Laparoscopic Donor Nephrectomy in Different Anatomical Scenarios: Our Experience

Abstract

Introduction:

Laparoscopic donor nephrectomy currently ranks as the gold standard surgical exercise for renal harvest for transplantation and has been widely practiced in both single and multiple renal arteries. ¹ We present a video demonstration of this exercise in interesting anatomical scenarios.

Methods:

Voluntary renal donors underwent a standard workup protocol involving various specialities. Three-dimensional helical computed tomography angiogram (64-slice computed tomography scanner) was employed for delineation of anatomy. The left renal unit was favored on most occasions. All procedures were conducted through transperitoneal access. Four ports were used for left donor nephrectomy and five ports for right side procedure. For right renal harvest, a terminal hand-assisted approach was followed. ² After hilar mobilization, the ureter was divided first followed by control of renal artery and lastly renal vein. In case of multiple arteries or veins, the most accessible artery or vein was clipped and divided first followed by the other member irrespective of vessel caliber. In all cases, control of renal vein was obtained by using 10-mL hem-o-loc clips. Additional titanium clips were used as necessary. In no case, a vascular stapler was utilized. Graft retrieval was undertaken through Pfannenstiel incision for left side and oblique muscle splitting incision on right side.

Results and Discussion:

Between 1999 and 2011, 715 laparoscopic donor nephrectomies were successfully performed by the same surgeon. Mean donor age was 37.6 years. Mean body mass index was 23.2 kg/m². 612 left and 103 right side renal allografts were harvested. 315 were men and 400 women. One hundred sixty-five renal units harbored multiple renal arteries (154 cases revealed two renal arteries, 10 cases revealed three renal arteries, and 1 case revealed four renal arteries). Interesting anatomical scenarios included double renal vein (two occasions, both right side), double lumbar vein (five occasions, all left side), double ureter (two occasions, one on left side and one on right side). In all these cases, a laparoscopic approach could be completed uneventfully. Mean warm ischemia time was 3.56 minutes. Mean operation duration was 110.4 minutes. Mean blood loss was 75.5 mL. Laparoscopic donor nephrectomy may be successfully attempted in the presence of different anatomical variants. Although a retroperitoneal approach has been favored by few operators, ³ we practice the transperitoneal route as it enables wider working space and the anatomy is familiar. Meticulous attention should be paid during dissection of the ureterogonadal pedicle or the renal hilum to identify anatomical variations and avoid inadvertent injuries. The operator needs to be sufficiently versed with laparoscopic exercises.

No competing financial interests exist.

Runtime of video: 7 mins 55 secs