Prospective, nonrandomized comparison between right- and left-sided hand-assisted laparoscopic donor nephrectomy.

Area of Science:

• Urology
• Transplant Surgery
• Minimally Invasive Surgery

Background:

• Laparoscopic living donor right nephrectomy presents challenges in achieving sufficient right renal vessel length.
• Hand-assistance is explored to overcome these technical limitations.

Purpose of the Study:

• To evaluate the safety and feasibility of right-sided, hand-assisted, laparoscopic donor nephrectomy (HALDN).
• To compare perioperative outcomes and graft survival between right and left HALDN.

Main Methods:

• A 7-year prospective study (2003-2010) involving 51 right HALDN and 40 left HALDN procedures.
• Perioperative data collection included procedure time, blood loss, warm ischemia time, and complications.
• One-year graft survival was calculated using the Kaplan-Meier method.

Main Results:

• No conversions to open surgery were required for either group.
• Mean procedure time (123 min vs. 135 min) and blood loss (92 mL vs. 101 mL) were similar between right and left HALDN.
• No instances of renal artery or vein thrombosis were observed; 1-year graft survival was high and comparable (98.1% vs. 97.5%).

Conclusions:

• Right HALDN is a safe and feasible alternative to left HALDN.
• Hand-assistance effectively provides adequate right renal vessel length without increasing vascular complications.
• The technique demonstrates excellent donor and recipient outcomes, including high graft survival rates.