title: Safe initiation of a laparoendoscopic single site living donor nephrectomy program in a small-volume transplant center.
abstract: OBJECTIVE
  To describe keys to successful programmatic implementation of laparoendoscopic single-site (LESS)-living donor nephrectomy (LDN) in a small-volume center. Laparoscopic LDN has become the standard of care. Technically challenging LESS-LDN has been limited to high-volume centers. However, approximately half of all U.S. transplant centers perform ≤15 LDNs/year, including our center.
  
  
  METHODS
  A hand-assisted laparoscopy (HAL) device was used as the LESS platform at a periumbilical midline incision. We used an adhesive drape to cover the platform to prevent gas leakage. A 30° telescope and 3-4 instruments were inserted through its gel-cap. After careful dissection, the kidney was bagged into a recovery device with an external handle before its vessels were ligated with staples and was then removed immediately through the LESS wound.
  
  
  RESULTS
  LESS-LDN was successful in all of 10 living donors without any multisite laparoscopic or open conversion and without any instruments inserted through extra wounds. No patient had perioperative complications or received transfusions. Median operative time was 271 minutes with a warm ischemia time (WIT) of 3.5 minutes. Hospital stay averaged 2 days with visual analog pain score 4 of 10 at discharge and 2 of 10 at 2 weeks. All recipients recuperated well with immediate graft function.
  
  
  CONCLUSIONS
  Our LESS-LDN technique offers improved cosmesis, favorable perioperative outcomes, and versatile options for conversion, if necessary, making it a viable approach for small-volume centers.
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA. chuehs@ccf.org
authors.forename: Shih-Chieh Jeff
authors.initials: SC
authors.lastname: Chueh
authors.forename: Bashir R
authors.initials: BR
authors.lastname: Sankari
authors.forename: Lorie
authors.initials: L
authors.lastname: Lipscomb
authors.forename: Alice M
authors.initials: AM
authors.lastname: Jones
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Jones
mesh_terms: D000328:Adult; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D061846:Hospitals, Low-Volume; D006801:Humans; D016030:Kidney Transplantation; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology; D020858:Tissue and Organ Harvesting / Q000009:adverse effects