Laparoscopic Hand-Assisted Donor Nephrectomy: A Decade of Single-Center Experience and Outcomes

Abstract

Objective: Kidney transplantation is the most effective treatment for end-stage renal disease, but the shortage of cadaveric donors has increased reliance on living donors. Traditional open donor nephrectomy, while effective, is associated with significant morbidity. Hand-assisted laparoscopic donor nephrectomy (HALDN) combines the advantages of minimally invasive surgery with the tactile feedback of open surgery. This study presents the outcomes of HALDN procedures performed at the center.

Methods: A total of 1221 living donor nephrectomies performed between September 2009 and August 2021 at Medicana !stanbul Hospital were analyzed. Donor characteristics, surgical details, and postoperative outcomes were recorded. Data analysis was conducted using SPSS version 22.0, with continuous variables assessed for normality and expressed accordingly.

Results: Donor ages ranged from 19 to 87 years (mean 48.50 ± 12.75 years), with 54.8% female donors. The average body mass index (BMI) was 27.99 ± 3.7 kg/m2. Left-sided nephrectomies constituted 78.5% of cases, with HALDN performed in 94.7% of these surgeries. Warm ischemia time averaged 99.21 ± 56.67 seconds. The average blood loss was 70 mL, and the mean hospital stay was 4.12 ± 1.2 days. Complications included conversion to open surgery due to bleeding in 3.3% of cases, postoperative atelectasis (0.6%), incisional hernia (0.33%), wound infection (0.16%), and scrotal swelling (0.25%). The findings indicate that HALDN is a safe and effective method for donor nephrectomy, aligning with similar studies regarding operation and warm ischemia times. The minimally invasive nature of HALDN contributes to shorter hospital stays and quicker postoperative recovery. The rate of conversion to open surgery was within acceptable limits, and complications were manageable. Obesity (BMI > 30 kg/m2) was identified as a risk factor for incisional hernia, suggesting the need for careful surgical technique in this group.

Conclusion: Hand-assisted laparoscopic donor nephrectomy offers a minimally invasive, safe, and effective alternative for living donor nephrectomy, enhancing donor recovery and potentially encouraging organ donation. Its adoption may play a signifi- cant role in reducing the number of patients awaiting organ transplants.

Keywords: Hand-assisted laparoscopic surgery; kidney transplantation; living donor nephrectomy.