Background: We describe an entirely retroperitoneal laparoscopic technique utilizing hand assistance, for live donor nephrectomy. The technique allows the surgeon to place the hand, and laparoscopic instruments, in the retroperitoneum simultaneously during the procedure. Thus this technique minimizes potential complications of peritoneal violation such as bowel and visceral injury in the intra-operative setting and long term sequelae of adhesions and intestinal obstruction.
Methods: This is a video of a 53 year old male who is donating a kidney to his friend. A 6-7 cm muscle splitting incision 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. A rolled laparotomy pad, anchored to an omni retractor, is used to retract the peritoneum. 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: This patient had a successful operation and an uneventful post-operative recovery. He was discharged home on post operative day 3. The kidney was transplanted successfully. One hundered and fifty six successful (left = 116, right=40) Hand Assisted Retroperitoneal laparoscopic Live Donor Nephrectomy, have been performed at our institution, in this fashion.
Conclusions: The retroperitoneum is a potentially large space that can be developed to accomodate the operators hand during the procedure. Thus, the procedure blends the safety of open retroperitoneal surgery with minimal invasiveness 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 live donor nephrectomy