Comparison of hand-assisted Laparoscopic and open donor nephrectomy: A single-center experience from South Korea

Purpose: We report our experience with hand-assisted laparoscopic donor nephrectomy (HALDN) and compare to our results with conventional open donor nephrectomy (ODN). Patients and Methods: From February 2000 to January 2003, 100 patients (M:F 54:46) underwent HALDN at the Kangnam St. Mary's hospital. These patients were divided into early (1(st) 50 cases) and late (2(nd) 50 cases) groups. These cohorts were compared with 40 patients (M:F 26:14) who underwent ODN via a flank incision from January 1999 to January 2003 at the same institution. Patient data were obtained from medical record review and personal and telephone interviews. Results: The HALDN was completed successfully in 99 donors. The mean operative times (minutes) were 225 (140-425), 178 (135-250), and 188 (140-260) in the early HALDN, late HALDN, and ODN groups, respectively (P < 0.05). The mean warm ischemia times (seconds) of the ODN (135 +/- 52.4) and late HALDN (150 +/- 76.7) groups were shorter than that of the early HALDN group (207 +/- 88.5) (P < 0.05). On average, a regular diet was resumed after 2.1, 1.89, and 2.05 days, respectively. (P > 0.05), and patients were discharged home 4.12, 4.04, and 6.8 days (P < 0.05) after surgery in the early HALDN, late HALDN, and ODN groups. Analgesic use was significantly reduced in the HALDN group in comparison with ODN (P < 0.05). Complications consisted of two cases of chyloperitoneum and one case each of open conversion, transfusion, prolonged ileus, liver enzyme elevation, and recipient ureteral necrosis in the early HALDN group; one case of subcutaneous emphysema in the late HALDN group; and one case each of transfusion and liver enzyme elevation in the ODN group. The mean donor (1 and 30 days) and recipient (6 months) serum creatinine concentrations did not differ among the groups (P > 0.05). Conclusions: The HALDN appears to be a safe, technically feasible, and effective alternative to conventional ODN. The procedure may offer several advantages over conventional ODN in terms of less postoperative pain, shorter convalescence, and minimal cosmetic disfigurement. The recipient graft function is similar to that after ODN.