Abstract
Introduction:
Living donor kidney transplant (LDKT) addresses the significant shortage of cadaveric donors for kidney transplantation (KT). Since living kidney donors (LKDs) are healthy individuals, LDKT surgery must be safe and minimally invasive. Therefore, the development of a simple surgical method to avoid peri- and postoperative complications is essential. Herein, we present a simple seven-step operative method for left- and right-hand-assisted laparoscopic donor nephrectomy (HALDN) in a step-by-step manner.
Methods:
For left HALDN, the LKD was positioned in a right semi-lateral decubitus position. A 7.5 cm incision was made in the upper middle abdomen for the hand port. For the laparoscope, a 1 cm incision was made on the left caudal side of the umbilicus. Subsequently, another 1 cm incision was made in the left lower abdomen for the dissecting instruments. The operative procedures were as follows: (1) mobilization of the descending colon and spleen, (2) dissection of the left ureter and gonadal vein, (3) detachment of the left adrenal gland from the left kidney along with transection of the left adrenal vein, (4) exposure of the left renal artery and vein including transection of the lumbar vein, (5) transection of the left ureter and gonadal vein, (6) transection of the left renal artery and vein using a laparoscopic vascular stapler, and (7) extraction of the kidney. For the right HALDN, the LKD was positioned in a left semi-lateral decubitus position. A 7.5 cm incision was made in the right lower abdomen for the hand port. For the laparoscope, a 1 cm incision was made on the right cranial side of the umbilicus. Then, another 1 cm incision was made in the right upper abdomen for the instrument. The operative procedures were as follows: (1) mobilization of the ascending colon and duodenum to expose the inferior vena cava and renal vein, (2) dissection of the right ureter and gonadal vein, (3) mobilization of the right kidney, (4) exposure of the right renal artery and vein, (5) transection of the right ureter and gonadal vein, (6) transection of the right renal artery and vein using endoscopic vascular staplers, and (7) extraction of the kidney.
Results:
Between January 2008 and December 2024, these operative methods were applied to 1,453 and 126 LKDs for left and right HALDN, respectively. The median operative time (interquartile range) was 195.0 minutes (156.0–228.0 minutes) and 186.0 minutes (159.0–220.0 minutes) for left and right HALDN, respectively. Blood loss (interquartile range) was 20.0 mL (10.0–35.0 mL) and 20.0 mL (10.0–40.0 mL) for left and right HALDN, respectively. Open conversion was performed in two LKDs for left HALDN and one LKD for right HALDN due to vascular injuries. No surgery-related deaths occurred.
Conclusion:
These simple seven-step operative methods allow a safe and minimally invasive HALDN for LDKT.
Patient Consent Statement:
All recipient data were retrospectively collected from the medical records and analyzed anonymously. Therefore, the need for informed consent was waived.
Author Disclosure Statement:
None of the authors have conflicts of interest to disclose.
Authors received and archived patient consent for video recording/publication prior to video recording of the procedure.
Runtime of video:
9 mins 53 secs.