Facebook
Twitter
LinkedIn
Email
 |
Checking for direct PDF access through Ovid | |
Excerpt
Introduction: Although the technique of laparoscopically assisted live donor nephrectomy (LDN) is well established for the left side, the perceived technical dificulty of safely obtaining enough length of the anatomically short right renal vein (RRV) has discouraged surgeons from approaching it laparoscopically. Some have experienced venous thrombotic complications and abandoned right sided laparoscopic harvest. Methods: For living donor transplants performed using laparoscopically harvested right kidneys, we recorded the anatomic features and compared donor outcome, early graft survival and median postoperative serum creatinine (days 1-7, months 1, 3, 12) with 74 laparoscopic left controls. Choice of side was based on conventional angiography performed in all potential donors. With the donor in left lateral decubitus position a transperitoneal approach to the right kidney was made. When dividing the vascular pedicle we use a single row endoscopic vascular stapled technique aimed at maximizing vein length by allowing the caval wall to be drawn into the stapler and reducing loss of graft vein from removal of the staples. Results: 21 right kidneys were removed for multiple left arteries in 15, venous anomalies in 4 and smaller right kidney in 2. One conversion followed endoscopic scissor injury to the renal artery. No donors required transfusion and there was no donor morbidity Mean hospitalization was 4.6 days for the open group and 2.3 days for the laparoscopic (p<0.05). Two grafts were lost. The first (the 15th right kidney in this series) was avoidable and due to venous thrombotic complications in the anastomosis of an anatomically shortRRV (≈5mm) which had been poorly visualized on angiography. The second was due to primary non-function following a straightforward donor operation and appeared unrelated to the method of harvest. There was no significant difference in recipient creatinine in either of the two groups despite the appearance of the accompanying chart, although the groups are of different sizes. Conclusion: Grafts harvested from the right appeared to function similarly to those from the left. Every effort to maximize the length of vein harvested without compromising donor safety must be made. Recipient vein should be generously mobilized to avoid tension on the anastomosis. Pre-operative imaging which best demonstrates the length of the RRV should be performed if considering the right kidney in order to identify an excessively short vein (<10 mm). If the RRV is found to be very short at surgery consideration should be given to making an incision which will give adequate exposure for a conventional vascular approach.
