Laparoscopic stapling devices are used to divide the renal vessels. Then a lower midline incision is made to remove the kidney. A second method, the hand-assisted approach, was developed about two years ago. This method utilizes an early incision. The surgeon s hand is then inserted into the abdomen and used as a dissection aid.
Most surgeons prefer the second method since it is intuitively easier.
The hand-assisted method allows surgeons who have a large experience with open nephrectomy to gain proficiency in laparoscopic surgery very rapidly. It also makes sense to take advantage of tactile sensation during the renal dissection, especially since an incision needs to be made anyway, in order to remove the kidney. Thus our preference has been to use the hand-assisted technique. More than 30 cases of laparoscopic nephrectomy have now been performed at the MCW Transplant Program at Froedtert Hospital. Donor safety and renal function have been excellent.