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

2. Anatomy

3. Kidney Ureter Renal Artery/Vein Iliac Vessels Abdominal Aorta Anatomy

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

5. 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

6. 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

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

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

9. Laparoscopic Instruments Ultrasonic Dissector Ligasure Clip Applier Scissors Stapler

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

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

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

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

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

15. 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

16. References Dr. Strup NTC #71, University of Kentucky http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2855464/ http://www.websurg.com/ref/doi-ot02en261.htm http://www.ncbi.nlm.nih.gov/pubmed/15735385