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Hand-assisted retroperitoneoscopic live donor nephrectomy: experience from the first 75 consecutive cases.
1Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden. jonas.wadstrom@akademiska.se
Transplantation
|November 10, 2005
Summary
The hand-assisted retroperitoneoscopic (HARS) technique for live donor nephrectomy offers a safe and effective approach, significantly reducing complications and enabling prompt graft function.
Area of Science:
- Nephrology
- Minimally Invasive Surgery
- Transplantation
Background:
- Laparoscopic live donor nephrectomy carries risks of bleeding and intestinal injury.
- The combined hand-assisted and retroperitoneoscopic (HARS) technique aims to mitigate these risks.
- This study reports outcomes from the initial 75 HARS procedures.
Purpose of the Study:
- To evaluate the safety and efficacy of the HARS technique in live donor nephrectomy.
- To assess complication rates, operating times, and graft outcomes associated with HARS.
Main Methods:
- Prospective data collection using an intention-to-treat principle for 75 consecutive HARS operations.
- Recording of warm ischemia time, operative time, and blood loss.
- Postoperative follow-up for complications, convalescence, and allograft outcomes (mean 701 days).
Main Results:
- Mean operative time was 138 minutes; mean warm ischemia time was 175 seconds.
- No conversions to open surgery; major complications included one pulmonary embolus and one blood transfusion.
- Graft survival was 96%, with 99% recipient survival; all but two kidneys showed immediate function.
Conclusions:
- HARS facilitates shorter operating times in live donor nephrectomy.
- The HARS technique significantly reduces risks compared to standard endoscopic procedures.
- HARS is a safe and effective method for live donor nephrectomy.