Hand-assisted laparoscopic donor nephrectomy: are hand port devices really necessary?

Area of Science:

• Minimally Invasive Surgery
• Transplant Surgery
• Surgical Technology

Background:

• Hand port devices (HPD) are standard in hand-assisted laparoscopic surgery (HALDN).
• The cost of HPD can be a barrier in financially constrained healthcare settings.
• The study investigated the safety and efficacy of device-free HALDN.

Purpose of the Study:

• To evaluate the outcomes of device-free hand-assisted laparoscopic donor nephrectomy (HALDN).
• To compare device-free HALDN with procedures using hand port devices (HPD).
• To assess the impact on operating time, wound infections, and incisional hernias.

Main Methods:

• Retrospective analysis of 84 device-free HALDN cases and 80 HPD-assisted HALDN cases (2007-2010).
• Primary endpoint: duration of operation.
• Secondary endpoints: postoperative wound infections and incisional hernia rates.

Main Results:

• No significant difference in operating time between device-free (98 min) and HPD groups (94 min).
• A device was needed in only 3.6% of attempted device-free cases.
• Similar rates of postoperative wound infections (0% vs 2.5%) and incisional hernias (1.5% vs 1.4%) in both groups.

Conclusions:

• Device-free HALDN is a viable alternative to HPD-assisted procedures.
• This technique offers cost benefits and is translatable to developing healthcare units.
• No compromise in patient outcomes or surgical efficiency was observed.