2074 A NOVEL BRIDGING HAND-ASSISTED LESS DONOR NEPHRECTOMY TECHNIQUE AND COMPARISON TO CONVENTIONAL HAND-ASSISTED LAPAROSCOPIC DONOR NEPHRECTOMY

Abstract

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation, Vascular Surgery I1 Apr 20102074 A NOVEL BRIDGING HAND-ASSISTED LESS DONOR NEPHRECTOMY TECHNIQUE AND COMPARISON TO CONVENTIONAL HAND-ASSISTED LAPAROSCOPIC DONOR NEPHRECTOMY Ryan Bowman, Kamyar Ebrahimi, Paymohn Mahdavi, Forrest Jellison, Chris Tenggardjaja, and D. Duane Baldwin Ryan BowmanRyan Bowman More articles by this author , Kamyar EbrahimiKamyar Ebrahimi More articles by this author , Paymohn MahdaviPaymohn Mahdavi More articles by this author , Forrest JellisonForrest Jellison More articles by this author , Chris TenggardjajaChris Tenggardjaja More articles by this author , and D. Duane BaldwinD. Duane Baldwin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2134AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recently, laparoendoscopic single-site surgery (LESS) has been employed to decrease the morbidity of kidney donation. Concerns have been raised about the increased surgical complexity, learning curve, and warm ischemia times. In an attempt to circumvent the complexity of LESS, we have developed a bridging hand-assisted-LESS (BLESS) technique that allows the surgeon to gain experience with single incision surgical techniques in the setting of traditional hand-assisted laparoscopy. The purpose of this study is to present the BLESS technique and to compare the outcomes of this technique with conventional hand-assisted laparoscopic donor nephrectomy (HALDN). METHODS Similar to LESS, the BLESS technique employs a single periumbilical incision. Enlargement of the fascial incision to 7 cm facilitates placement of a Gelport device and allows some triangulation of the three ports inserted through the hand-assist device. Parts or all of the case may be performed with single incision techniques. At the surgeon's discretion, placement of a single additional 5 mm port allows the surgeon to convert to a hand-assisted technique with additional ports placed through the Gelport to perform the dissection. A retrospective comparison of five BLESS donors to 20 consecutive HALDN patients performed by the same surgeon was performed. Preoperative, perioperative and postoperative variables were compared. RESULTS Compared to HALDN patients, BLESS patients had similar preoperative characteristics including age (p=0.881), sex (p=0.858) and preoperative creatinine (p=0.790), but had lower BMI (21.6 vs. 26.3; p=<0.001). The estimated blood loss (p=0.08), incision length (p=0.20) postoperative creatinine (p=0.052) and warm ischemia time (p=0.254) were similar between groups. BLESS patients had longer operative times compared to conventional HALDN patients (278 vs 247 min; p=0.02) but had shorter post-operative hospital stay (1.4 vs. 3.0 days; p = <0.001). There were no conversions or complications in the BLESS patients and all BLESS recipient kidneys functioned immediately. CONCLUSIONS The BLESS technique is less invasive than HALDN and allows the surgeon to develop experience with single incision techniques with an increased margin of safety. The ultimate benefits of this technique will need to be confirmed in a prospective randomized study. Loma Linda, CA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e806 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan Bowman More articles by this author Kamyar Ebrahimi More articles by this author Paymohn Mahdavi More articles by this author Forrest Jellison More articles by this author Chris Tenggardjaja More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...