 0.9% in the laser group. Both treatment modalities reduced pain after 6 weeks. One week post-treatment, patients in the EVLA group temporarily experienced more pain compared with the surgery group (31 vs 18 on a VAS from 0 to 100). There were no significant differences between the two groups with respect to quality of life. Both treatments did show improvement in quality of life. Also with regard to the cosmetics, there were no differences, aside from the fact that patients rated their scar as more beautiful after EVLA. After EVLA, patients could return to work more quickly. The operation time was longer in the surgery group. After 2 weeks, there were significantly more neurological complications in the surgery group: 18 (31%) vs 16 (17%) patients in the EVLA group. Ten percent of patients in the surgery group developed a surgical site infection vs 0% in the EVLA group., Conclusions: EVLA provides an excellent alternative to conventional surgery in the treatment of symptomatic varicose veins due to an incompetent small saphenous vein with SPJ. EVLA has a superior immediate success rate, is easier and faster, and has fewer complications., (Copyright © 2013 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: Determining possible differences in living donor nephrectomy procedures: laparoscopy against mini-incision concerning discomfort to the donor and the maintenance of good graft function., Design: Blind randomized study., Method: In two university medical centres, one hundred living kidney donors were randomly assigned to either total laparoscopic donor nephrectomy or mini-incision muscle-splitting open donor nephrectomy. Primary outcome was physical fatigue measured with the 'Multidimensional Fatigue Inventory' (MFI-20) during one-year follow-up. Secondary outcomes were physical function measured with the 'Short form-36' questionnaire, postoperative hospital stay, amount of pain, operating times and graft and patient survival., Results: Donors who underwent laparoscopy experienced less fatigue (difference: -1.3; 95% CI: -2.4 - (-0.1)) and physical function was better (difference: 6.2; 95% CI: 2.0-10.3) during one-year follow-up. Those donors who underwent laparoscopy required less morphine (16 mg versus 25 mg; p = 0.005) and the duration of hospital stay was shorter (3 versus 4 days; p = 0.003). The laparoscopic procedure resulted in a longer operation time (221 versus 164 min; p < 0.001) a longer first warm ischaemia time (6 versus 3 min; p < 0.001) and less blood loss (100 versus 240 ml; p < 0.001). Recipient renal function and one-year graft survival rates did not differ. The number of preoperative and postoperative complications did not differ significantly between both surgery techniques. Conversions did not occur., Conclusion: Donor nephrectomy through laparoscopy led to less fatigue and a better quality of life compared with the open procedure. The safety factors for donors and recipients were comparable for both techniques. Laparoscopic donor nephrectomy is therefore the better surgical choice for kidney donor programmes with living donors.

Objectives: To determine the best approach for live donor nephrectomy to minimise discomfort to the donor and to provide good graft function., Design: Single blind, randomised controlled trial., Setting: Two university medical centres, the Netherlands., Participants: 100 living kidney donors., Interventions: Participants were randomly assigned to either laparoscopic donor nephrectomy or to mini incision muscle splitting open donor nephrectomy., Main Outcome Measures: The primary outcome was physical fatigue using the multidimensional fatigue inventory 20 (MFI-20). Secondary outcomes were physical function using the SF-36, hospital stay after surgery, pain, operating times, recipient graft function, and graft survival., Results: Conversions did not occur. Compared with mini incision open donor nephrectomy, laparoscopic donor nephrectomy resulted in longer skin to skin time (median 221 v 164 minutes, P < 0.001), longer warm ischaemia time (6 v 3 minutes, P < 0.001), less blood loss (100 v 240 ml, P < 0.001), and a similar number of complications (intraoperatively 12% v 6%, P = 0.49, postoperatively both 6%). After laparoscopic nephrectomy, donors required less morphine (16 v 25 mg, P = 0.005) and shorter hospital stay (3 v 4 days, P = 0.003). During one year's follow-up mean physical fatigue was less (difference - 1.3, 95% confidence interval - 2.4 to - 0.1) and physical function was better (difference 6.2, 2.0 to 10.3) after laparoscopic nephrectomy. Function of the graft and graft survival rate of the recipient at one year censored for death did not differ (100% after laparoscopic nephrectomy and 98% after open nephrectomy)., Conclusions: Laparoscopic donor nephrectomy results in a better quality of life compared with mini incision open donor nephrectomy but equal safety and graft function.

