Telementoring Facilitates Independent Hand-Assisted Laparoscopic Living Donor Nephrectomy
Section snippets
Methods
A standard hand-assisted living donor nephrectomy surgical technique was used in all locally mentored, telementored, and independent cases. Under a general anesthetic patients were placed in the right lateral position and all donor organs were removed from the left side. A Gelport (Applied Medical) was placed in the midline above the level of the umbilicus and two further laparoscopic ports (one camera and one instrument) were introduced on the patient's left side. The transatlantic connection
Results
All procedures were completed laparoscopically without operative complication. There were no conversions to open surgery, postoperative complications, or blood transfusions required in any subgroup. The laparoscopic and hand-port wounds all healed well and the 2-week pain score was 0 for all donors. There were no adverse events in recipients and graft function was excellent. With regards to the telementored group the mean operative time was 240 minutes, the mean warm ischemia time 189 seconds,
Discussion
HALDN is a relatively new and effective technique designed to make kidney donation more attractive and minimally invasive without affecting recipient outcomes. It allows kidneys to be harvested with short operating and warm ischemia times.12 The operative and postoperative parameters for our telementored group and the subsequent independent practice group compare favorably with the large published series of HAL living donor nephrectomy13 and a recent systematic review.14 In particular the mean
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This work was supported by Guy's Hospital Research Funds.