Hand-assisted laparoscopic donor nephrectomy minimizes warm ischemia

Objectives. Traditional open donor nephrectomy is associated with good dono r outcomes and excellent allograft function. Laparoscopic donor nephrectomy may accomplish these same goals with less morbidity. We report our initial experience with hand-assisted laparoscopic living donor nephrectomy using a commercially available hand-assist device. Methods. Donor and allograft outcomes for the first 30 patients undergoing hand-assisted laparoscopic live donor nephrectomy in our institution were p rospectively analyzed. Results. Hand-assisted laparoscopic donor nephrectomy was successfully comp leted in 29 (97%) of 30 donors. Organ dissection was carried out purely lap aroscopically. Vessel division and allograft extraction were performed usin g a hand-assisted technique. The average operative time was 275 minutes (ra nge 193 to 360), with an estimated blood loss of 99 mL (range 50 to 300). P neumoperitoneum was consistently maintained during the hand-assisted portio n of the procedure. The mean warm ischemic time was 72.5 seconds (range 30 to 165). On average, the regular diet was resumed after 2.2 days (range 1 t o 3), and patients were discharged home 3.4 days (range 2 to 5) after surge ry. Eight minor complications occurred in the donor group. Immediate graft function occurred in all 30 cases. No ureteral complications occurred. The recipient creatinine levels ranged from 0.6 to 2.4 mg/dL at an average foll ow-up of 11.5 months (range 1 to 23). Conclusions. Laparoscopic donor nephrectomy is technically feasible and can be performed with minimal morbidity. Hand-assisted kidney extraction may h elp to facilitate immediate allograft function by minimizing the warm ische mic time. UROLOGY 58: 152-156, 2001. (C) 200 1, Elsevier Science Inc.