Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL.
JSLS. 2021 Apr-Jun;25(2). doi: 10.4293/JSLS.2021.00018.
BACKGROUND/OBJECTIVES: Laparoscopic living donor nephrectomy (LLDN) of the right kidney is currently considered as part of standard of care; however, dealing with the renal hilum when performing ligation/division of its renal vessels is still a main concern. Here, we describe a simple-to-perform technique, i.e., flipping the fully mobilized right kidney to the midline so that the renal artery becomes anteriorly, which offers better visualization and easier dissection of the renal vessels (achieving maximized lengths) when performing hand-assisted LLDN of the right kidney.
Living donors who underwent hand-assisted LLDN of the right kidney, along with their respective renal transplant recipients, were included in this report. Donor characteristics included renal artery and vein lengths; recipient characteristics included creatinine at months 12 - 36. Graft vein and arterial anastomosis data were also reported.
Nineteen living donors and 19 recipients, with median donor and recipient ages being 39 (24 - 60) and 53 (3 - 81) years, respectively, were included. None of the 38 patients had intra- or postoperative complications. Donor renal vein was anastomosed to the right external iliac vein (n = 16), right common iliac vein (n = 2), and inferior vena cava (n = 1). Gonadal vein (n = 1) and deceased donor iliac vein (n = 2) were used to increase the right renal vein length in 3 cases. Four donor kidneys had 2 arteries reconstructed side by side. None of the recipients developed any vascular or urological complications.
The laparoscopic technique described is safe and allows better visualization of the right hilum, mainly the renal artery, and helps in stapling the renal vein and renal artery.
背景/目的：腹腔镜右供体肾切除术（LLDN）目前被认为是标准治疗方法的一部分；然而，在结扎/分离其肾血管时处理肾门仍然是主要关注点。在这里，我们描述了一种简单易行的技术，即将完全游离的右肾翻转到中线，使肾动脉向前，在手助式 LLDN 右肾时提供更好的可视化效果和更容易分离肾血管（实现最大长度）。
本报告纳入了接受手助式 LLDN 右肾的活体供者及其各自的肾移植受者。供者特征包括肾动脉和静脉长度；受者特征包括术后 12-36 个月的肌酐。还报告了移植物静脉和动脉吻合的数据。
19 名供者和 19 名受者纳入本研究，供者和受者的中位年龄分别为 39（24-60）岁和 53（3-81）岁。38 例患者均无术中或术后并发症。供肾静脉吻合于右髂外静脉（n=16）、右髂总静脉（n=2）和下腔静脉（n=1）。3 例使用生殖静脉（n=1）和已故供者髂静脉（n=2）增加右肾静脉长度。4 个供肾有 2 个动脉并排重建。受者均未发生任何血管或尿外科并发症。
所描述的腹腔镜技术安全，可更好地观察右肾门，主要是肾动脉，并有助于吻合肾静脉和肾动脉。
