Laparoscopic Nephrectomy for Living Kidney Donor with Prior Laparotomy

Vasileios Drakopoulos, MD, PhD, FACS1, Nikolaos Roukounakis, MD, PhD1, Athanasios Bakalis, MD1, Sotirios Voulgaris, MD1, Sotiria Tsogka, MD2, Vassilis Vougas, MD, PhD1, Eleni Plesia, MD, PhD2, Spiros Drakopoulos, MD, PhD1. 1First Department of Surgery and Transplant Unit, Evangelismos General Hospital, Athens, Greece, 2Department of Anaesthesiology, Evangelismos General Hospital, Athens, Greece

Background. Laparoscopic nephrectomy for renal transplantation has become a standard operation worldwide since it provides faster recovery and return to the donor’s everyday activities.

Method. We present a case of a 68-year-old male, living kidney donor, who had undergone exploratory laparotomy following a car accident one year before laparoscopic nephrectomy. The patient was placed in the typical left decubitus position for nephrectomy. Two 5mm trocars, and a 10mm one were placed to the left midclavicular line, between the costal cartilage and the anterior superior iliac spine, in order to achieve triangulation. A 10mm trocar was placed suprapubically and was replaced by a gel-port for the graft’s removal. Laparoscopic nephrectomy was performed, following symphysiolysis. Operative time was three hours. Time of warm ischemia was three minutes.

Results. The recipient presented immediate diuresis. The donor had an uneventful recovery and was discharged four days later.

Conclusions. Laparoscopic approach seems to be safe for live kidney donors, even in cases of prior laparotomy. It is related to less pain, fewer complications and shorter hospitalization. The time of warm ischemia does not seem to affect the graft’s function. The donor returned to his everyday activity six days post-operatively

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