Laparoscopic living donor nephrectomy - Advantages of the hand-assisted method

Introduction. The laparoscopic technique for living donor nephrectomy is a technically difficult procedure that has not yet gained widespread acceptan ce in the transplant community. The procedure may be more acceptable if alt erations to the technique made it easier to perform and decreased operative times. Methods. In August 1998, we altered the laparoscopic procedure to include t he use of a device allowing hand assistance, Subsequently, all living donor nephrectomies have been done using the hand-assisted method, In this artic le, the results of 10 cases performed using the original laparoscopic techn ique are compared with the results of 12 cases using the hand-assisted tech nique, and a brief description of modifications to the original technique i s given. Results. No patients where turned down as living donors, and no contraindic ations to the pure or hand-assisted laparoscopic techniques where found, Th e hand-assisted technique significantly reduced the operative time (2.02+/- 0.44 vs. 3.12+/-0.36 hr, P<0,05) and the warm ischemic time (1.23+/-0.54 vs . 3.91+/-0.53 min, P<0.05). The length of stay and recovery time to normal activities were not different between the pure laparoscopic and hand-assist ed groups, Conclusion. The advantages of the hand-assisted technique include the abili ty to use tactile sense to facilitate dissection, retraction, and exposure. In addition, the final stages of vascular stapling and kidney removal are more sure and rapid. The modifications of the laparoscopic technique presen ted here provide measurable and subjective improvements to laparoscopic liv ing donor nephrectomy, The hand-assisted method of laparoscopic nephrectomy may make the operation available to more transplant centers.