Purpose: to investigate and introduce into practice the results of laparoscopic hand-assisted method of kidney harvesting from related living donor.
First laparoscopic donor nephrectomy in the world was performed in 1995 by L. Kavoussi and L. Ratner. Performing the donor nephrectomy by laparoscopic hand-assisted way for last few years became a main choice in many transplantation centers. According to the previous publications in Kazakhstan laparoscopic hand-assisted donor nephrectomy were never performed before. It’s known that the most of famous transplantation centers, dealing with minimal invasive organ harvesting consider Hand Assisted Laparoscopic Nephrectomy, as a “gold standard” approach.
From the 31 of May, 2012 to December 2017 259 kidney transplantations were performed in our hospital. Average age of living related donors was 39 ±1,4 years (max 62 y/o, min 21 y/o). There were 147 (57, 5 %) male and 112 (42.5%) females among the donors. Laparoscopic hand-assisted donor nephrectomy was performed to 259 patients. Laparoscopic and open surgery cases of conversion was not occurred. In some cases kidney grafts had anatomic specifications such as: in 1 case there were 3 arteries in the graft, in 36 cases there were 2 renal arteries in graft and in 3 cases there were 2 renal veins in graft.
Duration of surgery and warm ischemic time decreased as more experience was acquired. In the first year duration of surgery was 120 min ±26 and warm ischemic time was 132 sec ± 65 and in the fifth year - 86 ±21 min and 82 ± 23 sec, respectively. The duration of postoperative stay was 4.7 days (max 8 days and min 4 days). All patients returned to their life activities (except hard physical activity) two weeks postoperatively. There were a few complications in early postoperative period such as: wound infection in 4 cases, lymphorrhoea in 3 cases (managed conservatively). In one case postoperative hernia occurred in long-term postoperative period due to hard physical activity in early postoperative period.
As a result of acquired experience we consider laparoscopic hand-assisted donor nephrectomy as safe and effective intervention, which allows to minimize the traumatism of the surgery, thus decreasing the duration of rehabilitation period and leading to an increase in number of potential donors.