title: Retroperitoneoscopic donor nephrectomy with a gel-sealed hand-assist access device.
abstract: BACKGROUND
  The hand-assisted technique enables the rapid extraction of the graft, shortening the warm ischemia time (WIT), and the retroperitoneoscopic approach is potentially associated with a less incidence of postoperative ileus in donor nephrectomy for living kidney transplantation. The aim of this study was to assess the efficacy and safety of retroperitoneoscopic donor nephrectomy with a gel-sealed hand-assist access device (GelPort), which is a wound sealing device that permits the access of the hand to the surgical field, free trocar site choice within it, and rapid conversion to open surgery if necessary, while preserving the pneumoperitoneum/pneumoretroperitoneum.
  
  
  METHODS
  Seventy-five consecutive donors receiving this procedure were retrospectively studied. A 2-cm skin incision was made at the midpoint between the tip of the 12th rib and superior border of the iliac bone in the midaxillary line, through which retroperitoneal space was made. Preperitoneal wound with a 6 - 7-cm pararectal incision in the upper abdominal region was connected to the retroperitoneal space. A GelPort was put inside the pararectal surgical wound. The principle was pure retroperitoneoscopic surgery; hand-assist was applied for retraction of the kidney in the renal vessel control and graft extraction.
  
  
  RESULTS
  The mean operation time including waiting time for recipient preparation was 242.2±37.0 (range: 214.0-409.0) min, and the mean amount of blood loss was 164.3±146.6 (range: 10.0-1020.0) ml. The mean WIT was 2.8±1.0 (range: 1.0-6.0) min. The shortage of renal vessels or ureter was observed in none of the grafts. No donor experienced blood transfusion, open conversion, or injury of other organs. Blood loss was greater in patients with body mass index (BMI) of 25 kg/m2 or higher than in those with BMI of <25 kg/m2 (218.4±98.8 vs. 154.8±152.1 ml, P=0.031). No donor had postoperative ileus or reported wound pain leading to decreased activity of daily life or wound cosmetic problem.
  
  
  CONCLUSIONS
  Retroperitoneoscopic hand-assisted donor nephrectomy with the mentioned approach was suggested to be a feasible option without compromising safety, although further improvement in surgical techniques is warranted.
authors: Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1, Niigata, 951-8510, Japan.
authors: Kei
authors: K
authors: Arai
authors: Tsutomu
authors: T
authors: Nishiyama
authors: Noboru
authors: N
authors: Hara
authors: Takashi
authors: T
authors: Kasahara
authors: Kazuhide
authors: K
authors: Saito
authors: Kota
authors: K
authors: Takahashi
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D015992:Body Mass Index; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000379:methods*; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods*; D052096:Warm Ischemia
references: Urology. 2011 Dec;78(6):1332-7
references: 21996107
references: J Endourol. 2010 Nov;24(11):1783-7
references: 20919917
references: J Minim Access Surg. 2005 Sep;1(3):110-5
references: 21188007
references: J Endourol. 1994 Apr;8(2):143-8
references: 8061673
references: Transplantation. 2010 Apr 15;89(7):858-63
references: 20065916
references: J Endourol. 2011 Jul;25(7):1095-104
references: 21740261
references: J Urol. 2006 Apr;175(4):1208-13
references: 16515961
references: Pediatr Transplant. 2008 Aug;12(5):522-6
references: 18672483
references: J Urol. 2008 Apr;179(4):1488-92
references: 18295274
references: Int J Urol. 2011 Jul;18(7):503-9
references: 21658131
references: Clin Transplant. 2005 Feb;19(1):102-9
references: 15659142
references: J Urol. 1998 Jul;160(1):22-7
references: 9628597
references: Arch Surg. 2007 Feb;142(2):119-24; discussion 125
references: 17309962
references: Transplantation. 2011 Feb 27;91(4):462-9
references: 21169880
references: Urology. 2010 Jan;75(1):92-5
references: 19815261
references: Urology. 2007 May;69(5):832-4
references: 17482916
references: Urology. 2000 Jun;55(6):807-11
references: 10840081
references: Urology. 1998 Nov;52(5):885-7
references: 9801121