Live Donor Nephrectomy

Most of the kidneys for transplantation, across the world, come from living donors. A potential kidney donor must volunteer to donate and be in excellent health without risk factors for end-stage renal disease.1 If the donor is immunologically suitable, studies like magnetic resonance angiography (MRA) are done to evaluate the vascular anatomy. Selection of the side of the donated organ depends on the imaging findings. The left kidney is selected when the donor has a bilateral single vessel or bilateral multiple vessels. The operation is performed under general anaesthesia. A Foley catheter is inserted and prophylactic antibiotics are given. The patient is placed in the right/left lateral position on the operating table. The kidney rest is elevated, and the table is flexed to maximise exposure to flank. The kidney is approached through a mini anteriolateral flank incision (7 ± 2 cm in length) located at the last intercostals space, without resection of the rib. Using the Omni-tract retractor, an adequate operative field is created within the retroperitoneal space. This enables sufficient handling of the kidney. For the stapling and the division of the vessels and the ureter, the ETS-FLEX endoscopic linear vascular cutter or ELVC (ETHICON ENDO-SURGERY, INC, USA) is used.2 When positioned on a vessel the ELVC applies three staple lines proximally and three distally, and the vessel between them is divided. The distal end of the ELVC, which has the staples, can be rotated to fit perfectly on a vessel regardless of the angle. Before or after dissecting the vessels, the ureter is stapled and divided. The ELVC is applied initially to the main renal artery and, subsequently, to smaller arteries, if present. It is then applied to the main renal vein followed by smaller renal veins, if present. In our experience, this is the most efficient way of haemostasis. The previous method, involving hand sewn closure of the vascular stumps, was risky and time consuming. With the use of the stapler, perfect haemostasis is achieved. There is no bleeding whatsoever. Prior to clamping the vessels, 5000 IU Heparine is given bolus IV followed by a reversal with 50 mg of protamine following the removal of the kidney. The kidney is flushed after the removal of staple lines. At our centre, senior author has been using the vascular cutter for the past five years, and it has given excellent results with no postoperative haemorrhagic complications.

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