Hand-assisted technique facilitates preserving graft viability in laparoscopic donor nephrectomy.
BACKGROUND
To achieve patient safety and minimal operative invasion in living kidney donor nephrectomy, we have performed hand-assisted laparoscopic donor nephrectomy (HALDoN) since 2006.


OBJECTIVE
The aim of this study was to evaluate the utility and the technique of HALDoN.


METHODS
We analyzed 72 donors who underwent HALDoN from February 2008-August 2011.


RESULTS
Including 8/72 donors who underwent right nephrectomy, all subjects completed HALDoN without conversion to an open procedure. None of the recipients suffered delayed graft function or an ureteric problem. Knife-to-removal time (KRT) was longer among cases with graft weight (GW) >200 g than GW ≤200 g: 176.5 ± 35.1 minutes vs 142 ± 18.7 minutes (P < .001). Longer KRT (>180 minutes) and right nephrectomy produced longer reperfusion-to-urine secretion time (RUT; P = .002 and P = .027, respectively). Grafts with double renal arteries (N = 10) also tended to show longer RUT (P = .058). In a case with an early renal arterial branch <1 cm from the aorta, we transected the vessel to achieve a single orifice of the artery using a stapling device. At 6 months the average value of decreased renal function of donors had recovered to about 70%. The incidence of complication was 8.3% but there was no life-threatening morbidity.


CONCLUSIONS
The hand-assisted method could make the operating surgeon more confident to perform laparoscopic donor nephrectomy safely. HALDoN offers particular advantages for precise dissection using finger retraction and control of potential bleeding in the stages of vascular stapling and graft removal, preserving graft viability.
Department of Transplant Surgery, Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan. yuhjimarui@toranomon.gr.jp
Y
Y
Marui
M
M
Nakamura
K
K
Tanaka
S
S
Tomikawa
D000328:Adult; D000368:Aged; D005260:Female; D006085:Graft Survival; D058733:Hand-Assisted Laparoscopy / Q000009:adverse effects; D006801:Humans; D007564:Japan; D016030:Kidney Transplantation / Q000009:adverse effects; D010535:Laparoscopy / Q000009:adverse effects; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D013997:Time Factors; D014022:Tissue Survival; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome