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Hand Assisted Laparoscopic Donor Nephrectomy

Hand Assisted Laparoscopic Donor Nephrectomy. Ryan Lefevre MIS Elective UK College of Medicine April 20 th , 2011. Anatomy. Renal Artery/Vein. Anatomy. Kidney. Abdominal Aorta. Ureter. Iliac Vessels. Surgery Goals. Remove Healthy Kidney for Donation Ensure Safety of Donor Patient

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Hand Assisted Laparoscopic Donor Nephrectomy

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  1. Hand Assisted Laparoscopic Donor Nephrectomy Ryan Lefevre MIS Elective UK College of Medicine April 20th, 2011

  2. Anatomy

  3. Renal Artery/Vein Anatomy Kidney Abdominal Aorta Ureter Iliac Vessels

  4. Surgery Goals • Remove Healthy Kidney for Donation • Ensure Safety of Donor Patient • Minimize Scarring • Minimize Recovery Time

  5. Surgery Procedures • Free Colon to Visualize Kidney • Free Kidney • Maintain Fat on Lower Pole of Kidney • Dissect Ureter to Level of Iliac Vessels • Remain Medial to Gonadal Vein • Clip/Separate Ureter • Staple/Separate Renal Artery/Vein • Remove Kidney

  6. Procedure Notes • Possible Branches Off Renal Artery • Dessuflate After Dissection to Allow Kidney to Rest • Administer Mannitol to Ensure Urine Production • ‘Warm Time’ Starts at Closure of Renal Artery

  7. Port Placement 11mm Camera Port Hand Port 12mm Working Port

  8. Patient Position “Flexed Table Right Down Partial Flank” Surgeon Surgeon Top View Side View

  9. Laparoscopic Instruments • Ultrasonic Dissector • Ligasure • Clip Applier • Scissors • Stapler

  10. Laparoscopic Instruments • Ultrasonic Dissector • Ligasure • Clip Applier • Scissors • Stapler ethiconendosurgery.com

  11. Laparoscopic Instruments • Ultrasonic Dissector • Ligasure • Clip Applier • Scissors • Stapler ligasure.com

  12. Laparoscopic Instruments • Ultrasonic Dissector • Ligasure • Clip Applier • Scissors • Stapler covidien.com

  13. Laparoscopic Instruments • Ultrasonic Dissector • Ligasure • Clip Applier • Scissors • Stapler covidien.com

  14. Laparoscopic Instruments • Ultrasonic Dissector • Ligasure • Clip Applier • Scissors • Stapler covidien.com

  15. Final Thoughts • Work Quickly but Efficiently • Especially After Start of ‘Warm Time’ • Ensure Donor Patient Safety • Laparoscopy Can Provide a Viable Method for Donor Nephrectomy

  16. References • Dr. Strup NTC #71, University of Kentucky • http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2855464/ • http://www.websurg.com/ref/doi-ot02en261.htm • http://www.ncbi.nlm.nih.gov/pubmed/15735385

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