Traditional descriptions of laparoscopic transperitoneal left adrenalectomy and nephrectomy include complete division of the splenorenal ligament. The spleen is reflected toward the midline with the tail of the pancreas to expose the origin of the renal pedicle and adrenal gland. Yet despite aggressive mobilization of the upper pole of the spleen as far cephalad as the stomach, it is still common for exposure deep in the cleft between pancreas and renal vessels to be difficult. By avoiding division of the splenorenal ligament, if the upper pole of the kidney is freed from its attachments behind the spleen, the entire kidney can be dislocated inferiorly, no mobilization of the spleen is necessary while exposure of the renal pedicle remains good. Advantages of this approach include less risk of injury to the spleen and improved exposure of the renal artery in its oblique course to the surgically ptosed kidney. This video describes the steps we now employ in laparoscopic left donor nephrectomy. It appears to be applicable in both obese and normal weight donors and would be equally effective in left adrenalectomy.
Session: Podium Video Presentation
Program Number: V035
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