Laparoscopic donor nephrectomy

Abstract

(Fig. 2). Intraoperatively, two renal arteries were found originating in close proximity from the aorta (Fig. 2A). Each was taken separately, and a common orifice was reconstructed prior to transplantation in the recipient’s left iliac fossa. Warm ischemic time was 4 minutes and 20 seconds; estimated blood loss was 200 cc. There were no intraoperative complications, and the combined procedure took 4 hours, 24 minutes. The donor was discharged on the second postoperative day. She had required only 38 mg of morphine sulfate during the hospitalization. Upon discharge, only four acetaminophen with codeine tablets and eight plain acetaminophen tablets were required for pain relief. She returned to her usual activities, including child care for her granddaughter, two weeks postoperatively. She has had no long-term complications after six months of follow-up. The allograft functioned immediately upon placement in the CASE PRESENTATION recipient. The recipient was treated with tacrolimus, mycopheA 51-year-old woman presented for evaluation to donate a nolate mofetil, and prednisone, our standard immunosuppreskidney to her daughter-in-law, who had end-stage renal disease sive regimen. By day 4, the serum creatinine had decreased secondary to hypertension. The woman had no significant renal from 9.5 mg/dL to 1.5 mg/dL. The recipient was discharged on or urologic history. However, she had a history of irritable postoperative day 5. She has had no episodes of rejection. Her bowel syndrome, which had been treated with dietary manipucreatinine clearance 8 months postoperatively was 60 mL/min. lation. She had undergone an ovarian resection, appendectomy, and previous left laparoscopic oophorectomy for an ectopic pregnancy. She had no allergies and was not taking any medicaDISCUSSION tions. She did have intermittent symptoms of chronic cystitis. She was a full-time homemaker and was involved in taking Dr. Louis R. Kavoussi (Chief, Department of Urolcare of her 8-month-old granddaughter. ogy, Johns Hopkins Bayview Medical Center, and Patrick Physical examination was unremarkable, as was psychologiC. Walsh Distinguished Professor of Urology, Johns Hopcal screening. Laboratory studies were normal including comkins University, Baltimore, Maryland, USA): Kidney plete blood count, liver function study, and serum electrolytes. transplantation is the best option for treating end-stage Her BUN was 7 mg/dL; serum creatinine, 0.8 mg/dL; and creatinine clearance, 119 mL/min. A hepatitis profile and viral antirenal disease. Unfortunately, a large disparity exists bebody screening were negative. She was ABO compatible with tween the number of individuals who could benefit from her daughter-in-law, and HLA typing demonstrated a twothis treatment and the number of available kidneys. Moreantigen match. over, this disparity has worsened over the past few years, Preoperative three-dimensional computerized tomography as evidenced by increased waiting times for recipients (CT) reconstruction revealed a single renal artery with an early bifurcation as well as normal venous anatomy (Fig. 1). Both [1]. For example, at our institution, the average waiting kidneys appeared equal in size. A large gallstone was noted. time for a cadaveric kidney transplant has increased from Nine months ago, she underwent a left laparoscopic donor two years in 1990 to four years currently. Because the nephrectomy and simultaneous laparoscopic cholecystectomy. supply of cadaveric kidneys has remained relatively The kidney was removed through a Pfannenstiel incision. Two fixed, alternative sources of organs have been sought 1 cm and one 0.5 cm incisions were used for the dissection over the last decade. One great potential means for obtaining more kidneys The Nephrology Forum is funded in part by grants from AstraZeneca is through live donation. When compared with cadaveric LP; Amgen, Incorporated; Merck & Co., Incorporated; Dialysis Clinic, renal transplantation, living-donor transplantation has Incorporated; and R & D Laboratories. several advantages, including greater patient and graft