Pure Laparoscopic Versus Hand-Assisted Nephrectomy: Comparative Outcomes in Living Kidney Donors

Kidney transplantation remains the only curative therapy for end-stage renal disease, with living donor nephrectomy playing a vital role in addressing the shortage of deceased donors. This study compares the effectiveness and safety of two minimally invasive surgical techniques for kidney graft procurement: pure laparoscopic nephrectomy and hand-assisted laparoscopic nephrectomy.

This retrospective, observational study analyzed 50 living donor nephrectomies performed between 2021 and 2024 at a high-specialty hospital in Mexico. Sociodemographic, clinical, and surgical variables - including surgical time, bleeding, warm ischemia time, complications (Clavien-Dindo classification), and creatinine levels - were evaluated. Statistical analyses were conducted to assess differences between the two techniques.

The hand-assisted technique was performed in 31 (62%) cases, while the pure laparoscopic approach was used in 19 (38%). The mean surgical time (203.54 ± 62.72 min) and bleeding volume (258.78 ± 536.67 mL) showed no statistically significant differences between the techniques (p > 0.05). Complications occurred in four (8%) patients, with higher-grade complications (3B and 4B) observed exclusively in the pure laparoscopic group. Creatinine levels demonstrated no significant differences between groups at any postoperative interval.

Both techniques proved to be safe and effective for living donor nephrectomy, with comparable outcomes in surgical parameters and donor renal function. The hand-assisted technique offered advantages in terms of lower bleeding variability, while pure laparoscopic nephrectomy was associated with higher-grade complications in isolated cases.

Living donor nephrectomy is a safe and effective procedure using either technique, emphasizing the importance of institutional expertise and individualized surgical planning. Future research should focus on multicenter studies, donor quality of life, and the integration of advanced technologies such as robotic systems to optimize outcomes.