A Retrospective Analysis of a Single Center’s Experience with Hand-Assisted Retroperitoneoscopic Living Donor Nephrectomy: Perioperative Outcomes in 50 Consecutive Cases

Background: Minimally invasive techniques for living donor nephrectomy are crucial for donor safety and promoting organ donation. Hand-Assisted Retroperitoneoscopic Donor Nephrectomy (HARP-DN) combines the benefits of minimally invasive surgery with the tactile feedback of open surgery. This study analyzes a single center’s initial experience with this technique. Methods: A retrospective analysis was conducted on the first 50 consecutive living kidney donors who underwent HARP-DN at our institution. We collected and evaluated preoperative demographics, intraoperative data (operating time, warm ischemia time), and postoperative outcomes, including complication rates, length of hospital stay, and donor renal function at discharge. Results: All 50 HARP-DN procedures were successfully completed with zero conversions to open surgery and no donor mortality. The mean operating time was 192.4 ± 57.7 min, and the median warm ischemia time was a competitive 110 s. The overall perioperative complication rate was low at 4% (2/50 cases), involving manageable bleeding events. Donors experienced a rapid return to oral diet, and all were discharged with excellent renal function as indicated by a mean serum creatinine of 1.09 ± 0.30 mg/dL. Conclusions: Our initial experience demonstrates that Hand-Assisted Retroperitoneoscopic Donor Nephrectomy is a safe, reproducible, and effective procedure. It offers the advantages of a minimally invasive approach, including low morbidity and excellent preservation of donor renal function, while achieving a short warm ischemia time critical for graft quality. These findings support HARP-DN as a safe, reproducible, and effective option for living donor nephrectomy.