title: A fast and safe living donor "finger-assisted" nephrectomy technique: results of 359 cases.
abstract: OBJECTIVE
  To determine operative parameters and complications, using a modified approach to mini-incision living donor nephrectomy.
  
  
  METHODS
  Three hundred fifty-nine consecutive living donor procedures were performed between October 2000 and November 2008 using the finger-assisted, mini-incision living donor nephrectomy. Patient demographics, intraoperative parameters, and postoperative complications were prospectively recorded, including operative time, blood loss, incision length, warm ischemia time, and intraoperative adverse events.
  
  
  RESULTS
  Mean donor age was 44.2 +/- 12.3 years (range, 21-75 years), with an average body mass index of 28.2 +/- 5.3 kg/m(2) (range, 17.1-44.9 kg/m(2)). Right-sided donor nephrectomies were performed on 23 patients (6%), and 41 donors (11%) were found to have multiple renal arteries. Median incision length was 6.8 cm (range, 3.5-15 cm). Average operative time was 117 minutes (range, 50-265 minutes), with a median blood loss of 109 mL (range, 20-500 mL) and an average warm ischemia time of 4.5 minutes (range, 1.5-10 minutes). Four patients (1%) required perioperative blood transfusions. There were no other intraoperative complications, no patients required reexploration, and there were no donor deaths. Thirteen patients (4%) developed minor postoperative complications, including two incisional herniae, but no patients developed chronic wound pain, over a median follow-up period of 19 months (range, 2-97 months).
  
  
  CONCLUSIONS
  This prospective series demonstrated that a modified approach to open mini-incision nephrectomy can result in a smaller incision length while maintaining patient safety, with few postoperative complications.
authors.affiliation: The West London Renal and Transplant Centre, Imperial College Healthcare NHS Trust, London, UK. nadey@globalnet.co.uk
authors.forename: N
authors.initials: N
authors.lastname: Hakim
authors.forename: E
authors.initials: E
authors.lastname: Aboutaleb
authors.forename: A
authors.initials: A
authors.lastname: Syed
authors.forename: P
authors.initials: P
authors.lastname: Rajagopal
authors.forename: P
authors.initials: P
authors.lastname: Herbert
authors.forename: R
authors.initials: R
authors.lastname: Canelo
authors.forename: V
authors.initials: V
authors.lastname: Papalois
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D015992:Body Mass Index; D005260:Female; D005385:Fingers; D007839:Functional Laterality; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D019520:Living Donors; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods* / Q000592:standards; D009929:Organ Size; D011183:Postoperative Complications / Q000453:epidemiology; D012077:Renal Artery / Q000033:anatomy & histology; D012189:Retrospective Studies; D012449:Safety