LB-P-086
VENOUS DISPOSITION PROCEDURE (VDP) OF THE RIGHT RENAL VEIN AFTER LAPAROSCOPIC DONOR NEPHRECTOMY
- A SIMPLE PROCEDURE
Sinh Ngoc Tran1 and Thu Thi Ngoc Du1
Department of Urology, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
Introduction
Results
The renal vein of the right kidney (RRV) removed from the living donor is usually
short. Moreovssaryer, in the surgical endoscopic era, the RRV is invariably shorter
than that achieved by open nephrectomy. Some authors authors describe use of a
saphenous vein graft or genital vein. Others prefer use of the left kidney
irrespective of the number of arteries requiring anastomosis. We describe a simple
technique involving mobilisation of the right iliac vein (RIV) and prolongation of the
RRV. We call it the VDP.
From 1998 to 2010, 60 patients received a right living donor kidney. Mean age
33.15±9.17 years. 43 were male and 17 female. All RRVs were of sufficient
length for transplantation with the VDP technique and all were transplanted into
the RIF of the recipients. In all cases, the renal artery was anastomosed end-toend to the internal iliac artery, and, an extravesical ureroneocystostomy was
performed using ureteric stent. All kidneys achieved normal function without acute
vascular complication. There were no detected long term vascular complications
such as thrombosis or stenosis or need for trasplant ureter intervention. The
average following up time was 49+/-34 months (range 3 to 144).
Methods
This is a prospective case study of living donor kidney transplant procedures at
Cho Ray Hospital, Vietnam, from 1998 to 2010. The transplant recipients were all
immediate family members with at least a one haplotype match with the donor.
When necessary, the right kidney was removed by retroperitoneal laparoscopic
nephrectomy. Exclusion criteria were RRV < 0.5cm and previous surgery in the
right iliac fossa (RIF). The VDP involved 2 steps: (1) Kidney perfusion with Euro
Collins solution, ex-situ dissection of the hilum and prolong the RRV and
disposition of RRV (Fig. 1)
Figure1: Dissection of renal hilum, prolongation and disposition of RRV “ex-situ”
Figure 4: The presentation a case of short RRV with VDP
Conclusions
(2) After Gibson incision on the RIF of recipient, the right iliac vein is fully
mobilised and moved lateral to the external iliac artery. After this disposition, the
RIV is nearer to RRV. A comparatively easy end to side anastomosis of RRV to
the iliac vein is then performed (Fig. 2).
The described technique facilitates the use of the right living donor kidney. It is
based on the rearrangement of the normal surgical anatomy of the right iliac
vessels and the kidney hilum. After prolongation of the RRV by hilar disection and
complete mobilisation of the iliac vein the right kidney is subsequently easier to
transplant in the RIF than the left side. This reproducible technique was not
associated with related vascular or ureteric complications.
References
Figure 2: Dissection and disposition of RRV, then vascular anastomosis
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Presented at the 15th Congress of the European Society for Organ Transplantation, 4-7 September 2011, Glasgow, Scotland