Hand-assisted laparoscopic living donor nephrectomy.

INTRODUCTION: Laparoscopic living donor nephrectomy (LDN) for renal transplantation is increasingly being performed to improve donor outcomes, by reducing perioperative morbidity without adversely impacting on allograft function in the recipient. We report our initial experience with hand-assisted LDN. MATERIALS AND METHODS: From March 2002 to January 2003, 10 hand-assisted LDNs were performed in 2 institutions. Potential donors were evaluated for suitability, which included a renal angiogram. Only donors with uncomplicated vascular arrangements of the left kidney were offered this technique. During surgery, dissection of the donor kidney was performed laparoscopically, aided by the surgeon 's non-dominant hand inserted into the abdominal cavity through a hand-assist device via a 7-cm abdominal incision. The graft was subsequently delivered through the incision. RESULTS: The mean operating time was 163.5 +/- 32 minutes and the mean warm ischaemic time was 2.16 +/- 0.72 minutes. There were no conversions to the open nephrectomy technique or requirement for perioperative transfusions. Postoperatively, patients returned to normal diet by 1.8 +/- 0.8 days and needed opiate analgesia up to a maximum of 48 hours. On average, the patients started ambulation at 2.1 +/- 0.9 days and were discharged 4 +/- 1.5 days after surgery. There were no significant complications other than 3 superficial wound infections. All grafts had immediate graft function. Serum creatinine levels of all recipients fell within 24 hours and reached baseline at a mean of 5.7 +/- 4.6 days. CONCLUSIONS: Hand-assisted LDN is safe, feasible and can be performed with minimal morbidity. It also allows for excellent allograft function.

Uncommon benign intrascrotal tumours.

INTRODUCTION: Benign intrascrotal tumours are rare. CLINICAL PICTURE: Three patients with bilateral paratesticular leiomyomas, an adenomatoid tumour of the testis and a left paratesticular dermoid cyst coexisting with a synchronous left paratesticular epidermal cyst are presented. These tumours were discrete, hard and smooth lesions, in which the diagnosis of malignancy could not be safely excluded preoperatively even with ultrasonography. TREATMENT AND OUTCOME: The first patient had orchiectomy with contralateral testicular preserving surgery, the second patient underwent orchiectomy and the third had conservative testicular surgery. CONCLUSION: Awareness of these benign tumours may allow for testicular preservation.