Laparoscopic left nephrectomy for living donor kidney transplant

Objective: To present our personal technique for laparoscopic left nephrectomy for living donor transplant. Design, Setting, and Patient: The surgical technique is described in detail both in the text and in a commented video. The preoperative workup includes routine blood tests, chest radiography, electrocardiography, and high-definition abdominal computed tomographic angiography with 3-dimensional reconstruction to study the vascularization of the kidney. The patient is placed in right lateral decubitus, and 4 trocars are used. Intervention: The left colon is fully mobilized, the gonadic vessels and left ureter are identified, and the hilar vessels are dissected up to the origin on the renal artery from the aorta; the kidney is then mobilized. A 5- to 7-cm sovrapubic incision is made without entering the peritoneum, and a 15-mm laparoscopic bag is introduced through a small incision. The ureter and gonadic vessels are divided between clips and the main vessels are divided using an endoscopic stapler with a vascular cartridge. The kidney is quickly inserted in the endobag and removed through the sovrapubic incision. Results: The patients are allowed to drink the same day of the procedure, mobilized after 12 hours, and discharged on postoperative day 4 if no complications are recorded. Conclusion: Laparoscopic left nephrectomy for living donor transplant can be safely performed with good results and an excellent postoperative course for the donor.