Hand Assisted Laparoscopic Donor
Nephrectomy
Ryan Lefevre
MIS Elective
UK College of Medicine
April 20th, 2011
Anatomy
Renal Artery/Vein
Anatomy
Kidney
Abdominal
Aorta
Ureter
Iliac Vessels
Surgery Goals
 Remove Healthy Kidney for Donation
 Ensure Safety of Donor Patient
 Minimize Scarring
 Minimize Recovery Time
Surgery Procedures
 Free Colon to Visualize Kidney
 Free Kidney
 Maintain Fat on Lower Pole of Kidney
 Dissect Ureter to Level of Iliac Vessels
 Remain Medial to GonadalVein
 Clip/Separate Ureter
 Staple/Separate Renal Artery/Vein
 Remove Kidney
Procedure Notes
 Possible Branches Off Renal Artery
 Dessuflate After Dissection to Allow Kidney to Rest
 Administer Mannitol to Ensure Urine Production
 ‘Warm Time’ Starts at Closure of Renal Artery
Port Placement
Hand Port
11mm
Camera
Port
12mm
Working
Port
Patient Position
“Flexed Table Right Down Partial Flank”
Surgeon
Surgeon
Top View
Side View
Laparoscopic Instruments
 Ultrasonic Dissector
 Ligasure
 Clip Applier
 Scissors
 Stapler
Laparoscopic Instruments
 Ultrasonic Dissector
 Ligasure
 Clip Applier
 Scissors
 Stapler
ethiconendosurgery.com
Laparoscopic Instruments
 Ultrasonic Dissector
 Ligasure
 Clip Applier
 Scissors
 Stapler
ligasure.com
Laparoscopic Instruments
 Ultrasonic Dissector
 Ligasure
 Clip Applier
 Scissors
 Stapler
covidien.com
Laparoscopic Instruments
 Ultrasonic Dissector
 Ligasure
 Clip Applier
 Scissors
 Stapler
covidien.com
Laparoscopic Instruments
 Ultrasonic Dissector
 Ligasure
 Clip Applier
 Scissors
 Stapler
covidien.com
Final Thoughts
 Work Quickly but Efficiently
 Especially After Start of ‘Warm Time’
 Ensure Donor Patient Safety
 Laparoscopy Can Provide a Viable Method for Donor
Nephrectomy
References
 Dr. Strup NTC #71, University of Kentucky
 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2855464/
 http://www.websurg.com/ref/doi-ot02en261.htm
 http://www.ncbi.nlm.nih.gov/pubmed/15735385