title: Hand-assisted laparoscopic living-donor nephrectomy as an alternative to traditional laparoscopic living-donor nephrectomy.
abstract: The benefits of laparoscopic living-donor nephrectomy (LDN) are well described, while similar data on hand-assisted laparoscopic living-donor nephrectomy (HALDN) are lacking. We compare hand-assisted laparoscopic living-donor nephrectomy with open donor nephrectomy. One hundred consecutive hand-assisted laparoscopic living-donor nephrectomy (10/98-8/01) donor/recipient pairs were compared to 50 open donor nephrectomy pairs (8/97-1/00). Mean donor weights were similar (179.6 +/- 40.8 vs. 167.4 +/- 30.3 lb; p = NS), while donor age was greater among hand-assisted laparoscopic living-donor nephrectomy (38.2 +/- 9.5 vs. 31.2 +/- 7.8 year; p < 0.01). Right nephrectomies was fewer in hand-assisted laparoscopic living-donor nephrectomy [17/100 (17%) vs. 22/50 (44%); p < 0.05]. Operative time for hand-assisted laparoscopic living-donor nephrectomy (3.9 +/- 0.7 vs. 2.9 +/- 0.5 h; p < 0.01) was longer; however, return to diet (6.9 +/- 2.8 vs. 25.6 +/- 6.1 h; p < 0.01), narcotics requirement (17.9 +/- 6.3 vs. 56.3 +/- 6.4h; p < 0.01) and length of stay (51.7 +/- 22.2 vs. 129.6 +/- 65.7 h; p < 0.01) were less than open donor nephrectomy. Costs were similar ($11072 vs. 10840). Graft function and 1-week Cr of 1.4 +/- 0.9 vs. 1.6 +/- 1.1 g/dL (p = NS) were similar. With the introduction of HALDN, our laparoscopic living-donor nephrectomy program has increased by 20%. Thus, similar to traditional laparoscopic donor nephrectomy, hand-assisted laparoscopic living-donor nephrectomy provides advantages over open donor nephrectomy without increasing costs.
authors.affiliation: Division of Transplantation, The University of Cincinnati, Cincinnati, Ohio 45267, USA. Joseph.buell@uc.edu
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Buell
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hanaway
authors.forename: Steven R
authors.initials: SR
authors.lastname: Potter
authors.forename: David C
authors.initials: DC
authors.lastname: Cronin
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yoshida
authors.forename: Rino
authors.initials: R
authors.lastname: Munda
authors.forename: J Wesley
authors.initials: JW
authors.lastname: Alexander
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Newell
authors.forename: David S
authors.initials: DS
authors.lastname: Bruce
authors.forename: E Steve
authors.initials: ES
authors.lastname: Woodle
mesh_terms: D000203:Activities of Daily Living; D003365:Costs and Cost Analysis; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods / Q000502:physiology; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D007902:Length of Stay; D019520:Living Donors; D009392:Nephrectomy / Q000191:economics / Q000379:methods*; D009820:Ohio; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology; D011187:Posture; D013997:Time Factors