Renal Parenchyma Perfusion During Laparoscopic Donor Nephrectomy

Adam J Reid, MD, Myron Powell, MD, Carl Westcott, MD. Wake Forest University Baptist Medical Center.

INTRODUCTION
Renal blood flow during Laparoscopic Donor Nephrectomy is poorly documented. This is important because there is concern about the effects of arterial spasm on renal perfusion during mobilization and dissection of the renal artery. Some surgeons feel it is important to give the donor kidney a period of rest after complete mobilization prior to delivery. The purpose of this study is to identify changes in renal parenchyma perfusion by Restrictive Index (RI) during Laparoscopic Donor Nephrectomy, before and after renal artery dissection.

METHODS AND PROCEDURES
Restrictive Index (RI) in the renal parenchyma arterioles was collected using a doppler ultrasound and an intra-abdominal laparoscopic probe by a standardized technique. Pneumoperitoneum was set at 15mmHg. RI was measured at the beginning of the case and then immediately after ureter dissection, after renal vein dissection, and after renal artery dissection. RI was then followed at 5, 10, 15 and 20 minutes after renal artery dissection.

RESULTS
4 patients have been evaluated since June 2013. Average RI for the mentioned time points is summarized (Table 1). On average, RI immediately after Renal Artery dissection was 67% of the baseline RI. RI decreased after renal artery dissection and time to return of RI to near baseline levels was 5 minutes in 1 patient, 10 minutes in 2 patients and greater than 20 minutes in 1 patient.

CONCLUSION
In this preliminary evaluation it appears that arterial dissection does reduce renal perfusion. The effects lasted up to 20 minutes.  We are actively obtaining more data for this study.  Until further data is acquired the authors recommend a post arterial dissection rest period of at least 20 minutes prior to harvest and delivery of the organ so that normal arterial flow is reinstated prior to harvest.
 

Table 1

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