الفهرس 
Acknowledgement
Recipient TechniqueOnly 14 pages are availabe for public view
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Abstract
Summary
Renal transplantation is now the standard treatment of patients in end stage renal failure. Laparoscopic live donor nephrectomy was developed with the intent to improve live kidney donation by reducing the impact of the operation on the donor’s life. The use of hand assisted laparoscopic techniques potentiates the postoperative benefits of laparoscopic surgery, with added advantages of tactile sensation, which shortens the surgeon’s learning curve and increases safety during laparoscopic dissection.
The aim of the study is to initiate the practice and to gain the experience in kidney transplantation (KT). Also to study the technical difficulties and surgical tips in Hand Assisted Laparoscopic Donor Nephrectomy (HALDN).
Thirty nine (22 males and 17 females) HALDN cases were carried out in a combined retrospective and prospective non randomized hospital based study, done in the period from January 2010 till December 2013 at Urology department, Martin Luther University, Halle (Saale), Germany.
Our mean operative time was 192 ± 38.5 minutes, more or less average between the recorded time in the other series. Our results regarding warm ischemia time correspond to those in the literature. Moreover, they showed that with the use of a hand-assisted technique by an experienced surgeon, we achieved an average warm ischemia time of 48 seconds, confirming the advantages for patients undergoing a laparoscopic proce¬dure with reduced operative trauma and a shorter postop¬erative donor course.
Hand-assisted living-donor nephrectomy shows shorter operative and warm ischemia times than standard laparoscopic and open surgery, offering at least the same functional results and decreasing surgical complications compared with a com¬pletely laparoscopic technique.
Conclusions and Recommendations
In conclusion, the increasing numbers of terminally ill patients with renal insufficiency in the world, the long waiting times for kidney transplants, and the organ shortage together have led to an increased proportion of living-donor nephrectomies.
We concluded that, when the procedure is performed by experienced sur¬geons, hand-assisted living-donor nephrectomy shows shorter operative and warm ischemia times than standard laparoscopic and open surgery, offering at least the same functional results and decreasing surgical complications compared with a com¬pletely laparoscopic technique.
Such procedure should be done in a high volume center by an experienced surgeon with the best instruments available.
The normalization of the kidney function before the third postoperative day could be considered a good indicator of the long term graft function.
The reduced hospitalization time results in cost reduction and allows donors to return to work quickly. Although the cost analysis was not performed in our study, we recommend a comparative study between open donor nephrectomy, conventional laparoscopic donor nephrectomy and hand assisted laparoscopic donor nephrectomy to determine the optimal and the cost effective procedure for donor nephrectomy. The explana¬tion of the risks of the procedure to the donor and preparation for the procedure must be optimized. In addi¬tion, strict criteria should be established to decide in favor of either laparoscopic or open nephrectomy. A well estab¬lished kidney transplant center should have mastery of both operative techniques and be able to offer them to patients.
Concerning side of the donated kidney, right HALDN is as safe and feasible as left HALDN. The appropriate use of digital assistance during right-sided HALDN helps to overcome technical problems associated with the short right renal vessels that may jeopardize the results of living donor renal transplantation.
It could be suggested that in center who are converting from open donor nephrectomy to a minimally invasive surgery laparoscopic approach safety may increase by the use of HARDN technique.