title: Hand-assisted laparoscopic versus open donor nephrectomy: a retrospective comparison of perioperative and functional results in a tertiary care center in Mexico.
abstract: BACKGROUND
  Laparoscopic nephrectomy for living donors is the current procedure of choice. Hand-assisted laparoscopic donor nephrectomy (HALDN) is the variation of this technique currently used in our institution. Though the advantages and disadvantages have been described for this procedure, the graft function compared with open surgery has been shown to be equal. We compared the outcomes of patients undergoing the former standard open donor nephrectomy (ODN) versus the current HALDN technique.
  
  
  METHODS
  In this retrospective, comparative, and analytic study we reviewed our institutional database of renal transplantation procedures from January 2005 to April 2011 for perioperative variables and 1-year follow-up data. Donor renal function was evaluated with serum creatinine concentrations and estimated glomerular filtration rates with the Chronic Kidney Disease-Epidemiology formula. Complications were reported with the Clavien-Dindo classification.
  
  
  RESULTS
  The 190 consecutive donors included 99 ODN and 91 HALDN, who did not show baseline differences. ODN had a shorter mean operative time (217 ± 57.5 vs 270 ± 60.1 minutes) and shorter warm ischemia time (2.12 ± 1.4 vs 4.62 ± 2.7 minutes). HALDN had less operative blood loss (274.4 ± 198.1 vs 202.99 ± 157.1 mL) and shorter in-hospital stay (5.58 ± 2.2 vs 4.23 ± 1.8 days). There were no significant differences in 30-day surgical complications or transfusion requirements. No graft loss was reported. No difference in renal function was observed between the groups at days 1-2 or months 1, 6, or 12 after nephrectomy.
  
  
  CONCLUSIONS
  Laparoscopic surgery has replaced conventional open surgery for living renal donors. HALDN is a safe and successful procedure compared with ODN. It is now the procedure of choice in our institution.
authors.affiliation: Urology Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Tlalpan, México.
authors.forename: C I
authors.initials: CI
authors.lastname: Villeda-Sandoval
authors.forename: F
authors.initials: F
authors.lastname: Rodríguez-Covarrubias
authors.forename: G
authors.initials: G
authors.lastname: Cortés-Aguilar
authors.forename: J
authors.initials: J
authors.lastname: Alberú-Gómez
authors.forename: M
authors.initials: M
authors.lastname: Vilatobá-Chapa
authors.forename: M
authors.initials: M
authors.lastname: Sotomayor
authors.forename: G
authors.initials: G
authors.lastname: Feria-Bernal
authors.forename: F
authors.initials: F
authors.lastname: Gabilondo
authors.forename: B
authors.initials: B
authors.lastname: Gabilondo-Pliego
mesh_terms: D000328:Adult; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008800:Mexico; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D062606:Tertiary Care Centers
chemical_list: D003404:Creatinine