Technique, Indications and Outcomes of Pure Laparoscopic Right Donor Nephrectomy

Abstract

Our method of laparoscopic right donor nephrectomy yields excellent graft quality with adequate vascular length and without the need for elaborate modifications or hand assistance. Moreover, the right operation is technically easier and it achieved comparable donor morbidity and recipient renal function. With sufficient experience the right kidney should be procured laparoscopically when indicated.

Laparoscopic Living Kidney Donation

“…[13] One RCT, one prospective and some retrospective studies concluded that right sided-donor nephrectomy is also justified, and in some studies indicate the superiority of the right side. [14][15][16][17][18][19][20][21] In theory a shorter renal vein may lead to a more difficult anastomosis, but no studies so far confirmed this concept. Another issue is the use of kidneys with multiple arteries.…”

Hand-assisted right laparoscopic nephrectomy in living donor

“…After 300 pure laparoscopic nephrectomies with 44 performed on the right side, Abrahams et al (1), stated that the right laparoscopic nephrectomy is safe for the donor, effective for the recipient and allows immediate and excellent functioning of the graft, in addition to the fact that there was no case of venous thrombosis. Also, they state that the liver position is not a drawback for performing the right laparoscopic nephrectomy, since the superior trocar allows a proper liver displacement and dissection of the renal pedicle.…”

“…Laparoscopic nephrectomy has become routine for nephrectomy in a living donor, however the experience with techniques applied to the right kidney is quite limited (1).…”

Avaliação do comprimento das veias renais em cadáver e perda da sua extensão com três diferentes tipos de ligadura e secção

“…A idéia de nefrectomia laparoscópica de doador vivo (NLDV) foi originalmente descrita por Gill et al (14,17,18) em modelos porcinos e, em 1995, Ratner et al (1,4,6,8,12,13,14,23,25) realizaram a primeira NLDV (4,19,20,21,22,23,24) e, desde seu início, este acesso cirúrgico vem ganhando maior número de adeptos (1,4,6,8,12,14,23,25) , o mesmo ocorrendo na Divisão de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, com cerca de 200 pacientes assim tratados (26) .…”

“…Apesar de muitos autores realizarem a nefrectomia laparoscópica direita (NLD) para TR, a mesma continua sendo pouco utilizada e considerada um desafio na maioria dos serviços, pelos riscos impostos pela menor extensão da VRD, como acima mencionados (2,17,19,30) , além de alguns aspectos não consensuais, como, por exemplo, sobre qual dos clampeamentos utilizados proporciona menor perda de extensão da VRD. …”