Background: Laparoscopic live donor nephrectomy can be performed either via a trans-abdominal or retro-peritoneal approach. An abdominal incision is eventually made to retrieve the kidney. Hand assisted laparoscopic nephrectomy is usually performed trans peritoneally. We describe an entirely retroperitoneal laparoscopic technique utilizing hand assistance, for left and right sided kidneys. This technique minimizes potential complications of peritoneal violation such as bowel and visceral injury.
Methods: Although one hundered and fifty six successful (left = 116, right=40) Hand Assisted Retroperitoneoscopic Live Donor Nephrectomy(HARLDN), have been performed at our institution, this is a report of the last 36 consecutive procedures with the data collected prospectively. A 6-7 cm muscle splitting incision( yielding excellent cosmetic results) is made in the ipsilateral lower quadrant. Under direct vision, the retroperitoneal space is developed. The lap disc is inserted followed by two 12mm and one 5 mm port. Using the hand and the laparoscopic instruments the retroperitoneal space is developed further and the kidney is completely mobilized. Pneumo-retroperitoneum is maintained at 10-12 mm Hg. A TA 30 endovascular stapler or clips are used to secure the artery and vein. The kidney is removed through the lap disc incision. The entire procedure is performed retroperitoneally.
Results: Of the last 36 consecutive donors, 30 were on the left side and 6 on the right. Four patients had multiple (2) renal arteries each. One patient had a completely duplicated collecting system along with a retro-aortic renal vein. Average operative time was 190 (range: 123-260) minutes. Mean warm ischemia time was179 (150-240) seconds. There were no intra-operative complications. Average estimated blood loss was 96(50-200) ml. There were no transfusions. There were no open conversions. All allografts functioned immediately following revascularization. Post operatively, two patients had a pneumothorax (less than 10%), managed conservatively, one patient a superficial wound infection and one a small rectus hematoma. Average hospital stay was 3 (2-6) days. The average duration of post discharge narcotic analgesic use was 5(0-11) days and any analgesic use was 9(0-15) days.
Conclusions: To our knowledge, this is the first report describing the safety and efficacy of the HARLDN for both the left and right side. The technique incorporates the advantages of the surgeons hand in the retroperitoneum and that of laparoscopic surgery. The procedure has minimal morbidity and the donors’ convalescence is short. It is a reliable technique. It can be safely used for both, left and right sided donor nephrectomy