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Laparoscopic Donor Nephrectomy: A Step-by-Step Guide

The Evolution of Laparoscopic Donor Nephrectomy: Has It Now Become the Gold Standard?IntroductionWhat Comprises a "Gold Standard" in Medicine?History of Donor Nephrectomy for Renal TransplantationKidney Transplant Waiting Lists and the Push to Increase Organ DonationLaparoscopic Donor Nephrectomy Is Being Performed in the Vast Majority of CasesHas the Laparoscopic Technique Led to an Increase in the Number of Donors?What Are the Differences in Postoperative Graft Function Between LDN and ODN?Are There Potential Added Risks/Drawbacks of LDN for Donors?What Are the Contraindications to LDN?How Has LDN Evolved Since Its Inception in the 1990s?Hand-Assisted LDN Versus Pure LDN Versus ODN?Robotic LDN Versus Pure LDN?What Is the Evidence that LDN Can Now Be Considered the "Gold Standard" for Live Kidney Donation?Cost of LDN Versus ODNConclusionReferencesPreoperative General and Urologic Evaluation for Laparoscopic Donor NephrectomyIntroductionMedical Evaluation ProcessContraindicationsRadiologic EvaluationSpecific Medical EvaluationsAgeObesityHypertensionPsychosocial IssuesSpecific Urologic EvaluationsChoice of KidneyMultiple ArteriesConclusionsReferencesPsychosocial and Legal Issues with Laparoscopic Donor NephrectomyIntroductionPsychosocial IssuesAnxietyMental Health Checklist and Ability to Donate Out of Free WillSearch for the Kidney DonorDecision to DonateMotivational StatusAmbivalenceFamily Dynamics and RelationshipsBody ImageMarriage and Kidney DonationImpact on Employment, FinancesSpecial Issues Like ChildbearingFollow-UpLegal IssuesInformed Consent ProcessThe Human Organ Transplantation Act, 1994 (THOA-94)SummaryReferencesAnaesthesia Concerns for Laparoscopic Donor NephrectomyIntroductionPreoperative Assessment of Live-Related Kidney DonorIntraoperative effects of laparoscopic donor nephrectomyPhysiological Effects Due to CO2 PneumoperitoneumPatient PositioningAnaesthesia ManagementPreoperative Anaesthetic PreparationIntraoperative ManagementSpecial Consideration for Laparoscopic Donor NephrectomyPostoperative ManagementPostoperative AnalgesiaReferencesLaparoscopic Left Donor Nephrectomy (Transperitoneal Approach)IntroductionThe Armamentarium (Figure 5.1-Instruments Trolley)Procedure- Step by StepPatient Positioning (Fig. 5.2)Preplaced Incision (Fig. 5.3)Operating Room Setup (Fig. 5.4)Port Placement (Fig. 5.5)The Bowel Reflection (Figs. 5.6a and b)Uretero: Gonadal Packet (Fig. 5.7)Separation of the Fibrofatty Tissue up to the Renal HilumExposing the Renal and the Adrenal Vein (Fig. 5.8)Adrenal Gland DissectionLumbar Vein Dissection (Fig. 5.9)Dissecting the Upper Border of Renal Vein (Fig. 5.10)Renal Arterial Dissection (Fig. 5.11)Renal Vein Dissection (Fig. 5.11)Retrieval IncisionThe Retrieval (Fig. 5.12)Hem-o-lok ClipCheck LaparoscopyLaparoscopic Right Donor Nephrectomy (Transperitoneal Approach)IntroductionStep-by-Step ApproachPreoperative Preparation and EvaluationPositioning Patient and Room SetupThe Armamentarium (Fig. 6.2)Port Placements (Fig. 6.3)Exposure (Figs. 6.4 and 6.5)Medialization of the Colon and Duodenum (Figs. 6.6 and 6.7)Dissection of the IVCDissection of the Ureter (Fig. 6.9a, b)Dissection of the Adrenal Gland (Fig. 6.11a, b)Dissection of Hilar Vessels (Fig. 6.12)Retrieval of the KidneyReferencesHilar Control in Laparoscopic