Transition from Hand-Assisted Laparoscopic Donor Nephrectomy to Laparoscopic Donor Nephrectomy on a National Scale

Objectives: There is a lack of concrete evidence regarding the best approach for donor nephrectomy among transplant centers. We compared donor outcomes during the period of the transition from the hand-assisted laparoscopic donor nephrectomy method to the purely laparoscopic donor nephrectomy method and have provided suggestions to minimize the initial difficulties and to improve donor outcomes. Materials and Methods: Details (operative time, length of hospital stay, complications, creatinine at hospital discharge, and creatinine at the 1-month follow-up) were compared between the 32 hand-assisted laparoscopic donor nephrectomy cases and 16 purely laparoscopic donor nephrectomy cases. All participants were living donors and were first-degree or second-degree relatives of the recipients. Results: We did not establish superiority of the hand- assisted procedure with regard to all factors except operative time, which we attributed to the challenging learning curve of the laparoscopic method. The laparoscopic method was also associated with a less lengthy hospital stay. Conclusions: Both the hand-assisted technique and the laparoscopic technique are safe and effective methods for kidney procurement for transplant. Centers seeking to transition from the first to the second technique can do so smoothly by careful selection of donors and implementation of stepwise changes in both the operative techniques and the postoperative patient treatment.