title: Optimizing left-sided live kidney donation: hand-assisted retroperitoneoscopic as alternative to standard laparoscopic donor nephrectomy.
abstract: Laparoscopic donor nephrectomy (LDN) is less traumatic and painful than the open approach, with shorter convalescence time. Hand-assisted retroperitoneoscopic (HARP) donor nephrectomy may have benefits, particularly in left-sided nephrectomy, including shorter operation and warm-ischemia time (WIT) and improved safety. We evaluated outcomes of HARP alongside LDN. From July 2006 to May 2008, 20 left-sided HARP procedures and 40 left-sided LDNs were performed. Intra and postoperative data were prospectively collected and analysis on outcome of both techniques was performed. More female patients underwent HARP compared to LDN (75% vs. 40%, P = 0.017). Other baseline characteristics were not significantly different. Median operation time and WIT were shorter in HARP (180 vs. 225 min, P = 0.002 and 3 vs. 5 min, P = 0.007 respectively). Blood loss did not differ (200 ml vs.150 ml, P = 0.39). Intra and postoperative complication rates for HARP and LDN (respectively 10% vs. 25%, P = 0.17 and 5% vs. 15%, P = 0.25) were not significantly different. During median follow-up of 18 months estimated glomerular filtration rates in donors and recipients and graft- and recipient survival did not differ between groups. Hand-assisted retroperitoneoscopic donor nephrectomy reduces operation and warm ischemia times, and provides at least equal safety. Hand-assisted retroperitoneoscopic may be a valuable alternative for left-sided LDN.
authors.affiliation: Department of Surgery, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Leonienke F C
authors.initials: LF
authors.lastname: Dols
authors.forename: Niels F M
authors.initials: NF
authors.lastname: Kok
authors.forename: Turkan
authors.initials: T
authors.lastname: Terkivatan
authors.forename: Khe T C
authors.initials: KT
authors.lastname: Tran
authors.forename: Ian P J
authors.initials: IP
authors.lastname: Alwayn
authors.forename: Willem
authors.initials: W
authors.lastname: Weimar
authors.forename: Jan N M
authors.initials: JN
authors.lastname: Ijzermans
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D010537:Peritoneum / Q000601:surgery; D011184:Postoperative Period; D011446:Prospective Studies; D013514:Surgical Procedures, Operative; D016896:Treatment Outcome