Ryan Lefevre MIS Elective UK College of Medicine April 20 th, 2011 Hand Assisted Laparoscopic Donor Nephrectomy.

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Presentation transcript:

Ryan Lefevre MIS Elective UK College of Medicine April 20 th, 2011 Hand Assisted Laparoscopic Donor Nephrectomy

Anatomy

Kidney Ureter Renal Artery/Vein Iliac Vessels Abdominal Aorta Anatomy

Surgery Goals Remove Healthy Kidney for Donation Ensure Safety of Donor Patient Minimize Scarring Minimize Recovery Time

Surgery Procedures Free Colon to Visualize Kidney Free Kidney Maintain Fat on Lower Pole of Kidney Dissect Ureter to Level of Iliac Vessels Remain Medial to Gonadal Vein Clip/Separate Ureter Staple/Separate Renal Artery/Vein Remove Kidney

Procedure Notes Possible Branches Off Renal Artery Dessuflate After Dissection to Allow Kidney to Rest Administer Mannitol to Ensure Urine Production ‘Warm Time’ Starts at Closure of Renal Artery

Port Placement 11mm Camera Port 12mm Working Port Hand Port

Patient Position “Flexed Table Right Down Partial Flank” Top ViewSide View Surgeon

Laparoscopic Instruments Ultrasonic Dissector Ligasure Clip Applier Scissors Stapler

Laparoscopic Instruments Ultrasonic Dissector Ligasure Clip Applier Scissors Stapler ethiconendosurgery.com

Laparoscopic Instruments Ultrasonic Dissector Ligasure Clip Applier Scissors Stapler ligasure.com

Laparoscopic Instruments Ultrasonic Dissector Ligasure Clip Applier Scissors Stapler covidien.com

Laparoscopic Instruments Ultrasonic Dissector Ligasure Clip Applier Scissors Stapler covidien.com

Laparoscopic Instruments Ultrasonic Dissector Ligasure Clip Applier Scissors Stapler covidien.com

Final Thoughts Work Quickly but Efficiently Especially After Start of ‘Warm Time’ Ensure Donor Patient Safety Laparoscopy Can Provide a Viable Method for Donor Nephrectomy

References Dr. Strup NTC #71, University of Kentucky