Background: Laparoscopic donor nephrectomy is associated with several advantages for the donor. However, graft function may be impaired due to use of pneumoperitoneum and prolonged warm ischemia. This study investigated the impact of pneumoperitoneum and prolonged warm ischemia on long-term graft function in a syngeneic rat renal transplant model., Methods: A total of 27 Brown Norway rats were randomized for transplantation of kidneys after three different procedures: no insufflation and no warm ischemia (group 1), no insufflation with 20 min of warm ischemia (group 2), and CO2 insufflation and 20 min of warm ischemia (group 3). Glomerular filtration rate (GRF), serum creatinine, urine volume, urine creatinine, and proteinuria were determined monthly for 1 year. One year after transplantation, the grafts were removed for histomorphologic analysis., Results: No significant differences in GRF, serum creatinine, urine volume, and proteinuria were found among the three groups. Histologic analysis also showed no differences between the groups., Conclusion: Warm ischemia in combination with CO2 pneumoperitoneum, as used in laparoscopic donor nephrectomy, does not result in a negative effect on long-term graft function.

Background: The introduction of laparoscopic donor nephrectomy (LDN) has encouraged the development of less invasive open techniques. Aim of the present study was to compare short-term outcomes between contemporary cohorts of donors who underwent either mini-incision open or laparoscopic kidney donation., Methods: From May 2001 to September 2004 data of all living kidney donations and transplantations were prospectively collected. Fifty-one donors underwent mini-incision, muscle-splitting open donor nephrectomy (MIDN) and 49 donors underwent LDN., Results: Baseline characteristics of donors and recipients in the study groups were comparable except for donors' gender. Median incision length in MIDN was 10.5 cm. In two patients LDN was converted to open. MIDN resulted in significantly shorter warm ischemia and operation time (2.5 vs. 6.5 min and 157 vs. 240 min respectively). During MIDN, donors had more blood loss (200 vs. 120 ml, P=0.02). Disposables used for MIDN were cheaper (328 vs. 1784 Euros). In the LDN group 4 (8%) major intraoperative and 2 (4%) major postoperative complications occurred versus no major complications in the MIDN group. Morphine requirement, pain and nausea perception, and time to dietary intake did not significantly differ between the groups. Following MIDN, donors were discharged later (4 vs. 3 days, P=0.02). Transplantation of kidneys procured by either approach led to a similar decline in serum creatinine throughout the first year. One-year graft survival was 100% following MIDN and 86% following LDN (P=0.005)., Conclusion: MIDN and LDN both lead to satisfactory results. Both techniques can be used to expand living donor programs.

Pneumoperitoneum, as used in laparoscopic donor nephrectomy (LDN), may result in negative effects on renal function in donor and recipient. This study compares long-term serum creatinine in donor and recipient after laparoscopic and open donor nephrectomy (ODN). A retrospective analysis of 120 LDN and 100 ODN donors and their recipients was performed. Serum creatinine of donor and recipient was recorded and analyzed. The follow-up period posttransplantation was 3 years. Serum creatinine in the recipients was significantly higher in the LDN groups the first week after transplantation. Serum creatinine in the donor was significantly higher in the LDN group at 1 day, 3 months, and 1 year posttransplant. Finally, creatinine levels remained 40% higher compared to preoperative values in both donor groups. LDN results in higher short-term serum creatinine levels in donor and recipient. Long-term serum creatinine levels were comparable after LDN or ODN in donor and recipient.

