Hand-assisted laparoscopic live donor nephrectomy - initial experience

Introduction. The advantages of minimally invasive live donor nephrectomy have been well documented, with no adverse effect on graft function. Minimal access nephrectomy has now become the standard of care in many units. We have adopted the hand-assisted laparoscopic live donor (HALLDN) technique, and present our initial experience with the first 24 cases. Material and methods. HALLDNs were performed transperitoneally. Primary outcomes included total operative time, warm ischaemic time, time to discharge, and postoperative complications. Warm ischaemic time was measured from the time of clamping the renal artery to the time of perfusing the kidney on the back table. Results. Mean total operative time was 143 minutes and mean warm ischaemic time 188 seconds. A downward trend was displayed for operative times. Mean time to discharge was 60 hours. A right nephrectomy was performed in 2 cases. No surgical morbidity is reported. We describe one donor mortality. Discussion. Our results compare favourably with those documented in the literature. Aberrant renal vascular anatomy had no adverse effect on operative or warm ischaemic times. HALLDN proved beneficial in patients with a high BMI. Conclusion. Surgical experience is vital when performing HALLDN. Overcoming the learning curve with an animal model is beneficial.