Hand-assisted retroperitoneoscopic nephrectomy for living kidney transplantation: initial 44 cases.
OBJECTIVE
To report our technique and early results of hand-assisted retroperitoneoscopic nephrectomy (HARN) for living donor transplantation and to assess its feasibility.


METHODS
HARN was effectively and safely performed on 44 donors from July 2001 to September 2003 at Akita University Medical Center. We describe our techniques and experiences with HARN and compare the early results with those of 27 cases of open donor nephrectomy at our institution.


RESULTS
The mean operating time was 260 minutes (range 173 to 445), the mean estimated blood loss was 249 mL (range 15 to 967), and the mean warm ischemia time was 2.2 minutes (range 0.8 to 6.4). These parameters were similar to those of open donor nephrectomy. Intraoperative and postoperative complications occurred in 1 (2.3%) and 2 (4.6%) cases, respectively, but they were all minor. HARN was converted to open nephrectomy in 1 case (2.3%) because of uncontrollable bleeding. All HARN donors were ambulant within 2 days postoperatively and could initiate oral intake on the first postoperative day. Regarding graft function, 41 recipients (93.2%) had an immediate onset of diuresis and 3 (6.8%) had delayed renal function. The serum creatinine 7 days and 1 month postoperatively was not significantly different between the HARN group and the open nephrectomy group.


CONCLUSIONS
HARN for living donors is one excellent option for donor nephrectomy because the procedure does not require intraperitoneal manipulation, thus reducing the risk of abdominal visceral injury, and also because of the minimal warm ischemia time owing to rapid extraction of the kidney with hand assistance.
Department of Urology, Akita University School of Medicine, Akita, Japan.
Norihiko
N
Tsuchiya
Masahiro
M
Iinuma
Tomonori
T
Habuchi
Chikara
C
Ohyama
Shinobu
S
Matsuura
Kazunari
K
Sato
Shigeru
S
Satoh
Tetsuro
T
Kato
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D003404:Creatinine / Q000097:blood; D005260:Female; D006085:Graft Survival; D006225:Hand; D006801:Humans; D007327:Insufflation; D007432:Intraoperative Period / Q000706:statistics & numerical data; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D012187:Retroperitoneal Space; D020858:Tissue and Organ Harvesting / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data
D003404:Creatinine