Laparoscopic living donor nephrectomy: A single-center sequential experience comparing hand-assisted versus standard technique

OBJECTIVES To analyzed our institution's 8-year experience (October 1997 through March 2006) with laparoscopic donor nephrectomy (LDN) and hand-assisted LDN (HALDN), comparing donor and recipient outcomes. METHODS A total of 482 LDNs were compared with 318 HALDNs with respect to donor sex, age, body mass index, hospital length of stay, donor and recipient serum creatinine levels, and incidence and type of complications. All HALDN were performed using hand-assist devices. RESULTS Mean (+/- SD) ages were similar in both groups (41 +/- 10 years versus 39 +/- 10 years; P = NS). Mean body mass index was greater in the HALDN compared with the LDN group (29 +/- 5 kg/m(2) versus 27 +/- 5 kg/m(2); P <0.01). Hospital length of stay was longer in the LDN group (1.6 +/- 0.7 days versus 1.2 +/- 0.6 days; P <0.01). Graft function and donor's 1-week serum creatinine levels were similar (1.9 +/- 1.6 mg/dL versus 1.2 +/- 0.4 mg/dL; P = NS). The intraoperative complication rate for LDN and HALDN was 3.3% and 2.2%, respectively (P = NS). Postoperative complications occurred in 3.3% of LDNs and 4.7% of HALDNs (P = NS). The conversion rate was 1.9% for LDN and 0.6% for HALDN (P <0.01). CONCLUSIONS Both LDN and HALDN are safe and effective. Hand-assisted LDN was not associated with an increased risk of incisional morbidity, postoperative ileus, or delayed graft function. The HALDN group experienced as uneventful and as rapid a recovery as the LDN group.