Hand-assisted laparoscopic live-donor nephrectomy [HALDN] improves outcomes and results in increased kidney donation

ABSTRACT

Laparoscopic live-donor nephrectomy [LDN] has acquired an important role in the era of minimally invasive surgery. Modifications such as hand assistance may improve surgical outcomes with increase in organ donation. This study was performed to evaluate the impact of hand-assisted laparoscopic live-donor nephrectomy [HALDN] on kidney allograft function, peri-operative complications and organ supply. The results of 34 HALDON procedures carried out between July 2004 and January 2006 were evaluated retrospectively. Serum creatinine at discharge, length of hospital stay, estimated blood loss, operative time, warm ischemia time, use of analgesia and peri-operative complications were analyzed in donors and recipients. Also the number of volunteers of kidney donation was recorded. The mean values for donors and recipients subjected to the procedure were as follows 1.2 and 1.3 mg/dL for creatinine at discharge, 2.7 and 7.4 days for length of hospital stay, and 77.8 and 98.2 mL for estimated blood loss, respectively. No major complications were encountered in the donors. Immediate dieresis after renal re-perfusion was observed in 97.1% of the recipients. Following implementation of the laparoscopic program the number of living kidney donors has increased by 90% compared to the mean of the previous 4 years. HALDN is a safe and minimally invasive procedure, giving the chance to use tactile sense to facilitate dissection, retraction and exposure, thus improving the outcome and resulting in excellent allograft function and significantly increased donation