Open donor, laparoscopic donor and hand assisted laparoscopic donor nephrectomy: A comparison of outcomes

Purpose: In experienced hands laparoscopic surgery has been shown to be saf e for procuring kidneys for transplantation that function identically to op en nephrectomy controls. While searching for a safer and easier approach to laparoscopic donor nephrectomy, hand assisted laparoscopic techniques have been added to the surgical armamentarium. We compare allograft function in patients with greater than 1-year followup who underwent open donor (histo ric series), classic laparoscopic and hand assisted laparoscopic nephrectom y. Materials and Methods: The charts of 48 patients who underwent open donor, laparoscopic donor or hand assisted laparoscopic nephrectomy were reviewed. Only patients with greater than 1-year followup and complete charts were i ncluded in our study. Of these patients 34 underwent consecutive laparoscop ic live donor nephrectomy and 14 underwent open donor nephrectomy. Mean pat ient age plus or minus standard deviation (SD) was 36.5 +/- 8.4 years for d onors and 29 +/- 17 for recipients at transplantation (range 13 months to 6 9 years). In the laparoscopic group 11 patients underwent the transperitone al technique, and 23 underwent hand assisted laparoscopic nephrectomy. Results: Total operating time was significantly reduced with the hand assis ted laparoscopic technique compared with classic laparoscopy, as was the ti me from skin incision to kidney removal and warm ischemic time. Average war m ischemic time plus or minus SD was 3.9 +/- 0.3 minutes for laparoscopic n ephrectomy and 1.6 +/- 0.2 for hand assisted laparoscopy (p < 0.05). Long-t erm followup of serum creatinine levels revealed no significant differences among the 3 groups. Comparison of those levels for recipients of open neph rectomy versus laparoscopic and hand assisted laparoscopic techniques revea led p values greater than 0.5. No blood transfusions were necessary. Compli cations included adrenal vein injury in 1 patient, small bowel obstruction in 2, abdominal hernia at the trocar site in 1 and deep venous thrombosis i n 1. Conclusions: Classic laparoscopic donor and hand assisted laparoscopic dono r nephrectomies appear to be safe procedures for harvesting kidneys. The re cipient graft function is similar in the laparoscopic and open surgery grou ps.