title: Comparative Outcomes of Hand-assisted Laparoscopic Donor Nephrectomy Using Midline Incision or Low Transverse Incision for Hand-assisted Port Placement.
abstract: Hand-assisted laparoscopic donor nephrectomy is performed in many centers for donor nephrectomy. A midline incision for hand-assisted port placement is generally used but produces an unsightly scar. In this study, patients who had hand-assisted laparoscopic donor nephrectomy with low transverse incision were compared with those who received a midline incision.
  
  
  
  Our study group included patients who received hand-assisted laparoscopic donor nephrectomy from February 2012 to December 2014 at Korea University Anam Hospital. We retrospectively compared outcomes of these patients based on midline incision (45 patients) versus low transverse incision (17 patients). Risk factors, including age, sex, body mass index, creatinine level, glomerular filtration rate of allograft, side of graft kidney, number of renal arteries, duration of surgical procedure, and warm ischemic time, were compared between the midline and low transverse incision groups.
  
  
  
  When we compared the midline versus low transverse incision groups, duration of surgical procedure (P = .043), postoperative day 3 glomerular filtration rate (P = .017), and postoperative day 3 pain score (P = .049) were significantly higher in the low transverse incision group versus the midline incision group. Postoperative day 3 results for duration of hospitalization (P = .030) and pain score (P = .021) were also significantly higher in the low transverse versus midline incision groups when we focused on patients with left nephrectomy.
  
  
  
  Hand-assisted laparoscopic donor nephrectomy with low transverse incision is more painful and necessitates a longer hospital stay and longer surgical procedure. Despite these disadvantages, hand-assisted laparoscopic donor nephrectomy with low transverse incision can offer a better cosmetic outcome with no definitive differences regarding renal function compared with a midline incision. Surgeons should consider these aspects when deciding on the best method for donor nephrectomy.
authors.affiliation: From the Department of Surgery, University of Ulsan Medical College and Asan Medical Center, Seoul, Korea.
authors.forename: Jun Gyo
authors.initials: JG
authors.lastname: Gwon
authors.forename: Heungman
authors.initials: H
authors.lastname: Jun
authors.forename: Myung Gyu
authors.initials: MG
authors.lastname: Kim
authors.forename: Yoon Jung
authors.initials: YJ
authors.lastname: Boo
authors.forename: Cheol Woong
authors.initials: CW
authors.lastname: Jung
mesh_terms: D000328:Adult; D002921:Cicatrix / Q000209:etiology; D005260:Female; D005919:Glomerular Filtration Rate; D058733:Hand-Assisted Laparoscopy / Q000009:adverse effects; D006801:Humans; D007668:Kidney / Q000503:physiopathology / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D066106:Seoul; D013997:Time Factors; D016896:Treatment Outcome