Unexpected surgical difficulties leading to hemorrhage and gas embolus during laparoscopic donor nephrectomy: a case report

Abstract

P Pu ur rp po os se e: : To report the case of a laparoscopic donor nephrectomy in which the preoperative evaluation of the patient gave no indication of the surgical difficulties that were encountered intraoperatively, resulting in substantial bleeding, a suspected gas embolism, and emergency conversion of the procedure from laparoscopic to open donor nephrectomy.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 59-yr-old man -height: 175 cm, weight: 85.5 kg, American Society of Anesthesiologists physical status I -presented as kidney donor for laparoscopic donor nephrectomy. He was healthy, on no medication, and had no previous abdominal surgery or diseases of the urinary tract. The preoperative computed tomography (CT) scan evaluation of his kidneys confirmed this by reporting a normal bilateral renal and renal vascular anatomy. In contradiction to the preoperative CT scan findings, the surgeon discovered abnormalities in the operative field. This included extensive scarring surrounding the left kidney, adenopathy near the right hilum, and a large branch lumbar vein entering the renal vein. The large branch lumbar vein was clipped but the clips dislodged, causing significant blood loss, and a suspected gas embolus. The procedure was converted to an emergency open donor nephrectomy. Postoperatively the patient made a full recovery.

Laparoscopic hepatic left lateral lobectomy combined with fi ber choledochoscopic exploration of the common bile duct and traditional open operation

“…In traditional open common bile duct exploration, T-pieces are used for bile drainage and treatment of possible remnant gallstones [19] . However, it also brings about heavy mental burdens to the patients, such as prolonged hospitalization time, electrolytical and digestive unbalance caused by bile drainage and local infection of the abdominal wall near the T-piece [20][21][22] . In our study, laparoscopic hepatic left lateral lobectomy combined with fiber choledochoscopic exploration of the common bile duct was performed in 10 patients with gallstones in the left lobe of liver and in the common bile duct.…”

Control of the Renal Artery and Vein with the Nonabsorbable Polymer Ligating Clip in Hand-Assisted Laparoscopic Donor Nephrectomy

“…Multiple clinical cases of titanium clip dislodgment have been reported and have resulted in significant complications including gas embolus and hemorrhage (10)(11)(12)(13). Titanium clips are not able to reliably secure the renal vein (14).…”

Current concepts in transplant surgery: laparoscopic living donor of the kidney

“…From the underlying descriptions of the closure of the vessels, it can be argued that hemorrhage was more often associated with LDN. Furthermore, donor deaths because of gas embolism and hemorrhage are described [27,28]. However, in general, safety in very experienced hands seems to be equal or even better after LDN, and the rate of incision-related complications is less when compared with ODN.…”