Department of Surgery, Japan Community Health Care Organization Sendai Hospital, Sendai, Miyagi, Japan.
Department of Surgery, Japan Community Health Care Organization Sendai Hospital, Sendai, Miyagi, Japan.
Transplant Proc. 2021 May;53(4):1257-1261. doi: 10.1016/j.transproceed.2021.03.015. Epub 2021 Apr 21.
In living-donor kidney transplantation, laparoscopic nephrectomy from a donor has become widespread. However, more careful treatment is required for nephrectomy from a donor with horseshoe kidney. This report presents an interesting surgical case of laparoscopic nephrectomy from a donor with horseshoe kidney.
A woman aged 53 years was a donor candidate for living-donor kidney transplantation for her husband. She had no medical history and had no problems on preoperative examination, but contrast-enhanced computed tomography revealed that she had horseshoe kidney. As the isthmus was thin and the contrast effect was poor, the isthmus was considered to have poor kidney parenchyma and consisted almost exclusively of fibrous tissue. Therefore, laparoscopic nephrectomy was performed for the donor. On the basis of the 99m Tc-dimercaptosuccinic acid renal scintigraphy results, the right kidney was collected. A laparoscopic nephrectomy with a retroperitoneal approach was performed using GelPort access platforms in a right abdominal incision with an accessory port. We firmly expanded the isthmus and then dissected it just above the aorta using a linear stapling device. Subsequently, we sutured a renal artery and vein with linear stapling devices. The recipient's surgery was also performed without any problems, and the postoperative course of both donor and recipient was good.
We suggest that even if the donor has horseshoe kidney, laparoscopic donor nephrectomy should be actively considered depending on the thickness of the isthmus of the horseshoe kidney.
在活体供肾移植中，腹腔镜下供体肾切除术已经得到广泛应用。然而，对于马蹄肾供体的肾切除术需要更加小心的处理。本报告介绍了一例腹腔镜下马蹄肾供体肾切除术的有趣病例。
一名 53 岁女性，作为活体供肾移植的供者候选者，为其丈夫供肾。她没有既往病史，术前检查也没有问题，但增强 CT 显示她患有马蹄肾。由于峡部较薄，对比效果不佳，峡部被认为肾实质较差，几乎完全由纤维组织组成。因此，对供体进行了腹腔镜肾切除术。根据 99mTc-二巯丁二酸肾闪烁显像结果，采集了右侧肾脏。在右侧腹部切口和辅助端口处，使用 GelPort 接入平台进行了经腹膜后入路的腹腔镜肾切除术。我们牢固地扩张了峡部，然后使用线性吻合器在主动脉上方进行解剖。随后，我们使用线性吻合器缝合了肾动脉和静脉。受者的手术也没有任何问题，供者和受者的术后过程都很好。
我们建议，即使供体有马蹄肾，也要根据马蹄肾峡部的厚度积极考虑腹腔镜供体肾切除术。
