title: Hand-assisted laparoscopic donor nephrectomy: are hand port devices really necessary?
abstract: BACKGROUND
  Hand port devices (HPD) are used routinely for hand-assisted laparoscopic surgery including hand-assisted laparoscopic donor nephrectomy (HALDN). However, the cost of such devices may prove prohibitive, particularly in centers with financial constraints. The authors aimed to identify any adverse effects of performing device-free HALDN.
  
  
  METHODS
  A retrospective analysis was performed of patients undergoing HALDN at the authors' unit over a 3-year period (2007-2010). Eighty-four patients underwent device-free HALDN, whereas in 80 patients a HPD was used. The primary endpoint was duration of operation, with secondary endpoints including postoperative wound infections and incisional hernias.
  
  
  RESULTS
  here was no difference in duration of operation for the device free (98 minutes; range = 43-215 minutes) compared with the HPD group (94 minutes; range = 36-180 minutes; P = .37). A device was required in 3 (3.6%) patients in which a device-free approach was attempted. There was no difference in either group in terms of rates of postoperative wound infections (0% vs 2.5%, respectively; P = .24) or incisional hernia incidence (1.5% vs 1.4%, respectively; P = .50).
  
  
  CONCLUSIONS
  Device-free HALDN can be performed with no discernable compromise in operating time or patient outcome. This has implications in both cost benefit and translation of this technique to developing units.
authors.affiliation: Department of Renal Transplantation, University Hospital Birmingham NHS Trust, Edgbaston, UK. jaynath@yahoo.com
authors.forename: Jay
authors.initials: J
authors.lastname: Nath
authors.forename: David
authors.initials: D
authors.lastname: van Dellen
authors.forename: Steve J
authors.initials: SJ
authors.lastname: Mellor
authors.forename: Ahmed
authors.initials: A
authors.lastname: Hamsho
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Inston
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Ready
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D006555:Hernia, Ventral / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D016896:Treatment Outcome; D055815:Young Adult