title: Retroperitoneal laparoscopic live-donor nephrectomy: introduction of simple hand-assisted technique (without hand port).
abstract: OBJECTIVE
  Compared with the transperitoneal approach, retroperitoneal laparoscopic live-donor nephrectomy offers a substantial advantage. However, retroperitoneal access is more difficult because of the limited working space. The objective of this study was to report our experience with hand-assisted retroperitoneal laparoscopic live-donor nephrectomy without a hand port.
  
  
  METHODS
  Intraoperative and immediate postoperative surgical outcomes were reviewed for 23 modified retroperitoneal laparoscopic live-donor nephrectomies performed from May 2009 to January 2010. All kidneys were from living related donors. No prisoners or organs from prisoners were used in this study.
  
  
  RESULTS
  Retroperitoneal laparoscopic live-donor nephrectomy was successfully completed in all patients, without conversion to open surgery. Mean (range) operative was 114 (98-130) minutes; warm ischemia time was 1.6 (1.3-2.1) minutes; estimated blood loss was 20 (10-50) mL; and postoperative hospital stay was 6.9 (5-10) days. No serious complications such as massive bleeding or bowel injury occurred. In 1 patient, a hematoma of renal fossa developed, which was successfully treated at repeat operation. All kidneys demonstrated good primary function except 1 that exhibited delayed graft function.
  
  
  CONCLUSIONS
  Retroperitoneal laparoscopic live-donor nephrectomy combines the benefits of both hand assistance and the retroperitoneal approach, to minimize the risk of short- and long-term complications associated with the transabdominal approach. The technique could be a cost-effective procedure suitable for use in developing countries.
authors.affiliation: Department of Urology, Chinese PLA General Hospital, Beijing, China. jdong@medmail.com.cn
authors.forename: J
authors.initials: J
authors.lastname: Dong
authors.forename: J
authors.initials: J
authors.lastname: Lu
authors.forename: Q
authors.initials: Q
authors.lastname: Zu
authors.forename: G
authors.initials: G
authors.lastname: Guo
authors.forename: X
authors.initials: X
authors.lastname: Ma
authors.forename: H
authors.initials: H
authors.lastname: Li
authors.forename: S
authors.initials: S
authors.lastname: Yang
authors.forename: X
authors.initials: X
authors.lastname: Zhang
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*