Hand-assisted laparoscopic right donor nephrectomy: A case in a patient with a history of ureterolithotomy

Purpose:In living-donor nephrectomy, left-sided nephrectomy is generally preferred over right-sided nephrectomy for anatomical and technical reasons.We report a successful case of hand-assisted laparoscopic right-donor nephrectomy in a donor with a history of open ureterolithotomy for a right ureteral stone.Surgical Methods: The donor was a 51-year-old male with a history of open right ureterolithotomy performed 30 years earlier for a ureteral stone.Differential renal function on technetium-99m diethylene triamine pentaacetic acid renal scan showed no significant discrepancy between the two kidneys.Preoperative computed tomography revealed one artery with early branching and one vein on the left kidney and one artery with two veins on the right kidney.Considering possible adhesions from the previous surgery, a periumbilical incision including the umbilicus was created for the hand port, and the procedure was performed using a standard transperitoneal hand-assisted laparoscopic approach.Results: Dense intra-abdominal adhesions were found around the lower-to-mid ureter near the previous incision site.The total operative time was 230 minutes, warm ischemic time was 150 seconds, and estimated blood loss was 50 mL.The kidney graft weighed 152 g.The donor was discharged on postoperative day 5 without any complications.Conclusions: As donor safety is paramount in transplantation surgery, hand-assisted laparoscopic donor nephrectomy offers excellent intraoperative control in unexpected situations and can be performed safely even in the presence of intra-abdominal adhesions.