Right-sided terminal hand assisted laparoscopic donor nephrectomy. T0he Halle experience (2. Filmpreis 2013)
K. Weigand*1, G. Pini*1, L. Ascalone*1, T. Schaarschmidt*1, F. Kawan*1, A. Schumann*1, F. Greco*1, P. Fornara*1
1Universitätsklinik und Poliklinik für Urologie und Nierentransplantationszentrum, Halle / Saale, Germany
Introduction: The left kidney has been the preferred organ of choice in laparoscopic living donor nephrectomy due to thegreater vessel lengths.We describe the right side-terminal HALDN technique that allowed the exposure of the aortorenal junction providing maximallength of the vessel.In a prospective study we compared 51-right and 40-left sided HALDN during a 7-year period with a 1-year follow-up.
Material and methods: With the donor on the left flank we perform a 5-port transperitoneal approach. Ureter, gonadal vesselsrenal hilum are exposed and subsequently vena cava and aorta isolated. Afterward, it follows the complete dissection of thekidney until it is only fixed by the hilar vessels. The surgeon´s left hand is placed intra-abdominally via a lower-pararectalincision. After ureter section, the cava is digitally pushed aside with identification of right artery down to its aortic origin. Therenal vein is held between two fingers (index-thumb) and closed by a triple-row Endo-TA stapler. The same procedure followsfor the artery.
Results: The median operationtime, warm ischemia time and blood loss was (left vs right) 123 vs135 min, 44 vs 41 sec, 92 vs101 mL. No conversions. Discharge was 3.4 days. Delayed graft function occurred in 1 recipient for both side. After 1-yearfollow-up no significant difference in creatinine between the groups was noticed;graft survival rate was 97.5% vs 98.1%.
Discussion: Terminal-HALDN is safe and feasible. Dissection first of right renal vein allows a retrocaval isolation of the artery,obtaining significative longer vessel. Terminal-hand-assistance allows laparoscopy obtaining best vessels independently to sideof kidney.