title: Hand-assisted laparoscopic donor nephrectomy minimizes warm ischemia.
abstract: OBJECTIVE
  Traditional open donor nephrectomy is associated with good donor outcomes and excellent allograft function. Laparoscopic donor nephrectomy may accomplish these same goals with less morbidity. We report our initial experience with hand-assisted laparoscopic living donor nephrectomy using a commercially available hand-assist device.
  
  
  METHODS
  Donor and allograft outcomes for the first 30 patients undergoing hand-assisted laparoscopic live donor nephrectomy in our institution were prospectively analyzed.
  
  
  RESULTS
  Hand-assisted laparoscopic donor nephrectomy was successfully completed in 29 (97%) of 30 donors. Organ dissection was carried out purely laparoscopically. Vessel division and allograft extraction were performed using a hand-assisted technique. The average operative time was 275 minutes (range 193 to 360), with an estimated blood loss of 99 mL (range 50 to 300). Pneumoperitoneum was consistently maintained during the hand-assisted portion of the procedure. The mean warm ischemic time was 72.5 seconds (range 30 to 165). On average, the regular diet was resumed after 2.2 days (range 1 to 3), and patients were discharged home 3.4 days (range 2 to 5) after surgery. Eight minor complications occurred in the donor group. Immediate graft function occurred in all 30 cases. No ureteral complications occurred. The recipient creatinine levels ranged from 0.6 to 2.4 mg/dL at an average follow-up of 11.5 months (range 1 to 23).
  
  
  CONCLUSIONS
  Laparoscopic donor nephrectomy is technically feasible and can be performed with minimal morbidity. Hand-assisted kidney extraction may help to facilitate immediate allograft function by minimizing the warm ischemic time.
authors.affiliation: Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA.
authors.forename: K
authors.initials: K
authors.lastname: Kercher
authors.forename: D
authors.initials: D
authors.lastname: Dahl
authors.forename: R
authors.initials: R
authors.lastname: Harland
authors.forename: R
authors.initials: R
authors.lastname: Blute
authors.forename: K
authors.initials: K
authors.lastname: Gallagher
authors.forename: D
authors.initials: D
authors.lastname: Litwin
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects; D016063:Blood Loss, Surgical; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000517:prevention & control*; D007668:Kidney / Q000098:blood supply*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control; D011446:Prospective Studies; D014019:Tissue Donors