Midline Rotation of the Right Renal Hilum During Hand-Assisted Laparoscopic Living Donor Nephrectomy

Abstract

Background/Objectives: Laparoscopic living donor nephrectomy (LLDN) of the right kidney is currently considered as part of standard of care; however, dealing with the renal hilum when performing ligation/division of its renal vessels is still a main concern. Here, we describe a simpleto-perform technique, i.e., flipping the fully mobilized right kidney to the midline so that the renal artery becomes anteriorly, which offers better visualization and easier dissection of the renal vessels (achieving maximized lengths) when performing hand-assisted LLDN of the right kidney.Methods: Living donors who underwent hand-assisted LLDN of the right kidney, along with their respective renal transplant recipients, were included in this report. Donor characteristics included renal artery and vein lengths; recipient characteristics included creatinine at months 12 -36. Graft vein and arterial anastomosis data were also reported.Results: Nineteen living donors and 19 recipients, with median donor and recipient ages being 39 (24 -60) and 53 (3 -81) years, respectively, were included. None of the 38 patients had intra-or postoperative complications. Donor renal vein was anastomosed to the right external iliac vein (n = 16), right common iliac vein (n = 2), and inferior vena cava (n = 1). Gonadal vein (n = 1) and deceased donor iliac vein (n = 2) were used to increase the right renal vein length in 3 cases. Four donor kidneys had 2 arteries reconstructed side by side. None of the recipients developed any vascular or urological complications. Conclusions:The laparoscopic technique described is safe and allows better visualization of the right hilum, mainly the renal artery, and helps in stapling the renal vein and renal artery.

Venous vascular reconstruction of a robotically procured right kidney with two renal veins transplanted into a pediatric recipient

“…14,15 The possibility of multiple renal vessels and shorter renal veins are greater when transplanting right donor kidneys compared to left donor kidneys. 16 These anomalies present greater technical difficulties that can increase warm ischemia time, posing a potential risk for early graft dysfunction. 14 Therefore, left kidneys are preferred as right extracted kidneys present a greater risk of IVC lesions occurring in the donor and renal vein thrombosis occurring in the recipient.…”

“…14 Therefore, left kidneys are preferred as right extracted kidneys present a greater risk of IVC lesions occurring in the donor and renal vein thrombosis occurring in the recipient. 16 Although multiple vessel kidneys have historically been a limitation for renal transplantation, recent studies show that augmented anastomosis surgery time or ischemia time in multiple renal vessel kidney procedures has no considerable effect on graft function and graft survival in the long term. 10 Supernumerary renal veins are relatively common anatomical abnormalities defined as the existence F I G U R E 2 Back table vascular venous reconstruction utilizing complete deceased iliac vein system (common iliac vein with both external and internal veins) to extend the two renal veins.…”

“…Right donor kidneys are procured in living donors when left kidney function predominates or if the left kidney has multiple vessels, a duplicated collecting system, anatomical variances or calcified renal arteries 14,15 . The possibility of multiple renal vessels and shorter renal veins are greater when transplanting right donor kidneys compared to left donor kidneys 16 . These anomalies present greater technical difficulties that can increase warm ischemia time, posing a potential risk for early graft dysfunction 14 .…”

“…These anomalies present greater technical difficulties that can increase warm ischemia time, posing a potential risk for early graft dysfunction 14 . Therefore, left kidneys are preferred as right extracted kidneys present a greater risk of IVC lesions occurring in the donor and renal vein thrombosis occurring in the recipient 16 …”