Laparoscopic live donor right nephrectomy: a new technique with preservation of vascular length.
OBJECTIVE
We report our initial experience with right laparoscopic live donor nephrectomy using a modified vascular clamp for achieving maximal length of the renal vein.


METHODS
Since 1999, 34 patients have undergone laparoscopic live donor nephrectomy at Charité Hospital in Berlin, including 30 on the left and 4 on the right side. The right technique involves a 4-port transperitoneal laparoscopic approach with a muscle splitting lumbar incision for kidney extraction. To duplicate completely the comparable open operation a modified Satinsky atraumatic vascular clamp (Aesculap, Inc., Center Valley, Pennsylvania) was introduced through a 1 cm. lateral incision and placed across the vena cava, enabling harvest of the full length of the renal vein flush with the vena cava. The vena cavotomy is closed with a running suture placed in intracorporeal fashion.


RESULTS
All procedures were successfully accomplished without technical or surgical complications. Mean operative time was 170 minutes. Mean renal warm ischemia time from endoscopic cross clamping of the renal vessels to cold perfusion on the bench was 2.1 minutes. In all 4 kidneys it was possible to harvest the whole length of the renal vein, so that the recipient operation was performed under optimal vascular conditions. All 4 kidneys were transplanted successfully in the recipients and showed immediate function.


CONCLUSIONS
Right laparoscopic live donor nephrectomy is technically feasible, safe and a viable option for minimally invasive organ donation when left kidney donation is not desired. The Satinsky atraumatic vascular clamp enabled harvest of the whole right renal vein. We believe that this laparoscopic technique effectively duplicates the open operation with less morbidity.
Turk
Ingolf A
IA
Department of Urology, Charité Hospital, Medical School of the Humboldt University, Berlin, Germany.
Deger
Serdar
S
Davis
John W
JW
Giesing
Markus
M
Fabrizio
Michael D
MD
Schönberger
Bernd
B
Jordan
Gerald H
GH
Loening
Stefan A
SA
D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012082:Renal Veins; D013536:Suture Techniques