Category: Transplantation/ Donor Nephrectomy
Introduction & Objective : We aimed to present our experience and technique for laparoscopic kidney transplantation in which the allograft kidney was placed through the vagina.
40-year old woman with ESRD secondary to hypertension was admitted for left cadaveric kidney transplantation.İn low lithotomy position pneumoperitoneum was achieved from the Palmer’s point by Veress needle.12mm optical port just superior to umbilicus,12-mm right pararectal and one 5mm left pararectal port was placed.Following medialization of right colon,right external iliac artery(EİA) and vein(EIV) were freed from the surrounding tissues.Then the right side of the bladder was dissected and the bladder was filled with 100cc of saline and 2cm detrussorotomy on the right posterior aspect was performed and mucosa was opened with scissors and made ready for the ureteroneocystostomy(UNC).At this point gynecologist made a posterior colpotomy from the vagina that was visualized from the abdomen by the urologist in order to prevent excess lateralization to avoid injury to uterine vessels.The kidney was introduced into abdomen by the gynecologist in an 800cc endobag and the tip of the bag was caught by an endo-dissect clamp by the urologist and pulled into abdomen.Then the bag was cut and the kidney was released from the bag.Bag was pulled back by gynecologist and transvaginal closure of the posterior colpotomy was performed and vagina was packed with povidone-iodine soaked gauze.Then endo-bulldog clamps were placed on the right EİV and venotomy was performed.Allograft’s vein was anastomosed to right EIV in an end-to-side fashion by using 6-0 Gore-Tex sutures.After placing third endo-bulldog clamp on the renal vein,two clamps were released from the right EIV and replaced on the right EİA.After performing arteriotomy on the right EIA,allograft’s artery was anastomosed to right EIA with 6-0 Gore-Tex in end-to-side fashion.All clamps were released and the kidney was reperfused.Then Lich-Gregoir style UNC was carried out laparoscopically over double-J stent.Anastomose lines were rechecked and kidney was placed into retroperitoneal position by bringing lateral peritoneal leaves together by vicryl sutures.Then intraoperative Doppler USG confirmed both the arterial and venous blood flows.
Vein,arterial anastomosis and UNC duration was 37,18 and 15 minutes,surgical time and rewarming time was 145 and 70 minutes respectively.Estimated blood loss was 150cc.Allograft started to produce urine immediately.
Lack of abdominal incision in kidney transplantation seems to be advantageous for preventing incision related complications,however it requires top notch expertise.
Ender Ozden– Professor in Urology, Ondokuz Mayis University, School of Medicine, Department of Urology, Atakum, Samsun, Turkey
Yarkın Kamil Yakupoglu– Atakum, Samsun, Turkey
Suleyman Oner– atakum, Samsun, Turkey
Mehmet Ozen– Atakum, Samsun, Turkey
Murat Gulsen– Atakum, Samsun, Turkey
Handan Celik– Atakum, Samsun, Turkey
Melda Dilek– Atakum, Samsun, Turkey
Yakup Bostanci– Atakum, Samsun, Turkey
Professor in Urology
Ondokuz Mayis University, School of Medicine, Department of Urology
Atakum, Samsun, Turkey