Troncoso P, Guzman S, Domínguez J, Ortiz A M
Unidad de Trasplante Renal, Pontificia Universidad Católica de Chile, Santiago, Chile.
Transplant Proc. 2009 Jan-Feb;41(1):82-4. doi: 10.1016/j.transproceed.2008.08.148.
Vascular management of the right renal vein during laparoscopic living donor nephrectomy is still an unsolved problem. This short vessel has limited the use of right kidneys. However, the right kidney should be harvested in some instances. Based on experience in open donor nephrectomy, our unit has used the donor gonadal vein to obtain a longer renal vein in this setting.
Four consecutive living related donors with the indication for laparoscopic right nephrectomy underwent this procedure. Three donors were females and the overall average age was 48.5 years. The renal vein was controlled with a 30-mm stapler and we included 5-6 cm of the ipsilateral gonadal vein during the harvest. The donor kidney was perfused and renal vessels prepared under cold conditions. The gonadal vein was opened longitudinally and sutured to the donor right renal vein as a wide tube in 3 cases and as a spiral tube in 1 case with 6-0 monofilament suture.
This procedure extended the bench work between 25 to 40 minutes permitting an 2.5- to 3.5-cm extension of the donor vein. The transplantations were performed in the usual mode and the vein enlargement enormously facilitated the implantation surgery. All recipients displayed immediate graft function; no complications were observed with this strategy.
Vein extension with the gonadal vein was a simple, safe method to enlarge the renal vein among right living donor kidneys procured using laparoscopy.
腹腔镜活体供肾肾切除术期间右肾静脉的血管处理仍是一个未解决的问题。这条短血管限制了右肾的使用。然而，在某些情况下仍应摘取右肾。基于开放供肾肾切除术的经验，我们单位在此种情况下利用供体性腺静脉获得更长的肾静脉。
连续4例有腹腔镜右肾切除术指征的活体亲属供者接受了该手术。3例供者为女性，总体平均年龄为48.5岁。用30毫米吻合器控制肾静脉，摘取时纳入同侧性腺静脉5 - 6厘米。供肾在低温条件下进行灌注并准备肾血管。3例将性腺静脉纵向切开，用6-0单丝缝线作为宽管缝合至供体右肾静脉，1例作为螺旋管缝合。
该手术使离体操作时间延长了25至40分钟，供体静脉延长了2.5至3.5厘米。移植按常规方式进行，静脉增粗极大地便利了植入手术。所有受者移植肾立即发挥功能；该策略未观察到并发症。
在腹腔镜获取的右活体供肾中，利用性腺静脉进行静脉延长是扩大肾静脉的一种简单、安全的方法。
