Hospital Stay and Analgesic Requirement
Hospital stay is decreased in LND as compared to OND (2-3 days vs 4-6 days) [6, 8]. Analgesic requirement in OND is more as compared to LND (36.4{5-98 mg of morphine equivalents} vs 28.1{0-7,798 mg of morphine equivalents}) [7]. The intensity of the pain experienced by patients undergoing OND is more. [7]. The mean time to resume all routine activities is less in LND [10]. Also the mean donor satisfaction is also higher in LND [7].
Graft Function
Graft function is comparable in both groups, and increased warm ischemia probably does not impact the graft outcome [7, 9].
Complications
The complication rate in both modalities is comparable, but the pattern of complications is different. ODN can cause pneumothorax, flank nerve entrapment, and flank hernia [11], whereas complications with LND include vascular injury, adjacent organ injury, and ureteric ischemia.
After discussing ODN in detail, we would have to agree that LDN is replacing ODN and it is here to stay. But nonetheless all the donor surgeons should be well versed with open technique, as it may be grace saving whenever complication occurs. Also in situations where the renal vein is less than 1.5 cm on the right side and when donor has already undergone multiple surgeries, OND would be the way to do it.
Acknowledgment Dr. Dhanajay Bokare (Consultant Urologist, Care Hospital, Nagpur, India): for providing intraoperative pictures of open donor nephrectomy.
Dr. Ankush Jairath: (Consultant Urologist, Ludhiana, India): for providing intraoperative sketch of the left and right open donor nephrectomies.
