Surgical Aspects

The technique of cadaver organ retrieval is well established and standardized in all centers. The use of perfusion solutions with intracellular composition enables most kidneys to produce urine output very soon after release of vascular clamps in the recipients. Two aspects of live donor nephrectomy have made this operation more attractive and acceptable. Firstly, with regard to evaluation, spiral CT angiography has virtually replaced the conventional digital subtraction angiography to map the arterial pattern of the donor kidney. Cadavers presenting after sudden cardiac arrest are another source of expanding the donor pool and good results can be obtained by asystolic cadaver donors (non-heart beating) technique. It is essential to ensure a rapid and effective cooling of the kidneys once irretrievable cardiac arrest has been diagnosed. The cooling is done in the emergency or in the ward. Asystolic donors are declared dead by cardiac-arrest criteria. While the technique of vascular anastomosis is well standardized, careful placement of sutures, ensuring that an intimal flap is not lifted especially in diseased vessels, and the use of optical magnification helps in reducing the incidence of arterial thrombosis and ensuring a good outcome. With regard to the venous anastomosis, a wide anastomosis with a stretched open renal vein will reduce the risk of venous thrombosis. The advent of ultrasound has shown fluid collections around renal allografts in the region of about 10-50%.  Most lymphocoeles produce symptoms when they are more than 3 cm in size and when they contain more than 100 ml of fluid. The peak incidence is usually around 6 weeks following transplant but lymphocoeles have been reported as late as 8 years after transplant.

                         

  • Open living-donor nephrectomy
  • Mini-incision living-donor nephrectomy
  • Laparoscopic living-donor nephrectomy
  • Hand-assisted laparoscopic living-donor nephrectomy
  • Retroperitoneoscopic living-donor nephrectomy
  • Robot-assisted living-donor nephrectomy
  • Surgical techniques under development

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