Retroperitoneal laparoscopic hand-assisted live-donor nephrectomy: our initial experience.
Since the introduction of the hand port in laparoscopic surgery 4 years ago, only a few articles have appeared in the medical literature discussing its use in live-donor nephrectomy. None of these procedures was performed by the retroperitoneal laparoscopic approach. This paper presents our initial experience of three hand-assisted retroperitoneoscopic live-donor nephrectomies. The procedure was performed with the patient in a lateral position, using a total of three ports: a hand port, camera port and working port. The surgeon, standing at the front, made the hand-port incision in the anterior abdominal wall and deepened it down to the parietal peritoneum, by either splitting or dividing the muscles. Once the retroperitoneal space had been dissected down to the kidney and the ureter, the surgeon moved to the back of the patient. The procedure was successful in all three patients and there were no complications in either the donors or recipients, with a mean follow-up of 10 weeks. The surgeon was seated comfortably throughout the procedure, with the hand-port arm resting on the pelvis of the patient. The mean operative time was 118 min. The mean estimated blood loss was 50 mL and the warm ischaemia time 92 s. Retroperitoneal laparoscopic hand-assisted donor nephrectomy is a viable alternative for those who prefer the extraperitoneal approach for their laparoscopic procedures.