Hand-assisted laparoscopic right nephrectomy and autotransplantation for treatment of renovascular hypertension.

Renal autotransplantation has been described as an effective method for addressing complicated urological disorders, including debilitating ureteral injury or loss, upper ureteral malignancies, complex nephrolithiasis, loin pain hematuria syndrome, and branch or distal renal artery disease. Standard autotransplantation involves 2 distinct surgical procedures: nephrectomy and subsequent renal graft into the iliac fossa. The technique mimics standard allografting procedures and typically uses a separate flank incision for the live donor nephrectomy and an extraperitoneal pelvic incision for renal transplantation. Alternatively, a long midline incision from the xiphoid process to the symphysis pubis maybe used to perform the entire operation transperitoneally. In an effort to decrease the morbidity and improve the cosmetic results associated with traditional autotransplantation, we describe a laparoscopic hand-assisted approach to right nephrectomy and autotransplantation through the same handport incision in 2 patients with renovascular hypertension.