title: Hand-assisted and conventional laparoscopic live donor nephrectomy: a comparison of two contemporary techniques.
abstract: OBJECTIVE
  Laparoscopic nephrectomy may make kidney donation more attractive. Modifications such as hand assistance may improve surgical outcomes. We compared our initial experience with hand-assisted laparoscopic nephrectomy with that of the conventional laparoscopic technique.
  
  
  METHODS
  Two series of similar patients underwent conventional laparoscopic donor nephrectomy (LDN; N = 15) or hand-assisted laparoscopic donor nephrectomy (HLDN; N = 29). Operative time, warm ischemia time, estimated blood loss, complications, analgesic use, postoperative recovery, and serum creatinine concentration were compared.
  
  
  RESULTS
  Open conversion was required in one HLDN patient because of intra-abdominal adhesions, and this patient was excluded from further analysis. The operative time, time to kidney extraction, and warm ischemia time were significantly shorter in the HLDN group, averaging 204.8 v 275.7 minutes, 173.4 v 239.3 minutes, and 2 minutes 21 seconds v 3 minutes 45 seconds, respectively. The intraoperative complication rates were 3.6% and 13.3%, respectively (P = 0.07). The postoperative complication rates were 6.8% and 6.7%. All grafts were functioning at the end of the study period, and there were no differences in rejection episodes, need for dialysis, complications, or nadir creatinine concentration according to the method of harvest.
  
  
  CONCLUSIONS
  Hand-assisted laparoscopic donor nephrectomy provides shorter operative and warm ischemia times without a significant increase in donor morbidity.
authors.affiliation: Endourology Institute, Cedars Sinai Medical Center, 8635 W. 3rd Street, Suite 1070, Los Angeles, CA 90048, USA. shsannon.piazza@cshs.org
authors.forename: Abbey B
authors.initials: AB
authors.lastname: Gershbein
authors.forename: Gerhard J
authors.initials: GJ
authors.lastname: Fuchs
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D001810:Blood Volume; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D010535:Laparoscopy; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications; D020858:Tissue and Organ Harvesting / Q000379:methods*; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome