Length Of Renal Vein Research Articles

LAPAROSCOPIC MULTIPLE VESSEL DONOR NEPHRECTOMY

P160 Aims: Laparoscopic donor nephrectomy usually involves the kidney that has one artery to achieve ease of operation, improve outcomes and minimize complications. Occasionally, multiple vessel nephrectomy is preferred for a variety of reasons. Although multiple vessel donor nephrectomy has been reported in the literature, no single study reports more than 20 operations. This retrospective study evaluates donor and allograft outcomes for single and multiple vessel laparoscopic donor nephrectomy. Methods: All laparoscopic donor nephrectomies performed at a single transplant program from 2000 to 2004 were reviewed for pre-operative and post-operative outcomes of the donor patient, the recipient patient and the renal allograft. Donor age, gender, race, body mass index (BMI), operative time, warm ischemia, cold ischemia, urine output (UOP), estimated blood loss (EBL), vessel length, complication rate and post-operative recipient creatinine were evaluated. Results: Of 240 laparoscopic donor nephrectomies performed, 37 had multiple vessels (15%). There were no significant differences in mean age (41 ± 11 years), gender (45% male), race (75% Caucasian) or BMI (27.5 ± 5.8) of donors. Of the 37 organs with multiple vessels, nine were right kidneys (25%) and 28 were left kidneys (75%). The multiple vessel kidney was selected for donation based on anatomic and donor considerations. There was no difference in total operative time. Cold ischemia time (CIT) was longer for the multiple vessel organs (46 ± 24 mins) than for single vessel organs (35 ± 13 mins)(p = 0.001). Warm ischemia time (WIT) was also longer for the multiple vessel organs (4:20 ± 2:05 min) than the single vessel organs (3:13 ± 0:47 min)(p = 0.001). There was no difference in the intra-operative UOP or EBL. The renal artery length (3.0 ± 0.6 cm) showed no difference, but the renal vein length showed a difference in the multiple vessel group (3.0 ± 0.9 cm) compare to the single vessel group (4.0 ± 0.9 cm)(p<0.05). There was no difference in the complication rate of 18%, the most common being hemorrhage (15%), resulting in only rare conversions to an open procedure (1%). Post-operative hospital length of stay was similar for both donor groups (46 ± 17 hours). Post-operative allograft function was similar for both groups at post-operative day one (creatinine 4.65 ± 2.57 for multiple vessel kidney donor, 4.63 ± 2.95 for single vessel kidney donor), post-operative day seven (creatinine 1.76 ± 1.38 for multiple vessel kidney donor, 1.7 ± 1.47 for single vessel kidney donor) and one year post-operatively (creatinine 1.06 ± 0.3 for multiple vessel kidney donor, 1.34 ± 0.44 for single kidney donor). Conclusions: Although multiple vessel laparoscopic kidney donor nephrectomy is performed only rarely due to concerns about patient safety and vessel length, this operation can be performed safely. CIT and WIT are slightly increased due to the need to reconstruct multiple arteries or to perform multiple anastomoses. We report no significant differences in donor demographics or allograft function through one year post-transplant. With experience laparoscopic donor nephrectomy of organs with multiple vessels can be performed safely for the donor and recipient

Right retroperitoneal versus left transperitoneal laparoscopic live donor nephrectomy

Objectives To describe our preferred method of right laparoscopic live donor nephrectomy (LDN) using a retroperitoneoscopic approach to determine the indications for, and overall rate of, right LDN and to compare the donor and recipient early outcomes of right retroperitoneal LDN to those of left transperitoneal LDN in a consecutive single-institution series. Methods At our institution, LDN for allotransplantation was performed in 143 consecutive patients. The indications for right LDN (n = 29) included multiple left renal vessels (n = 18), early branching of the left renal artery (n = 1), left renal vein anomaly (n = 2), right renal arterial fibromuscular dysplasia (n = 2), right renal cyst (n = 3), mild right hydronephrosis with delay on renal scan (n = 1), or right nephrolithiasis (n = 2). Results Right LDN was performed in 29 (20.3%) of 143 patients using a retroperitoneal approach in all but the first case. Right retroperitoneal LDN was associated with decreased blood loss and operative time compared with left transperitoneal LDN. The hospital stay, analgesic use, and donor serum creatinine at discharge were similar in both groups. Despite a statistically significantly increased warm ischemia time and decreased renal vein length, right retroperitoneal LDN was associated with recipient functional outcomes at 5 and 30 days after transplant that were no different from those after left transperitoneal LDN. Conclusions Right retroperitoneal laparoscopic LDN provides similar donor and recipient outcomes when compared with the left transperitoneal approach and obviates most of the technical challenges encountered with a right transperitoneal approach.