title: Hand-assisted laparoscopic nephrectomy in living donors.
abstract: Hand-assisted laparoscopic nephrectomy (HLN) in living donors is a minimally invasive surgical modality that uses classic laparoscopic techniques either combined or not with the use of the surgeon's hand as a support tool during renal dissection maneuvers. The purpose of this study was to describe the initial experience with HLN technique in renal donors. Among 58 hand-assisted laparoscopic nephrectomies, the left kidney was removed in 39 donors (67%) and the right in 19 (33%). Surgery time ranged from 55 to 270 minutes (mean 156.9 +/- 49.5). Warm ischemia time ranged from 2 to 11 minutes (mean 4.38 +/- 2.31 min), with an estimated mean blood loss during the intraoperative period of 268 mL. Conversion to open surgery was required for four (6.8%) patients due to a vascular lesion. Upon graft evaluation, we observed immediate diuresis in 56 (96.3%) cases, with a mean serum creatinine on postoperative day 7 of 1.74 +/- 1.61 mg/dL. Renal vein thrombosis requiring graft removal occurred in one (1.7%) patient. Lymphocele was observed in three recipients (5.1%), and urinary leakage due to ureteral necrosis in three cases (5.1%). HLN for living donors is a safe procedure and an effective alternative to open nephrectomy. In this series, the procedure displayed low morbidity after surgery, providing a good morphological and functional quality of the graft for the recipient.
authors.affiliation: Hospital Santa Casa de Misericórdia de Curitiba, Rua Visconde de Nacar, 865 sl 507 Curitiba, PR, 80.410-201 Brazil.
authors.forename: L S
authors.initials: LS
authors.lastname: Percegona
authors.forename: F
authors.initials: F
authors.lastname: Meyer
authors.forename: C
authors.initials: C
authors.lastname: Machado
authors.forename: A T
authors.initials: AT
authors.lastname: Bignelli
authors.forename: M C
authors.initials: MC
authors.lastname: Riella
authors.forename: L S
authors.initials: LS
authors.lastname: Santos
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods*