Slide 1

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

Slide 2

Anatomy

Slide 3

Kidney Ureter Renal Artery/Vein Iliac Vessels Abdominal Aorta Anatomy

Slide 4

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

Slide 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

Slide 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

Slide 7

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

Slide 8

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

Slide 9

Laparoscopic Instruments Ultrasonic Dissector Ligasure Clip Applier Scissors Stapler

Slide 10

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

Slide 11

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

Slide 12

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

Slide 13

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

Slide 14

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

Slide 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

Slide 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