Hand-assisted laparoscopic donor nephrectomy in patients with aberrant inferior vena caval anatomy.
OBJECTIVE
Hand-assisted laparoscopic donor nephrectomy has become an established technique for live-donor organ retrieval. In most cases, the left kidney is removed because of its more favorable anatomic relations, particularly with the major abdominal vessels.


METHODS
We present 2 cases of live donation in which a hand-assisted laparoscopic approach was used to remove the right kidney as indicated by the presence of aberrant vascular anatomy, 1 being situs inversus totalis, the other a left-sided inferior vena cava.


RESULTS
A 41-year-old woman and a 51-year-old man underwent assessment for live-kidney donation. During preoperative investigation, they underwent magnetic resonance imaging that demonstrated situs inversus totalis and a left-sided inferior vena cava. No contraindications to live donation were found during the investigation. In both cases, a right donor nephrectomy was performed owing to an anatomically longer right renal vein. Living donation proceeded without complication in both cases, and both patients had uneventful recoveries.


CONCLUSIONS
Abnormalities in vascular anatomy should not be considered an absolute contraindication to donation, even by the hand-assisted laparoscopic donor approach. The use of magnetic resonance scanning preoperatively allows detailed planning of the approach required.
van Dellen
David
D
Department of Renal Transplantation Surgery, University Hospital Birmingham NHS Trust, Birmingham, United Kingdom. davidvandellen@yahoo.com
Ready
Andrew R
AR
Inston
Nicholas G
NG
D000328:Adult; D005260:Female; D058733:Hand-Assisted Laparoscopy; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011300:Preoperative Care; D012857:Situs Inversus / Q000175:diagnosis*; D014682:Vena Cava, Inferior / Q000002:abnormalities*