Hand-assisted laparoscopic living-donor nephrectomy versus open surgery: evaluation of surgical trauma and late graft function in 82 patients.
OBJECTIVE
We evaluated and quantified surgical trauma and late graft function in cases of hand-assisted laparoscopic living-donor nephrectomy (HALLDN) versus open living-donor nephrectom (OLDN).


METHODS
This study is a retrospective nonrandomized single-center analysis. Between 1995 and January 2008, 82 patients with end-stage renal disease received kidney transplantations from living donors. Open living-donor nephrectomy was performed in 37 donors, and 45 underwent laparoscopic hand-assisted nephrectomy. Demographic data and perioperative and postoperative data, such as markers of acute phase (C-reactive protein; serum amyloid A) and biochemical markers of glomerular filtration (serum creatinine, serum cystatin C), were compared at serial time points.


RESULTS
The mean operative times for HALLDN and OLDN were 165 min and 195 min, respectively. The average warm ischemia time was 45 seconds for laparoscopy and 87 seconds for open surgery. The evaluation of acute phase markers demonstrated a minimally invasiven nature of laparoscopy, with same late graft function compared with open surgery.


CONCLUSIONS
When the surgery was performed by experienced surgeons, hand-assisted living- donor nephrectomy showed shorter operative and warm ischemia times than open surgery, offering at least the same functional results and decreasing surgical complications compared with a completely laparoscopic technique.
Greco
F
F
Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120 Halle/Saale, Germany. francesco.greco@medizin.uni-halle-de
Hamza
A
A
Wagner
S
S
Hoda
M R
MR
Inferrera
A
A
Lupo
A
A
Fischer
K
K
Fornara
P
P
D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000378:metabolism; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007166:Immunosuppressive Agents; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D000685:Serum Amyloid A Protein / Q000378:metabolism; D013997:Time Factors
D055316:Cystatin C; D007166:Immunosuppressive Agents; D000685:Serum Amyloid A Protein; D002097:C-Reactive Protein; D003404:Creatinine