Laparoscopic donor nephrectomy: New combination of hand-assisted and standard approaches

Although laparoscopic live donor nephrectomy (LLDN) was conceived to decrease morbidity and reduce donor disincentives, it requires considerable experience. We present a new combination of hand-assisted and standard laparoscopic approaches to live donor nephrectomy. Between March 2002 and February 2003, ten LLDNs were performed with the new procedures. Using the new methodology the surgeon can withdraw his hand and insert a trocar through the hand-assisted device whenever he desires. Although the hand-assisted procedure was performed in most patients, we attempted to dissect the renal hilum without hand assistance in the final patient, successfully procuring the kidney. Mean operation time was 245 minutes and warm ischemic time was 179 seconds. No vascular, renal parenchymal, or ureteral injuries occurred. The patient with multiple left renal arteries had a longer warm ischemic time and delayed graft function. Mean predonation creatinine was 0.97 mg/dL, it increased to 1.44 and 1.15 mg/dL at 7 days and 3 months postdonation, respectively. One patient had chylous ascites and another had a transient left brachial plexus paralysis. Both pure laparoscopic and hand-assisted LLDN have advantages and disadvantages. In our modification, the free conversion from hand-assisted to a purely laparoscopic approach allows the surgeon to practice two procedures simultaneously. With this combination, 90% of the LLDN were accomplished, with pure laparoscopy in the last case.