Donor Nephrectomy: Clips, Staplers and Other MethodsIntroductionTechnique and Difficulties with Hilar Control and Techniques to Increase Renal Vein Length in Laparoscopic Donor Nephrectomy (LLDN)Available Options for Hilar ControlClipsStaplersOther Alternatives for Hilar ControlConclusionsReferencesRetroperitoneoscopic Donor NephrectomyIntroductionModifications for Right-Sided RDNTroubleshootingDiscussionReferencesLaparoendoscopic Single-Site Surgery Donor Nephrectomy (LESS DN)What Is LESS DN?TerminologyProblems with LESS Donor NephrectomyExtracorporeal ChallengesClashing of Surgeon's Own HandsClashing of Surgeon's Hands with Cameraman's HandsDamage to Accessory EquipmentIntracorporeal ChallengesLack of TriangulationLack of Assistant Retraction PortsSolutions to the ProblemsSwitching of PortsUse Instruments of Differing LengthsCameraman Sits DownUse of Thinner LaparoscopeUse of Longer LaparoscopeUse of Laparoscope with Coaxial Light and Optic CableCameraman's Hands Kept Away Down UnderUse of Articulating InstrumentationUse of Prebent InstrumentsUse of Deflectable Tip LaparoscopeTechnique of Disentangling LaparoscopeUse of an Additional Retraction InstrumentAccess Devices for LESS DNOur TechniqueColonic ReflectionUretero-gonadal Packet MobilizationAdrenal Vein DivisionUpper Pole SeparationLumbar Vein DivisionRenal Pedicle DissectionDivision of the Gonadal Vein and UreterDivision of the Renal PedicleGraft RetrievalScientific EvidenceWhy LESS DN?ReferencesRobotic Donor NephrectomyIntroductionOperating Room Setup and InstrumentationOperative Room SetupPatient PositioningRight RDNLeft RDNReview of LiteratureReferencesExtraction Incisions for Laparoscopic Donor NephrectomyIntroductionTypes of Extraction Incisions (Fig. 11.1)Pfannenstiel Incision (Fig. 11.2)Midline Periumbilical IncisionIliac Fossa IncisionTransvaginal ExtractionExtraction Incision for Single Site SurgeriesComparison Between Different IncisionsRisk Reduction Strategies for Safe ExtractionConclusionReferencesTroubleshooting in Laparoscopic Donor NephrectomyIntroductionPresurgery FactorsObesityPrevious Abdominal SurgeryCigarette UseAgeHigh Blood PressureGlucose IntolerancePregnancyMultiple VasculatureAnatomic EvaluationPeri-Surgery FactorsLaparoscopic ComplicationsComplications of AccessVascular ComplicationsStapler Failure ComplicationsDigestive System ComplicationsUrinary System ComplicationsSolid-Organ ComplicationsAbdominal Wall ComplicationsRespiratory ComplicationsPostoperative FactorsReferencesOpen Donor Nephrectomy in the Era of Laparoscopic Donor NephrectomyIntroductionOpen Donor NephrectomyDonor Selection and PreparationInstrument Trolley (Fig. 13.1)Patient Positioning [3] (Figs. 13.2 and 13.3)Surgical Steps PrinciplesOn the Left SideOn the Right Side (Fig. 13.12)Pros of Standard Open Donor Nephrectomy [4]Cons of Standard Open Donor Nephrectomy [4]Minimally Invasive Open Surgical Nephrectomy (Fig. 13.14)Principle [5]Surgical instruments and trolley [5]Patient PositioningIncisionDissectionRetrieval (Fig. 13.16)ClosurePros for MininephrectomyCons for MininephrectomyIntraperitoneal Open Donor NephrectomyInstrumentation Required Remains the SameSurgical StepsHow Does Open Donor Nephrectomy Compare with Laparoscopic Donor Nephrectomy?Operative TimeWarm IschemiaHospital Stay and Analgesic RequirementGraft FunctionComplicationsReferences
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