title: Hand-assisted laparoscopic donor nephrectomy: a low rate of complications.
abstract: BACKGROUND
  Laparoscopic donor nephrectomy is associated with a higher incidence of ureteral complications. Hand-assisted dissection minimizes the use of instruments for intraoperative retraction and handling of periureteric tissue, and may reduce posttransplant complications.
  
  
  OBJECTIVE
  To assess the outcome of hand-assisted laparoscopic donor nephrectomy, in particular ureteral complications.
  
  
  METHODS
  Records of 143 kidney transplant recipients who received allografts removed using the hand-assisted laparoscopic technique were retrospectively studied.
  
  
  RESULTS
  Total operating time was 2.0 +/- 0.55 (range 1.08-4) hours. Warm ischemia time was 1.45 +/- 0.60 (range 0.58-3.00) minutes. Length of artery, vein, and ureter was 2.4 +/- 0.5 cm, 3.0 +/- 0.5 cm, and 10.3 +/- 2.1 cm, respectively. Estimated blood loss averaged 86.3 +/- 55.6 mL. Intraoperative suction was not needed in 65% of patients. Two donors developed incisional hernias and 1 had a postoperative ileus. Four of 143 (2.8%) recipients developed ureteral complications: reoperations for ureteral necrosis (1), stenting for ureteral stenosis (2), and urethral catheterization for ureterovesical leak (1). Graft loss in the first year after transplantation occurred because of renal vein thrombosis, thrombosis of revised arterial anastomosis, arterial thrombosis due to myocardial infarction, vasculitis, focal segmental glomerulosclerosis, and chronic rejection. Delayed graft function developed in 3 recipients. The acute rejection rate was 14.6%. Mean serum creatinine levels at 1 and 3 years were 134 +/- 61 micromol/L (1.52 +/- 0.69 mg/dL) and 121 +/- 35 micromol/L (1.37 +/- 0.40 mg/dL), respectively.
  
  
  CONCLUSIONS
  Hand-assisted laparoscopic donor nephrectomy is associated with a low incidence of ureteral complications; may reduce the technical difficulty of the operation and minimize retraction with instruments, resulting in fewer complications for donors and recipients; and minimizes donor blood loss.
authors.affiliation: Tulane University Health Sciences Center, New Orleans, LA, USA.
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Sharma
authors.forename: Scott
authors.initials: S
authors.lastname: Meier
authors.forename: Louis
authors.initials: L
authors.lastname: Larmeu
authors.forename: Sander
authors.initials: S
authors.lastname: Florman
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Slakey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D005923:Glomerulosclerosis, Focal Segmental / Q000209:etiology; D006084:Graft Rejection / Q000209:etiology; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D007418:Intestinal Pseudo-Obstruction / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery; D016030:Kidney Transplantation; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014515:Ureteral Diseases / Q000209:etiology; D014657:Vasculitis / Q000209:etiology
chemical_list: D003404:Creatinine