Use of Flexible Retractor to Facilitate Vascular Length in Living Related Total Laparoscopic Donor Nephrectomies

Background Minimally invasive Laparoscopic Donor Nephrectomy (LDN) is the gold standard procedure for donor nephrectomy. Various techniques of donor neprectomy have been described and the utility of any one technique depends upon the skill of the surgeon. Donor vascular length facilitates adequate recipient anastomosis and prevents technical difficulties associated with short vessels. Our preference has been Total laparoscopic Trans peritoneal donor kidney mobilization and disconnection of the vascular pedicle using the flexible retractor to facilitate the vascular length.

Aim: We present our technique for retracting the kidney using a flexible triangular endoscopic retractor to gain maximum donor vascular length.

Methods: Patient position and port sites as depicted in figure 1. The kidney is mobilized laparoscopically and prior to vascular disconnection, the diamond snake angled retractor (Snowden pencer, Tucker GA) is introduced through a second 12 mm port and passed behind the kidney and the retractor is locked around the kidney. The kidney is then retracted using the angled retractor as a handle. The renal vascular pedicle is then transected using the endovascular GIA stapler (Ethicon Endo Surgery, Cincinnati, Ohio) the artery first followed by the vein (picture 1). The kidney is extracted through a 3-4 cm oblique incision incorporating the third port similar to a Macburney’s incision. Outcomes of 877 patients who underwent LDN at Saint Barnabas health care system were analyzed retrospectively and compared to the outcomes with other regional centers in the United States. Outcome variables evaluated include: patient demographics, length of hospital stay, operative time, preoperative and postoperative creatinine levels, estimated surgical blood loss, and postoperative complications.

Results: Data of 727 LDN procedures analyzed and compared to the data from a high volume center- University of Maryland (UM) and John Hopkins Bayview Medical (JHBMC) center will be presented. All procedures were performed at a large tertiary community hospital. The results of the demographics, operative statistics, post operative complications and recipient graft survival will be discussed. The table depicts some of our results in comparison:

Outcomes of LDN at our center have been comparable to other institutions in the world. Total Trans peritoneal laparoscopic surgery with the use of flexible retractor adds to the ease of the procedure, stabilizes and prevents vascular avulsion and facilitates vascular length thereby reducing the overall operative time significantly. This technique is effective to both left and right LDN.

Session: Podium Presentation

Program Number: S090

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