Comparison of open, laparoscopic, and hand-assisted approaches to live-donor nephrectomy.
BACKGROUND
Minimally invasive donor nephrectomy has become a favored procedure for the procurement of kidneys from live donors. The optimal minimally invasive surgical approach has not been determined. In the current work, we compared the outcome of kidneys procured using the traditional open approach with two minimally invasive techniques: the standard laparoscopic procedure and a hand-assist procedure.


METHODS
The function of live-donor kidneys procured by open versus minimally invasive procedures was compared (procedures compared were the traditional open donor nephrectomy [ODN], the standard laparoscopic [LAP] approach, and the hand-assisted [HA] laparoscopic technique). The length of donor operation, donor length of stay in the hospital, surgical complications, and cost of hospitalization for three groups of patients were assessed in a series of 150 live-donor nephrectomies.


RESULTS
We found that both minimally invasive procedures yielded kidney allografts with excellent early function and a minimum of complications in the donor. The open procedure was associated with a reduced operative time but increased donor length of stay in the hospital. Resource utilization analysis revealed that both minimally invasive techniques were associated with a slight increase in costs compared with the open procedure, despite a shorter hospital stay.


CONCLUSIONS
Minimally invasive donor nephrectomy is safe and effective for procuring normally functioning organs for live-donor transplantation. Of the two minimally invasive approaches examined, the hand-assisted technique was found to afford a number of important advantages, including facilitating teaching of residents and students, that it is more readily mastered by transplant surgeons, and that it may provide an additional margin of safety for the donor.
Velidedeoglu
Ergun
E
Departments of Surgery and Nephrology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, 19104, USA.
Williams
Noel
N
Brayman
Kenneth L
KL
Desai
Niraj M
NM
Campos
Luis
L
Palanjian
Maral
M
Wocjik
Martin
M
Bloom
Roy
R
Grossman
Robert A
RA
Mange
Kevin
K
Barker
Clyde F
CF
Naji
Ali
A
Markmann
James F
JF
D000328:Adult; D006801:Humans; D016030:Kidney Transplantation; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D014019:Tissue Donors