title: Laparoscopic live donor nephrectomy in the presence of circumaortic or retroaortic left renal vein.
abstract: OBJECTIVE
  Laparoscopic live donor nephrectomy is now an accepted alternative to open surgery in donors with normal renal vasculature. However, the suitability of laparoscopy for donors with anomalous vasculature is less well known. We compared the donor and recipient outcome data of 16 patients with circumaortic or retroaortic left renal vein to 20 recent patients with normal left renal venous anatomy undergoing laparoscopic donor left nephrectomy.
  
  
  METHODS
  Of 170 patients undergoing laparoscopic donor nephrectomy at our institution from October 1997 to October 2002, 18 (10.6%) had either a circumaortic or retroaortic left renal vein (group 1). Demographic and perioperative parameters of these donors and their recipients were retrospectively compared to a contemporary cohort of 20 recent patients with a normal single left renal vein (group 2).
  
  
  RESULTS
  All laparoscopic procedures were completed successfully without open conversion. Groups 1 and 2 were similar in regard to operative time (199 vs 226 minutes, p = 0.90), blood loss (125 vs 100 cc, p = 0.45), warm ischemia time (3.4 vs 3.9 minutes, p = 0.14) and hospital stay (2.9 vs 3.2 days, p = 0.45). Length of allograft renal artery and vein was similar between groups. Cold ischemia and revascularization times were also comparable between groups. Recipient serum creatinine was comparable at 5 days (1.7 vs 1.6 mg/dl), 3 months (1.5 vs 1.4 mg/dl) and 1 year (1.5 vs 1.5 mg/dl).
  
  
  CONCLUSIONS
  Presence of a circumaortic or retroaortic renal vein is not a contraindication to laparoscopic live donor left nephrectomy. A left kidney with vasculature anatomically adequate for transplantation can be achieved with excellent donor and recipient outcomes.
authors.affiliation: Section of Laparascopic and Minimally Invasive Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Ohio 44195, USA.
authors.forename: Chia-Hsiang
authors.initials: CH
authors.lastname: Lin
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Steinberg
authors.forename: Anup P
authors.initials: AP
authors.lastname: Ramani
authors.forename: Sidney C
authors.initials: SC
authors.lastname: Abreu
authors.forename: Mihir M
authors.initials: MM
authors.lastname: Desai
authors.forename: Jihad
authors.initials: J
authors.lastname: Kaouk
authors.forename: David A
authors.initials: DA
authors.lastname: Goldfarb
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D010535:Laparoscopy; D019520:Living Donors; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D012082:Renal Veins / Q000002:abnormalities*