title: Terminal hand-assist for laparoscopic donor nephrectomy.
abstract: BACKGROUND
  Laparoscopic donor nephrectomy (LDN) has become widely popular in developed countries but not so in developing countries. One explanation for this maybe the difficulty in getting access devices due to the prohibitive cost. We report our method of terminal hand-assisted LDN in which successful donor nephrectomy is feasible without expensive access devices.
  
  
  METHODS
  The patient is placed in the corresponding classic renal surgery position. Three ports are placed for left-sided and four for right-sided LDN. After complete mobilization of the kidney laparoscopically, the assistant's right hand is introduced for left-sided LDN through a 7-cm left lower quadrant transverse muscle-splitting incision. For right-sided LDN, the surgeon's right hand is inserted through a corresponding ipsilateral incision (for right-handed surgeons). A simple method to prevent the leakage of pneumoperitoneum is described. The hand inside the abdomen aids in the final steps and completes the extraction of the kidney swiftly. Manual mopping, lavage, and hemostasis are also possible.
  
  
  RESULTS
  Five cases of LDN at our centre were done in this fashion, four on the left side and one on the right. The mean kidney retrieval time after clamping the renal artery was 3:18 +/- 0:46 minutes (range 2:30 to 4:30). Postoperative stay was 4 to 5 days. Recipient serum creatinine normalized within 3 to 4 days.
  
  
  CONCLUSIONS
  Short duration terminal hand-assist for LDN without any special access device is possible without the fear of excessive gas leakage. It is helpful to reduce prolonged warm ischemia and to relieve the surgeon's apprehension, at least in the initial learning phase of LDN.
authors.affiliation: Amrita Institute of Medical Sciences and Research Centre, Kerala, India. hsanjaybhat@hotmail.com
authors.forename: H S
authors.initials: HS
authors.lastname: Bhat
authors.forename: K V
authors.initials: KV
authors.lastname: Sanjeevan
authors.forename: S
authors.initials: S
authors.lastname: Sudhindran
mesh_terms: D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D009392:Nephrectomy / Q000379:methods*; D020858:Tissue and Organ Harvesting / Q000295:instrumentation / Q000379:methods*