title: Nine-yr experience of 700 hand-assisted laparoscopic donor nephrectomies in Japan.
abstract: OBJECTIVE
  We reviewed the introduction of a new, minimally invasive, live kidney donation program in our department.
  
  
  METHODS
  The operating times of 700 consecutive hand-assisted laparoscopic donor nephrectomies (HALDN) conducted from February 2001 to April 2010 were examined. The risk factors for prolonging operating times were analyzed and major surgical barriers in HALDN investigated.
  
  
  RESULTS
  All procedures were successfully performed without the requirement for conversion to open surgery or blood transfusion. The overall prevalence of perioperative complications was 3.0%, with no mortality, in this non-obese donor population with mean body mass index (BMI) as low as 23.2 ± 3.2 kg/m(2) . After the initial learning curve, a second learning plateau was detected until around case 300. Multivariate analyses showed that the significant risk factors were male sex, graft weight, number of renal arteries, right nephrectomy, and previous epigastric surgery (p < 0.05). HALDN provided direct handling of the surgical field, secure vascular control, safe manipulation of adhesive tissues, and served to maintain surgical safety. Mean values of the BMI of donors had a significant positive correlation with the prevalence of complications between large studies (p = 0.042).
  
  
  CONCLUSIONS
  Laparoscopic donor nephrectomy was safely introduced and established in a single institution with the help of the hand-assistance method.
authors.affiliation: Department of Surgery III, Tokyo Women's Medical University, Shinjuku Ward, Tokyo, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Nakajima
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Iwadoh
authors.forename: Ichiro
authors.initials: I
authors.lastname: Koyama
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Tojimbara
authors.forename: Satoshi
authors.initials: S
authors.lastname: Teraoka
authors.forename: Shohei
authors.initials: S
authors.lastname: Fuchinoue
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007564:Japan; D016030:Kidney Transplantation; D010535:Laparoscopy / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D017063:Outcome Assessment, Health Care; D059035:Perioperative Period; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult