title: Hand assisted laparoscopic donor nephrectomy: a comparison with the open approach.
abstract: OBJECTIVE
  Hand assisted laparoscopy combines aspects of open and laparoscopic surgery. A hand in the abdomen may facilitate laparoscopic live donor nephrectomy, allowing more urologists to participate. We report and compare our initial series of hand assisted laparoscopy donor nephrectomy with nephrectomy performed by standard open methods.
  
  
  METHODS
  In the last 18 months 60 patients at 2 institutions underwent hand assisted laparoscopy donor nephrectomy. This cohort was compared to a contemporary group of 31 patients who underwent open donor nephrectomy via a flank incision at our 2 institutions. Demographic and outcome data were compared retrospectively in a nonrandomized fashion in the 2 groups.
  
  
  RESULTS
  Demographic data on patient age, male-to-female ratio and body mass index were similar in the 2 groups. Operative time, transfusion rate, time to oral intake and complications were also similar. However, estimated blood loss, change in hematocrit preoperatively to postoperatively, hospitalization, parenteral and oral narcotic requirement, and donor convalescence were significantly less in the hand assisted laparoscopy versus open groups. In terms of allograft function, nadir creatinine, time to nadir creatinine, creatinine clearance at 6, 12, and 18 months, delayed graft function, episodes of acute rejection and ureteral stricture were similar in the groups.
  
  
  CONCLUSIONS
  Hand assisted laparoscopy is safe, efficacious and reproducible for living related donor nephrectomy. Compared with the open technique hand assisted laparoscopy provides the donor with significantly decreased postoperative morbidity, while enabling excellent allograft function. Further randomized prospective studies are warranted.
authors.affiliation: James Buchanan Brady Foundation, Department of Urology, New York Presbyterian Hospital, Weill Medical College-Cornell University, New York, New York, USA.
authors.forename: M D
authors.initials: MD
authors.lastname: Stifelman
authors.forename: D
authors.initials: D
authors.lastname: Hull
authors.forename: R E
authors.initials: RE
authors.lastname: Sosa
authors.forename: L M
authors.initials: LM
authors.lastname: Su
authors.forename: M
authors.initials: M
authors.lastname: Hyman
authors.forename: W
authors.initials: W
authors.lastname: Stubenbord
authors.forename: S
authors.initials: S
authors.lastname: Shichman
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D003404:Creatinine / Q000097:blood; D005260:Female; D006400:Hematocrit; D006801:Humans; D016030:Kidney Transplantation; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D009294:Narcotics / Q000008:administration & dosage; D009392:Nephrectomy / Q000379:methods* / Q000534:rehabilitation; D011183:Postoperative Complications; D012189:Retrospective Studies; D014019:Tissue Donors
chemical_list: D009294:Narcotics; D003404:Creatinine