Background: Laparoscopic donor nephrectomy (LDN) is thought to result in a better cosmetic outcome for the altruistic healthy donor than open donor nephrectomy (ODN). To the authors' knowledge, no studies have established the opinion of donors with respect to their bodily appearance. This study investigates the body image of donors after ODN and LDN., Methods: Donors who underwent surgery between 1994 and 2001 were invited to fill out a body image questionnaire. This questionnaire consists of two subscales: the body image scale (BIS) and the cosmetic scale (CS). A total of 56 LDN subjects and 69 ODN subjects responded to the questionnaire (72% of 174 donors)., Results: Both groups were comparable in terms of gender, current age, and body mass index (BMI). The time from donation until the time of this study (follow-up assessment) was significantly longer for the ODN groups. The BIS and CS were found to be comparable between the two groups. No associations were found between BIS or CS and follow-up duration. There also was no association between BIS or CS and gender, age and BMI., Conclusions: The body image ratings of donors do not significantly differ after ODN or LDN.

Objectives: To describe our experience with laparoscopic donor nephrectomy (LDN) and open donor nephrectomy (ODN) regarding ureteral complications. LDN has proved to be safe and to offer significant benefits to the donor compared with ODN. Of major importance is the effect of the surgical technique on the graft. Studies have shown an increased incidence of ureteral complications in recipients of laparoscopically procured kidneys. Operative reconstruction results in additional morbidity for the recipient., Methods: Living donors and their recipients, who underwent surgery from January 1994 to April 2002, were included in this retrospective study. A total of 122 LDN and 77 ODN recipients were included., Results: Of the 122 LDN and 77 ODN recipients, 15 (12%) and 10 (13%), respectively, required percutaneous nephrostomy drainage. In total, 5 LDN (4.1%) and 5 ODN (6.5%) recipients required reconstruction of the ureter because of obstruction of the ureter or urine leakage (P value not statistically significant, excluding reconstruction required for technical errors). The operating time, warm ischemia time, and serum creatinine were comparable between recipients with or without ureter complications requiring reconstruction., Conclusions: In our experience, LDN was not associated with an increased incidence of ureteral complications in the recipient compared with ODN.

Background: Several studies report an earlier return to work after minimal invasive kidney donation compared to open donor nephrectomy. However, this variation in outcome might be influenced by other factors than the surgical technique used, such as the advice given by the physician regarding return to work. In this study, we compare the absence from work after open (ODN), laparoscopic (LDN), and hand-assisted donor nephrectomy (HA) performed in the Netherlands, in relation to the advice given., Methods: Questionnaires containing questions about return to work or return to daily activities were sent to 78 donors from three hospitals. In the HA and ODN hospitals, advice on full return to work was 3 months. In contrast, advice given in the LDN hospital was 6 weeks., Results: After LDN, donors resumed their work after 6 weeks, 5 weeks faster compared to ODN (p = 0.002) and HA (p <0.001). Complete return to work occurred 9 weeks sooner in the LDN group compared to the ODN and HA groups (both p <0.001). In the unemployed group, there was no significant difference in length until full return to daily activities., Conclusion: Return to work is influenced by the advice on return to work given by the physician as well as the morbidity associated with the surgical approach.

Background: Laparoscopic donor nephrectomy (LDN) of the right kidney is performed with great reluctance because of the shorter renal vein and possible increased incidence of venous thrombosis., Methods: In this retrospective, clinical study, right LDN and left LDN were compared. Between December 1997 and May 2001, 101 LDN were performed. Seventy-three (72%) right LDN were compared with 28 (28%) left LDN for clinical characteristics, operative data, and graft function., Results: There were no significant differences between the two groups regarding conversion rate, complications, hospital stay, thrombosis, graft function, and graft survival. Operating time was significantly shorter in the right LDN group (218 vs. 280 min)., Conclusion: In this study, right LDN was not associated with a higher number of complications, conversions, or incidence of venous thrombosis compared with the left LDN. Thus, reluctance toward right LDN is not justified, and therefore, right LDN should not be avoided.