ANAHEIM, CA (UroToday.com) - Dr. Sanjaya Kumar from Boston, MA, presented his experience with hand-assisted retroperitoneoscopic live donor nephrectomy. Traditionally the retroperitoneal approach has been thought to be more technically challenging due to the “limited” working space. These authors elegantly described their technique for the most recent 60 cases, though their overall experience is 180 cases. After making a 6 cm ipsilateral lower quadrant muscle splitting incision, the retroperitoneal space is developed bluntly and under direct vision. Then, a Lap Disc (Ethicon EndoSurgery, Cincinnati, OH), is placed followed by two 12mm and one 5 mm port. The operating surgeons hand for these cases is glove size 7.5. Of the 60 patients reviewed, 49 were left sided and 11 were right sided. The mean operative time was 190 minutes (120 – 260 minutes) and the mean warm ischemia time was 179 seconds (150 – 240 seconds). The mean blood loss in this group was 95 cc (50 – 200cc). The complications encountered were minor and icluded 2 pneumothoraces, 1 wound infection and 1 rectus hematoma, each of which was treated conservatively. This series demonstrates the feasibility of performing hand-assisted retroperitoneoscopic live donor nephrectomy and that the working space, though thought to be limited, can be well developed to facilitate safe dissection and retrieval of the organ for donation, despite the surgeon’s hand being in the field.

( ABST [1902] - Transplantation and Vascular Surgery (II))

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