Hand-assisted laparoscopic living donor nephrectomy

Introduction: Laparoscopic living donor nephrectomy (LDN) for renal transplantation is increasingly being performed to improve donor outcomes, by reducing perioperative morbidity without adversely impacting on allograft function in the recipient. We report our initial experience with hand-assisted LDN. Materials and Methods: From March 2002 to January 2003, 10 hand-assisted LDNs were performed in 2 institutions. Potential donors were evaluated for suitability, which included a renal angiogram. Only donors with uncomplicated vascular arrangements of the left kidney were offered this technique. During surgery, dissection of the donor kidney was performed laparoscopically, aided by the surgeon's non-dominant hand inserted into the abdominal cavity through a hand-assist device via a 7-cm abdominal incision. The graft was subsequently delivered through the incision. Results: The mean operating time was 163.5 +/- 32 minutes and the mean warm ischaemic time was 2.16 +/- 0.72 minutes. There were no conversions to the open nephrectomy technique or requirement for perioperative transfusions. Postoperatively, patients returned to normal diet by 1.8 +/- 0.8 days and needed opiate analgesia up to a maximum of 48 hours. On average, the patients started ambulation at 2.1 +/- 0.9 days and were discharged 4 +/- 1.5 days after surgery. There were no significant complications other than 3 superficial wound infections. All grafts had immediate graft function. Serum creatinine levels of all recipients fell within 24 hours and reached baseline at a mean of 5.7 +/- 4.6 days. Conclusions: Hand-assisted LDN is safe, feasible and can be performed with minimal morbidity. It also allows for excellent allograft function.