Retroperitoneoscopic donor nephrectomy with a gel-sealed hand-assist access device

Area of Science:

• Nephrology
• Minimally Invasive Surgery
• Transplantation Surgery

Background:

• Hand-assisted laparoscopic techniques can reduce warm ischemia time (WIT) in donor nephrectomy.
• Retroperitoneoscopic approaches may decrease postoperative ileus incidence.
• GelPort facilitates hand access while maintaining pneumoretroperitoneum.

Purpose of the Study:

• To evaluate the safety and efficacy of retroperitoneoscopic donor nephrectomy using a GelPort hand-assist device.
• To assess the impact of this technique on WIT and postoperative complications.

Main Methods:

• Retrospective study of 75 consecutive donors undergoing retroperitoneoscopic donor nephrectomy with GelPort.
• Procedure involved a small flank incision and a larger pararectal incision for GelPort placement.
• Hand-assist used for retraction, vessel control, and graft extraction.

Main Results:

• Mean WIT was 2.8 minutes.
• No graft vascular or ureteral shortage occurred.
• No blood transfusions, open conversions, or organ injuries were reported.
• Higher BMI (≥25 kg/m²) correlated with increased blood loss (P=0.031).
• No instances of postoperative ileus or significant wound pain.

Conclusions:

• Retroperitoneoscopic hand-assisted donor nephrectomy with GelPort is a feasible and safe option.
• The technique effectively minimizes WIT and avoids major complications.
• Further refinement of surgical techniques is recommended.