title: Hand-assisted laparoscopic surgery (HALS) for live donor nephrectomy is more time- and cost-effective than standard laparoscopic nephrectomy.
abstract: BACKGROUND
  Hand-assisted laparoscopy (HALS) was introduced to increase the safety of living donor nephrectomies. Herein we evaluate the first HALS living donor nephrectomies performed at our center.
  
  
  METHODS
  Traditional laparoscopic nephrectomies (TLS) (n = 11) and HALS nephrectomies (n = 11) were included in the study. One patient from the TLS group was excluded because the operation was converted to open nephrectomy. We compared the operating times (OT) and warm ischemia times (WIT) for the two procedures and calculated the operating costs.
  
  
  RESULTS
  Mean OT was 270 min in the TLS group and 197 min in the HALS group; thus, there was, a significant reduction of 27% with HALS. WIT was 297 sec for the TLS group and 214 sec for the HALS group, for a reduction of 28%. Costs were also lowered for HALS.
  
  
  CONCLUSIONS
  In addition to shortening both OT and WIT, HALS enhances the safety margin of the procedure, especially during trocar placement. It is further helpful in preventing torsion of the kidney and controlling potential bleedings, as well as during vascular stapling and kidney removal.
authors.affiliation: Department of Transplantation Surgery, Uppsala University Hospital, S-751 85 Uppsala, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Lindström
authors.forename: M
authors.initials: M
authors.lastname: Häggman
authors.forename: J
authors.initials: J
authors.lastname: Wadström
mesh_terms: D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D009392:Nephrectomy / Q000191:economics / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies; D013997:Time Factors