Manually assisted laparoscopic live donor kidney harvesting: technique andresults.

Objective: To evaluate the feasibility and complications of manually assist ed laparoscopic live donor kidney harvesting. Material and method: Since June 1999, all related live donor kidney harvest s have been performed by manually assisted laparoscopy. The patient is plac ed in the lumbotomy position and an 8 cm midline periumbilical incision is made. The assistant's hand is introduced through a watertight port (HandPor t (R)). Three trocars are used. The assistant presents the structures to be dissected and controls the ureter. The artery is clipped and the vein is s tapled or clipped, depending on its diameter. The kidney is extracted via t he midline incision and washed. Results: Five kidney harvests were performed (three right kidneys and two l eft kidneys) with a mean operating time of 220 +/- 30 minutes. Conversion w as necessary in one case following the intraoperative discovery of two righ t renal veins. Warm ischaemia lasted 5 minutes for the first patient and on e to two minutes for the other four non-converted patients. Blood losses we re minimal. The mean duration of major analgesia was 2.4 days and the mean length of hospital stay was 7.2 days. Complications were: bacteriuria in 2 cases and prolonged lymphorrhoea in 1 case. One transplanted kidney had to be removed because of immediate thrombosis of the recipient iliac artery. With a mean follow-up of 6 months (1 to 12 months), no ureteric or venous c omplications have been observed in the 4 evaluable transplanted kidneys. Conclusion: An intra-abdominal hand during laparoscopic live donor kidney h arvesting simplifies dissection, ensures intraoperative security and allows rapid extraction of the kidney.