Hand-assisted laparoscopic donor nephrectomy: Initial 40 cases

Abstract

Objective: The laparoscopic donor nephrectomy (LDN) is becoming the standard of care, by keeping in with the success of the open approach and offering potential advantages such as less post-operative pain, early mobilization, shorter hospitalization, earlier return to normal activity, less incisional morbidity, and more acceptable cosmetic results. Here, we present our experience and outcome of LDN in 40 patients. Materials and methods: Forty patients underwent hand-assisted LDN operation between November 2005 and January 2007 in our clinic. The operation was carried out transperitoneally utilizing 2-3 trochars and a hand-assisted port. Collected data included donor age; sex; estimated blood loss; warm ischemia time; postoperative hospital stay; preoperative and one week postoperative serum creatinine levels; preoperative, immediate postoperative, and one week postoperative hemoglobin levels; and intraoperative and postoperative complications. Results: The left LDN was performed in 95% of the cases. Of the donors, 27% had multiple renal arteries. Conversion to open surgery was required in one patient due to technical difficulties. Conversion rate was 2.5%. Bleeding secondary to splenic capsular tear was controlled laparoscopically in one patient. Intraoperative complication rate was 2.5%. One patient required laparotomy because of bleeding in the postoperative period. One patient required laparoscopic exploration due to postoperative bleeding. One patient had postoperative intestinal obstruction due to an inadvertent serosal stitch during closing the extraction incision. Postoperative complication rate was 7.5%. Conclusion: Hand-assisted LDN is a safe and minimally invasive procedure.