Hand port use for extraction during laparoscopic donor nephrectomy

Objectives: To report our technique of laparoscopic donor nephrectomy using the hand port for specimen extraction. In 1999, our institution began a kidney transplant program. Donor nephrectomies have since been exclusively performed laparoscopically. Early in our experience, we used a specimen extraction bag to assist in graft removal, but encountered some complications. We subsequently changed our technique to include a hand port for specimen extraction. Methods: A database of our experience was kept prospectively. The records of both donors and recipients were reviewed. We describe our technique of laparoscopic donor nephrectomy, including our new method of specimen extraction using a hand port. Results: A total of 230 consecutive procedures were reviewed. We had excellent donor outcomes, including a mean operative time of 107.9 minutes and an estimated blood loss of 112.4 mL. In addition, the complication (12.6%) and open conversion (1.3%) rates were low. The time needed for specimen extraction decreased from 3.16 minutes to 1.16 minutes (P <0.05) after implementation of the hand port. Conclusions: The hand port modification decreased the extraction time and allowed for a safer method of extraction. We believe that the hand port facilitates a procedure that contains a small margin of error.