Right laparoscopic donor nephrectomy and the use of inverted kidney transplantation: an alternative technique

Abstract

OBJECTIVES To report a novel approach to overcome the problems associated with a short right renal vein harvested by clipping the vein during right laparoscopic donor nephrectomy (RLDN). PATIENTS AND METHODS This prospective study included 32 donors and their recipients; all donors had transperitoneal RLDN. The right renal artery and vein were ligated by Hem‐o‐lok and titanium clips, which resulted in a very short renal vein (<1.5 cm). When the kidney was positioned inverted in the recipient, the renal vein was placed posteriorly, adjacent to the external iliac vein, making a safe and simple venous anastomosis possible. RESULTS All RLDN were completed with no conversion or re‐operation. The mean (range) warm ischaemia time was 9.59 (3–17) min and there was no malfunction of the vascular clips on the major vessels. After a mean follow‐up of 14 months the recipient survival rate was 97%. Graft function was excellent, with a mean (sd) serum creatinine level of 1.35 (0.31) mg/dL at 3 months after surgery, and there was no renal artery or vein thrombosis in any of the grafts. There were two ureteric complications (6%), i.e. one ureterocutaneous fistula resolved by secondary ureteroureterostomy, and one stricture at the site of ureteric anastomosis, which was managed by ureteroneocystostomy. CONCLUSION The right renal vein obtained by LDN, after clipping the renal vein, is quite short, but by placing the kidney upside‐down in the right iliac fossa transplantation is possible with no increased incidence of vascular thrombosis. This simple modification might obviate the need for removing a patch from the inferior vena cava, which is a challenging procedure for laparoscopic surgeons during RLDN.

Outpatient percutaneous nephrolithotomy in a renal transplant patient: World’s first case

“…In the literature, renal transplant inversion is often intentional but can also be unintentional, [19][20] and in this case it was most likely unintentional. It is unknown if renal transplant inversion causes urinary stasis and kidney stones.…”

“Inverted” positioning of renal allograft during kidney transplantation in children and adolescents: A single‐institution comparative analysis

“…The right iliac fossa is often preferred in renal transplantation because the ipsilateral iliac vein is easier to access than the left, which is located deeper in the pelvic cavity . Placement on the right side also avoids issues related to dissection of the sigmoid colon, which, in contrast to the cecum, can be less mobile due to its continuity with the descending colon and rectum.…”

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“…Simforoosh and associates 11 have reported that the right renal vein obtained by right laparoscopic donor nephrectomy when using simple clipping of the renal vein is short, but by placing the kidney inverted in the right iliac fossa, transplant is possible, with no increased incidence of vascular thrombosis or graft malfunction. Additionally, using several materials to remodel the transplant renal vein and extend its length is effective.…”