This recently published paper followed one surgeon as he performed 60 living donor nephrectomies. The first 30 were hand-assisted laparoscopic and the second 30 were pure laparoscopic. Here’s how his patients fared (emphasis mine):
Thirteen patients (43.3%) in the [hand-assisted] group experienced a total of 17 intraoperative errors, and 11 (36.7%) in the [pure lap] group experienced a total of 14 intraoperative errors.
The most common intraoperative complication was adrenal gland injury (two intra-adrenal hematomas and 10 adrenal gland injuries, including 7 that required repair).
Twenty-six patients (86.7%) in the [hand-assisted] group experienced a total of 47 postoperative complications, and 21 (70.0%) in the [pure lap] group experienced a total of 28 postoperative complications.
Ileus and aspartate aminotransferase/alanine aminotransferase elevation were commonly reported in the [hand-assisted] group.
Note: Ileus refers to the intestine. Aspartate aminotransferase refers to an enzyme that is released when tissue/organs are damaged. The higher the level, the more damage the tissue/organ has sustained
Three patients experienced major postoperative complications, defined as grade II or higher. One patient in the [hand-assisted] group had prolonged chyle leakage (aka lymph leakage) from a Jackson-Pratt drain; this patient was treated with long-term drainage (14 days) and a low-fat diet.
One patient in the [pure lap] group underwent wound revision under local anesthesia for wound dehiscence (in other words, the wound ruptured along the surgical site).
A second patient in the [pure lap] group had a blood transfusion for postoperative bleeding. However, this bleeding originated mainly from a concomitantly performed ovarian cystectomy site and menstruation.
If all of this horrifies you, which it should, the conclusion should trip your gag reflex:
“The technical transition from HALDN [hand-assisted] to PLDN [pure lap] does not involve a steep learning curve for surgeons less experienced with laparoscopic renal surgery and maintains similar perioperative donor and graft outcomes.”
Somehow I doubt those wounded kidney donors would agree.
ETA 8-17-2015: When this link was posted on a LD-related FB group, someone remarked that potential living donors should make sure they know their surgeon’s experience level. Obviously, i agree with this sentiment, but it’s not that simple. It’s not required that surgeons disclose this information and there is no way to confirm or crosscheck a potential surgeon’s answer to the question. That doesn’t mean a potential donor shouldn’t ask though. The surgeon’s reaction to the query itself might communicate a lot about his/her veracity and/or attitude toward patients advocating for themselves.If s/he attempts to intimidate or brush off the question, that might be a good sign to find another surgeon.
You, D., Lee, C., Jeong, I., Han, D., & Hong, B. (2015). Transition From Hand-Assisted to Pure Laparoscopic Donor Nephrectomy JSLS : Journal of the Society of Laparoendoscopic Surgeons, 19 (3) DOI: 10.4293/JSLS.2015.00044