Manually assisted laparoscopic bilateral nephrectomy for refractory hypertension in renal transplant recipients.

Objective: The authors report their preliminary experience of a manually as sisted laparoscopic bilateral nephrectomy technique for refractory hyperten sion in renal transplant recipients. Material and Methods: Between April and May 1999, 2 laparoscopic bilateral nephrectomies were performed with manual assistance using the Hand-Port (R) . One patient was operated 4 months before renal transplantation and the ot her was operated 13 months after renal transplantation. Both patients p resented severe hypertension refractory to several antihypertensive drugs. An 8 cm midline supra-umbilical incision and 3 trocars were necessary. One hand was introduced into the abdominal cavity via the Hand-Port (R) at the beginning of the operation. The intra-abdominal hand assisted all phases of dissection of the kidney and control of vessels. The renal vessels and ure ter were clipped The kidneys were removed by the intra-abdominal hand throu gh the supra-umbilical incision. Results: Operating times were 200 min and 130 min. Blood loss,formed The duration of was 220 ml. No conversion was pe r major postoperative analgesics was 3 days. Length of hospital stay was 6 days and 7 days. There were no complications. Blood pressure was controlled by bilateral nephrectomy in both cases, with significant reduction of anti hypertensive therapy. One year after the operation, both patients were sati sfied with the aesthetic result. Conclusions: Laparoscopic bilateral nephrectomy manually assisted by the Ha nd-Port (R) is an alternative to open bilateral nephrectomy. Larger series are necessary to evaluate the morbidity of this technique.