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  • Title: Laparoscopic donor nephrectomy: new combination of hand-assisted and standard approaches.
    Author: Wu CT, Chiang YJ, Liu KL, Chu SH.
    Journal: Transplant Proc; 2004 Sep; 36(7):1909-11. PubMed ID: 15518695.
    Abstract:
    BACKGROUND: Although laparoscopic live donor nephrectomy (LLDN) was conceived to decrease morbidity and reduce donor disincentives, it requires considerable experience. We present a new combination of hand-assisted and standard laparoscopic approaches to live donor nephrectomy. METHODS: Between March 2002 and February 2003, ten LLDNs were performed with the new procedures. Using the new methodology the surgeon can withdraw his hand and insert a trocar through the hand-assisted device whenever he desires. Although the hand-assisted procedure was performed in most patients, we attempted to dissect the renal hilum without hand assistance in the final patient, successfully procuring the kidney. RESULTS: Mean operation time was 245 minutes and warm ischemic time was 179 seconds. No vascular, renal parenchymal, or ureteral injuries occurred. The patient with multiple left renal arteries had a longer warm ischemic time and delayed graft function. Mean predonation creatinine was 0.97 mg/dL, it increased to 1.44 and 1.15 mg/dL at 7 days and 3 months postdonation, respectively. One patient had chylous ascites and another had a transient left brachial plexus paralysis. CONCLUSIONS: Both pure laparoscopic and hand-assisted LLDN have advantages and disadvantages. In our modification, the free conversion from hand-assisted to a purely laparoscopic approach allows the surgeon to practice two procedures simultaneously. With this combination, 90% of the LLDN were accomplished, with pure laparoscopy in the last case.
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