Hand-assisted Laparoscopic Live Donor Nephrectomy; Comparison to Open Donor Nephrectomy

Yeo, Woon Geol; Kim, Heon Hoe

Abstract

PURPOSE: To search for a safer and easier approach for laparoscopic donor nephrectomy, hand-assisted laparoscopic techniques have been added to the surgical armamentrium. Hand-assisted live donor nephrectomy (HALDN) for renal transplantation is being performed in increasing numbers with the goal of broadening organ supply while minimizing pain and duration of convalescence for donors. Here, we compared our initial series of HALDN with open donor nephrectomy (ODN).
MATERIALS AND METHODS
Between July 2001 and February 2003, a total of 63 patients underwent consecutive live donor nephrectomy in our hospital, which were all performed by a single surgeon. Of these patients 22 underwent HALDN and 41 underwent ODN. Objective data and subjective recovery information was obtained from medical records, telephone interviews, and questionnaires.
RESULTS
Twenty-two HALDNs were performed successfully without open conversion. There was a significant reduction in postoperative visual analogue pain scale (p<0.05), and there were characteristics of rapid return to normal activities (p<0.05) in the HALDN group. The mean operative time, estimated blood loss, hospitalization, and complications were similar in both groups. The mean warm ischemic time was significantly longer in the HALDN group (p<0.05). However, warm ischemic time between the latter HALDN and the ODN group was not significant (p=0.46). In terms of allograft function, serum creatinine at 1, 2 days, 1 week, 2 weeks, 1 month, 2 months, delayed graft function, episodes of rejection, and ureteral complication were similar in both groups. Transfusion was required in one patient of the HALDN group.
CONCLUSIONS
HALDN is efficacious and reproducible, and it is safe for live donor nephrectomy. Compared with ODN, HALDN significantly lessened the pain for the donor, and it allows a more complete convalescence, while enabling excellent allograft function.