Hand-assisted right laparoscopic nephrectomy in living donor

OBJECTIVE: To assess results obtained with the authors' technique of right hand-assisted laparoscopic nephrectomy in living kidney donors. MATERIALS AND METHODS: We retrospectively analyzed 16 kidney donors who underwent hand-assisted right laparoscopic nephrectomy from February 2001 to July 2004. Among these patients, 7 were male and 9 were female, with mean age ranging between 22 and 58 years (mean 35.75). RESULTS: Surgical time ranged from 55 to 210 minutes (mean 127.81 min) and warm ischemia time from 2 to 6 minutes (mean 3.78 min) with mean intra-operative blood loss estimated at 90.62 mL. There was no need for conversion in any case. Discharge from hospital occurred between the 3rd and 6th days (mean 3.81). On the graft assessment, immediate diuresis was seen in 15 cases (93.75 percent) and serum creatinine on the 7th post-operative day was 1.60 mg/dL on average. Renal vein thrombosis occurred in 1 patient (6.25 percent) who required graft removal, and lymphocele was seen in 1 recipient (6.25 percent). CONCLUSION: Hand-assisted right laparoscopic nephrectomy in living donors is a safe and effective alternative to open nephrectomy. Despite a greater technical difficulty, the procedure presented low postoperative morbidity providing good morphological and functional quality of the graft on the recipient.

Hand-assisted laparoscopic nephrectomy in living donor

OBJECTIVE: Report the authorsÆ initial experience with hand-assisted laparoscopic nephrectomy technique in renal donors for transplantation. MATERIALS AND METHODS: Twenty-seven donors submitted to hand-assisted laparoscopic nephrectomy were retrospectively analyzed from February 2001 to June 2002. Technical aspects of the donor surgery, results, and complications, are discussed, as well as recipientÆs complications and outcomes. RESULTS: Among 27 hand-assisted laparoscopic nephrectomies, left kidney was withdrew in 18 donors (66.6 percent), and right kidney in 9 (33.3 percent). The operative time ranged from 55 to 210 minutes (mean 132.7 ± 37.6 min), and the time of hot ischemia ranged from 2 to 11 minutes (mean 4.7 ± 2.5 min), with an estimated mean blood loss during the intraoperative period of 133.3 mL. Conversion to open surgery was necessary for 1 (3.7 percent) patient due to vascular lesion. In graft evaluation, immediate diuresis was observed in 26 (96.3 percent) cases, and mean serum creatinine in PO day 7 was 1.5 ± 1.1 mg/dL. Renal vein thrombosis occurred in 1 (3.7 percent) patient requiring graft removal. Lymphocele was observed in 3 recipients (11.1 percent), and urinary leakage due to ureteral necrosis in 1 case (3.7 percent). CONCLUSION: Hand-assisted laparoscopic nephrectomy in living donors is a safe procedure and an effective alternative to open nephrectomy. In this series, the procedure presented low morbidity after surgery providing to the recipient a good morphological and functional quality of the graft