Korean J Urol.  2010 Jan;51(1):34-39.

Hand-Assisted Laparoscopic Right Donor Nephrectomy: Safety and Feasibility

• Chung MS
• Kim SJ
• Cho HJ
• Ha US
• Hong SH
• Lee JY
• Kim JC
• Kim SW
• Hwang TK

Abstract

PURPOSE
We aimed to prove the safety and feasibility of right-sided hand-assisted laparoscopic donor nephrectomy (HALDN). MATERIALS AND METHODS: Between May 2006 and May 2009, 16 patients underwent right-sided HALDN at our institution. Of these patients, 15 showed significantly lower renal function in the right kidney than in the left one and 1 had a stone in the right kidney. When the right renal vein was divided, an EndoGIA stapling device was placed on the wall of the inferior vena cava to gain a maximal length of the vein. We evaluated intraoperative and postoperative parameters such as operative time, delivery time, warm ischemic time, estimated blood loss, intraoperative and postoperative complication rates, length of hospital stay, and serum creatinine levels of donors (at the time of discharge) and recipients (4 weeks postoperatively), comparing the right-sided HALDN group (our study) with a left-sided HALDN group (from a previously reported study). RESULTS: A total of 16 right-sided HALDNs were successfully performed without any complications or open conversion. All of the intraoperative and postoperative parameters were similar between the right-sided HALDN and left-sided HALDN groups. There were no technical problems in the recipients in the anastomosis of the renal vein, and the ureteral anastomoses were also successful. CONCLUSIONS: Right-sided HALDN is safe and technically feasible in a donor, showing favorable graft outcomes. The results of our study suggest that right-sided HALDN may be preferable in patients with significantly lower renal function in the right kidney than in the left one.

Keyword

Laparoscopy; Living donors; Nephrectomy; Hand

MeSH Terms

Creatinine
Hand
Humans
Kidney
Laparoscopy
Length of Stay
Living Donors
Nephrectomy
Operative Time
Postoperative Complications
Renal Veins
Tissue Donors
Transplants
Ureter
Veins
Vena Cava, Inferior
Warm Ischemia
Creatinine

Figure

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  FIG. 1 Port placement for right-sided hand-assisted laparoscopic donor nephrectomy (HALDN). (A) Hand port. (B) 11 mm port for a camera. (C) 12 mm port for right-hand working instruments including Hem-o-lock or EndoGIA stapler. (D) 5 mm port for liver retraction. (E) Additional 10 mm port (optional).

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  FIG. 2 Skeletonization of the right renal hilum (A), clamping and dividing of the right renal artery (B), and endoGIA stapling of the right renal vein (C).

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