Hand-assisted laparoscopic nephrectomy in living donor

Abstract

Objective: Report the authors' initial experience with hand-assisted laparoscopic nephrectomy technique in renal donors for transplantation.Materials and Methods: Twenty-seven donors submitted to hand-assisted laparoscopic nephrectomy were retrospectively analyzed from February 2001 to June 2002. Technical aspects of the donor surgery, results, and complications, are discussed, as well as recipient's complications and outcomes.Results: Among 27 hand-assisted laparoscopic nephrectomies, left kidney was withdrew in 18 donors (66.6%), and right kidney in 9 (33.3%). The operative time ranged from 55 to 210 minutes (mean 132.7 + 37.6 min), and the time of hot ischemia ranged from 2 to 11 minutes (mean 4.7 + 2.5 min), with an estimated mean blood loss during the intraoperative period of 133.3 mL. Conversion to open surgery was necessary for 1 (3.7%) patient due to vascular lesion. In graft evaluation, immediate diuresis was observed in 26 (96.3%) cases, and mean serum creatinine in PO day 7 was 1.5 + 1.1 mg/ dL. Renal vein thrombosis occurred in 1 (3.7%) patient requiring graft removal. Lymphocele was observed in 3 recipients (11.1%), and urinary leakage due to ureteral necrosis in 1 case (3.7%).Conclusion: Hand-assisted laparoscopic nephrectomy in living donors is a safe procedure and an effective alternative to open nephrectomy. In this series, the procedure presented low morbidity after surgery providing to the recipient a good morphological and functional quality of the graft.

Hand-Assisted Laparoscopic Donor Nephrectomy

“…4 These advantages in turn may lead to a shorter operative and warm ischemic time. [5][6][7] Hand port devices (HPDs) are thought to be necessary in hand-assisted surgery in order to maintain a pneumoperitoneum. [8][9][10] Potential benefits include a reduced incidence of wound infections and improved surgeons comfort.…”