***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Laparoscopic  donor nephrectomy ( LDN )  has been proven feasible in overweight individuals , but remains technically challenging . As the perirenal fat distribution and consistency significantly differ between men and women , we investigated possible differences between the genders . Prospect ively collected data of 37 female and 39 male donors with a body mass index ( BMI ) over 27 who underwent total LDN were compared . Ninety-one donors with a BMI < 25 served as controls . Clinical ly relevant differences were not observed between men and women of normal weight . In overweight donors , two ( 5 % ) procedures were converted to open in females and five ( 13 % ) in males . None of these conversions in females , but four conversions in males , appeared to be related to the donor 's perirenal fat ( P = 0.05 ) . Operation time ( median 210 vs. 241 min , P = 0.01 ) and blood loss ( median 100 vs. 200 ml , P = 0.04 ) were favorable in female donors . The number of complications did not significantly differ .  Total LDN  in overweight female donors does not lead to increased operation times , morbidity or technical complications . In contrast , the outcome in obese males seems to be less advantageous , indicating that  total LDN  in overweight women can be advocated as a routine procedure but in obese men reluctance seems justified BACKGROUND Laparoscopic live donor nephrectomy  for renal transplantation is being performed in increasing numbers with the goals of broadening organ supply while minimizing pain and duration of convalescence for donors . Relative advantages in terms of recovery provided by laparoscopy over st and ard open surgery have not been rigorously assessed . We hypothesized that laparoscopic as compared with open surgical live donor nephrectomy provides briefer , less intense , and more complete convalescence . METHODS Of 105 volunteer , adult , potential living-renal donors interested in the laparoscopic approach , 70 were r and omly assigned to undergo either h and -assisted laparoscopic or open surgical live donor nephrectomy at a single referral center . Objective data and subjective recovery information obtained with telephone interviews and vali date d question naires administered 2 weeks , 6 weeks , and 6 - 12 months postoperatively were compared between the 23 laparoscopic and 27 open surgical patients . RESULTS There was 47 % less analgesic use ( P=0.004 ) , 35 % shorter hospital stay ( P=0.0001 ) , 33 % more rapid return to nonstrenuous activity ( P=0.006 ) , 23 % sooner return to work ( P=0.037 ) , and 73 % less pain 6 weeks postoperatively ( P=0.004 ) in the laparoscopy group . Laparoscopic patients experienced complete recovery sooner ( P=0.032 ) and had fewer long-term residual effects ( P=0.0015 ) . CONCLUSIONS Laparoscopic donor nephrectomy is associated with a briefer , less intense , and more complete convalescence compared with the open surgical approach Abstract 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 , r and omised controlled trial . Setting Two university medical centres , the Netherl and s. Participants 100 living kidney donors . Interventions Participants were r and omly 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 result ed 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 . There is an ongoing discussion in living renal transplantation whether the right or the left donor nephrectomy is to be preferred if both kidneys are equal , due to the lack of prospect i ve studies . Methods . A prospect i ve single-center r and omized trial was conducted from April 2002 to September 2006 , in which 60 eligible consecutive donors were r and omized to either left-sided or right-sided h and -assisted laparoscopic donor nephrectomy ( HALDN ) .  Primary endpoint was operation time . Secondary endpoints were donor morbidity , warm ischemia time , delayed graft function , urological complications , quality of life , and graft survival . Results . Median operating time for left-sided HALDN ( 180 min ) was significantly longer compared with right-sided HALDN ( 150 min ; P=0.021 ) . There were no conversions in both groups . There were no major intra- or postoperative complications . One-year graft survival rate was 96 % in the left group versus 93 % in the right group ( P=0.625 , log rank ) . Conclusions . Operating time of HALDN of the right kidney is significantly shorter than HALDN of the left kidney . No differences were detected in complication rates and graft survival between left and right-sided donor nephrectomy The aim of the present study was to compare postoperative pain and convalescence in patients r and omized to laparoscopic or open donor surgery  in a prospect i ve , controlled trial . The donors were r and omly assigned to undergo laparoscopic ( n = 63 ) or open ( n = 59 ) donor nephrectomy .  Our end points were amount of administered analgesics in the recovery period , postoperative pain on the second postoperative day and at one month after surgery and duration of sick leave Background . Older living kidney donors remain controversial because of their physiological decline in glomerular filtration rate and their increased susceptibility of surgical complications . Little is known about the quality of life ( QOL ) of this elderly group . The purpose of this study is to examine surgical outcome and the QOL in older living donors . Patients and Methods . All 105 consecutive living donors who underwent a laparoscopic donor nephrectomy between June 2002 and February 2006 were prospect ively included in the study . Intra- and postoperative complications were measured . Quality of life was recorded preoperatively and at several endpoints postoperatively . Older donors were defined as 55 years and older . Results . There were no significant differences in intra- and postoperative complication rates and 1-year graft survival rate between both groups . Elderly donors ( n=34 ) had both a significant lower postoperative pain at rest at day 1 compared with the younger group ( P=0.019 ) and a lower total pain score in the analysis for the whole follow-up period ( P=0.002 ) . Although small solitary significant differences in Short Form-36 Health Survey , Multidimensional Fatigue Inventory-20 and visual analogue scale measuring pain , between both groups were detected , in general QOL of older donors was not different than of younger donors . Conclusion . Although small solitary significant differences exist with respect to pain , social functioning and mental health older donors , in general , have similar surgical outcome and quality of life when compared with younger donors . There is no need to exclude older donors in screening programs for transplantation OBJECTIVES To evaluate the use of laparoscopic techniques in patients with a renal transplant . METHODS Since 1992 , 358 patients have undergone urologic laparoscopy at our hospital . Among these , 37 procedures ( 10.4 % ) were performed in patients with a renal transplant : 14 bilateral nephrectomies for severe drug-resistant hypertension , 9 marsupializations of symptomatic lymphoceles , 6 renal allograft biopsies in patients with clotting abnormalities , 6  unilateral nephrectomies  , and 2 nephroureterectomies for recurrent episodes of pyelonephritis and symptomatic vesicoureteral reflux , respectively . RESULTS Five complications ( 14 % ) and three conversions ( 8 % ) occurred . Patients who underwent successful laparoscopic operations began mobilization and oral intake on the day after the operation . The hospital stay ranged from 1 to 6 days . In the nephrectomy groups , perioperative urine outputs remained stable and post-operative urine outputs were increased as compared with those in the perioperative period ( P < 0.05 ) . Post-operatively , serum creatinine remained stable or improved in patients who underwent nephrectomy or marsupialization of lymphocele . CONCLUSIONS Our results indicate that laparoscopic techniques are safe and effective in the treatment of patients with a renal transplant . Renal allograft function apparently is not affected by laparoscopic procedures Background . The aim of this r and omized study was to compare patient-reported outcome after  laparoscopic versus open donor nephrectomy  during 1 year follow-up . The evidence base has so far not allowed for a decision as to which method is superior as seen from a long-term quality of life-perspective . Methods . The donors were r and omized to laparoscopic ( n=63 ) or open ( n=59 ) nephrectomy  , with follow-up at 1 , 6 , and 12 months . Primary outcomes were health status ( SF-36 ) and overall quality of life ( QOLS-N ) . Secondary outcomes were donor perception of the surgical scar , the donation ’s impact on personal finances , and whether the donor would make the same decision to donate again . Results . There was a significant difference in favor of laparoscopic surgery regarding the SF-36 subscale bodily pain at 1 month postoperatively ( P<0.05 ) . Analysis based on intention to treat revealed no long-term differences between groups in SF-36 scores . When subtracting the reoperated/converted donors of the laparoscopic group , significant differences in favor of laparoscopy were revealed in the subscales bodily pain at 6 months ( P<0.05 ) and social functioning at 12 months ( P<0.05 ) . No significant differences were found in QOLS-N scores between groups . Conclusions . Laparoscopic donor nephrectomy is an attractive alternative to open donor nephrectomy because of less postoperative pain . However , long-term comparison only revealed significant differences in favor of laparoscopy when adjusting for reoperations/conversions . Both groups reached baseline scores in most SF-36 subscales at 12 months and this may explain why possible minor benefits are hard to prove Laparoscopic versus  open living‐donor nephrectomy  has become a frequent debate amongst urologists involved in this area of expertise , with the laparoscopic argument being most popular at present . Authors from Australia describe a prospect i ve comparative trial using both techniques , finding that the laparoscopic approach could be introduced without compromising results Authors from Iran compare various outcomes between  laparoscopic and open donor nephrectomy in kidney transplantation ; they carried out a large comparative trial , and found that laparoscopic donor nephrectomy gave better donor satisfaction and morbidity , with equivalent graft outcome PURPOSE H and assisted laparoscopy combines aspects of open and laparoscopic surgery . A h and in the abdomen may facilitate laparoscopic live donor nephrectomy , allowing more urologists to participate . We report and compare our initial series of h and assisted laparoscopy donor nephrectomy with nephrectomy performed by st and ard open methods . MATERIAL S AND METHODS In the last 18 months 60 patients at 2 institutions underwent h and assisted laparoscopy donor nephrectomy .  This cohort was compared to a contemporary group of 31 patients who underwent open donor nephrectomy via a flank incision at our 2 institutions . Demographic and outcome data were compared retrospectively in a nonr and omized fashion in the 2 groups . RESULTS Demographic data on patient age , male-to-female ratio and body mass index were similar in the 2 groups . Operative time , transfusion rate , time to oral intake and complications were also similar . However , estimated blood loss , change in hematocrit preoperatively to postoperatively , hospitalization , parenteral and oral narcotic requirement , and donor convalescence were significantly less 
    Output:
    
With regard to the perioperative outcome parameters , laparoscopy was better than open surgery in terms of blood loss , analgesic requirements , and duration of hospital stay and convalescence .
Postoperative graft function was not significantly different between the different forms of donor nephrectomy , although longer warm ischemia times are reported for laparoscopy .
All three techniques of live-donor nephrectomy are st and ard of care .
The laparoscopic techniques result in less postoperative pain and estimated blood loss with shorter hospital stay , while postoperative graft function is not inferior to that after open live-donor nephrectomy