200 consecutive hand assisted laparoscopic donor nephrectomies: evolution of operative technique and outcomes

The Journal of Urology
Peter C FisherJ S Wolf

Abstract

Despite the popularity of hand assisted laparoscopic donor nephrectomy published experience is less than that with standard laparoscopic donor nephrectomy and few critical assessments of operative maneuvers have been described. We describe the impact of changes in operative technique made by a single surgeon during 200 hand assisted laparoscopic donor nephrectomies. With a mean operative time of 229 minutes and hospital stay of 1.9 days the rates of conversion to open surgery, intraoperative complications and major postoperative complications were 1%, 1.5% and 6%, respectively. Lasting changes in technique were dissection of a ureteral/gonadal packet, bipolar cautery use on gonadal/adrenal/lumbar veins and resting the kidney before removal. The incidence of ureteral complications decreased from 8% to 5.1% with dissection of the ureter in conjunction with the gonadal vein rather than isolating it. Warm ischemia time decreased from a mean of 186 to 143 seconds with bipolar electrocautery instead of clips to control gonadal/adrenal/lumbar veins. After starting to rest the kidney before removal the incidence of primary graft nonfunction and delayed function decreased from 6.7% to 0% and 30% to 11.8%, respectively, with a correspond...Continue Reading

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Citations

Sep 25, 2008·Surgical Endoscopy·Mark SawatzkyJaap Bonjer
Nov 15, 2006·Transplantation·Mirza M IduWillem A Bemelman
Sep 14, 2010·Transplantation Proceedings·R C MinneeM M Idu
Apr 27, 2010·European Urology·Francesco GrecoPaolo Fornara
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Dec 7, 2013·Transplantation·Ahmed H GabrJ Stuart Wolf
Aug 23, 2018·Langenbeck's Archives of Surgery·Nicole M ShockcorRolf N Barth

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