Background
Our study reports last 139 consecutive hand assisted retroperitoneoscopic live donor nephrectomies (HARS) performed at our institution since 6/2011. HARS nephrectomy technique has been introduced by the author in Prague/Czech Republic in January 2003, since June 2011 is being used for all the donors including right sided and complex anatomy cases (mutliple vessels and ureters, retroaortic renal vein, renal artery diseases, etc). The main benefit of HARS approach is increased safety for the donor. Risk of bleeding and intraabdominal injury is low thanks to hand assistance and extraperitoneal approach.

Material and Methods
Data were collected prospectively. The operation is performed in the manner described by Wadström et al 2002, with minor modifications. Tere were all anatomical variations accepted for surgery, including right sided cases when indicated.

Results
There was no conversion to open nephrectomy, one donor was re-operated on the first postoperative day for bleeding from paraaortic lymphatics, this donor was also given two units of blood. The median blood loss was zero otherwise, meaning no use of suction or no blood in container. The median post-operative hospital stay was 2 days. We observed few minor complications including one wound infection, one wound seroma and three wound haematomas. There was one case of postoperative bleeding from paraaortic lyphatics mentioned above which required retroperitoneoscopic re-operation, there was one case of incisional hernia which occured some 8 months after surgery. All donors have life-long long follow up. There was one case of delayed graft function due to early rejection observed, all the other patients had immediate graft function.

Conclusion
HARS is a safe way of performing living-donor nephrectomy with low risk of severe complications, minimal morbidity and fast recovery. It is safe alternative to the transperitoneal miniinvasive as well as other nephrectomy techniques. It can be used safely for all the anatomical variations as well as right sided cases.