Hand-assisted Laparoscopic Donor Nephrectomy: A Comparison with Open Approach

Hwangbo, Kyung; Kim, Joon Cheol; Hwang, Tae Kon

Abstract

PURPOSE
We report our initial experience with hand-assisted laparoscopic donor nephrectomy (HALDN) and compare it to our results with open donor nephrectomy (ODN).
MATERIALS AND METHODS
Using the medical records of consecutive, renal, living donor-recipient pairs, 60 HALDN patients were compared with 19 ODN patients. In addition, the HALDN group was divided into two groups, initial HALDNs (n=20) and late HALDNs (n=40), for consideration of the surgeons' learning curve.
RESULTS
Except 1 case of open conversion, 59 patients underwent HALDN successfully. Mean operation times were 202, 255, and 201 minutes for ODNs, initial HALDNs, and late HALDNs respectively. Mean warm ischemic time decreased from 4.5 minutes in the initial HALDNs to 3.1 minutes in the late HALDNs. Major intraoperative complications included 1 transfusion in the ODNs, 1 open conversion and 1 transfusion in the initial HALDNs, but none in the late HALDNs. Mean hospital stay decreased from 6.4 days in the ODNs to 4.6 and 3.8 days in the initial and late HALDNs, respectively. Mean analgesic use decreased from 403mg and 323mg in ODNs and initial HALDNs, respectively, to 219mg in late HALDNs. Serum creatinine levels of the recipients on post operation days 7 and 30 showed no differences among the three groups.
CONCLUSIONS
All but one, HALDNs resulted in a safe donor operation with a kidney of excellent quality. The length of hospital stay and postoperative analgesic use were decreased. The cosmetic result was enhanced. Additionally, the number of living donors can be potentially increased.