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Terminal hand-assist for laparoscopic donor nephrectomy.

H S Bhat1, K V Sanjeevan, S Sudhindran

  • 1Amrita Institute of Medical Sciences and Research Centre, Kerala, India. hsanjaybhat@hotmail.com

Transplantation Proceedings
|November 3, 2004
PubMed
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This study introduces a cost-effective hand-assisted laparoscopic donor nephrectomy (LDN) technique, making the procedure accessible in developing countries. This method simplifies kidney retrieval without expensive devices, reducing warm ischemia time.

Area of Science:

  • Surgical Innovation
  • Minimally Invasive Surgery
  • Nephrology

Background:

  • Laparoscopic donor nephrectomy (LDN) is prevalent in developed nations but less so in developing countries due to the high cost of access devices.
  • This study addresses the accessibility barrier by presenting an alternative LDN technique.

Purpose of the Study:

  • To describe a novel, cost-effective method for terminal hand-assisted laparoscopic donor nephrectomy (LDN).
  • To demonstrate the feasibility of LDN without expensive specialized access devices, particularly for resource-limited settings.

Main Methods:

  • A modified LDN technique utilizing a surgeon's or assistant's hand through a muscle-splitting incision for kidney retrieval.
  • Standard laparoscopic ports were used, with a simple method to maintain pneumoperitoneum.

Related Experiment Videos

  • The hand insertion facilitated swift kidney extraction, mopping, lavage, and hemostasis.

    • Main Results:

    • Five cases of terminal hand-assisted LDN were successfully performed (4 left, 1 right).
    • Mean kidney retrieval time was 3:18 minutes.
    • Patients experienced a short postoperative stay (4-5 days) with normalized recipient serum creatinine within 3-4 days.

    Conclusions:

    • Terminal hand-assist LDN is feasible and safe without specialized access devices, mitigating concerns about gas leakage.
    • This approach can reduce warm ischemia time and alleviate surgeon apprehension during the LDN learning curve.
    • The technique offers a viable, cost-effective solution for expanding LDN in developing countries.