Tuesday September 15, 2020 - 23:30 to 00:15
When length becomes less: Minimum renal artery length required in left laparoscopic live donor nephrectomy
Anant Kumar1, Devanshu Bansal1, Amit Bansal1, Vikas Singh1, Pragnesh Desai1, Samit Chaturvedi1, Ruchir Maheshwari1.
1Urology, Uro-oncology, Robotics and Renal Transplantation, Max Healthcare, New Delhi, India
Introduction: During Laparoscopic donor nephrectomy if the main artery is short then it may get converted into multiple arteries, increasing the technical challenge of implantation. We evaluated our experience to identify minimum length of donor renal artery predictive of single lumen implantation after left laparoscopic nephrectomy.
Materials and Methods: All left laparoscopic donor nephrectomies from January 2016 until June 2019 were studied, and preoperative imaging reviewed for donor artery length, multiplicity and intra operative findings. Post operative outcomes were compared at different Renal artery length till first branching.
Results: A total of 600 left laparoscopic live donor nephrectomies (102 multiple vessels and 498 single vessel) were studied. Renal artery length was measured from preoperative donor computed tomography angiogram. All patients with single renal artery were divided in four groups based on length of main artery to first branch: Group A( n= 378), B (n= 43), C (n=35), and D( n=32)with length to first branch > 7mm, =7 mm, =6 mm and <= 5 mm respectively. Two non-absorbable Polymer Locking Clips Weck® Hem-o-lok® and one Titanium clip was used to clip donor renal artery in all cases. Three seventy (97.88%), 41 (95.34%), 4 (11.42%) and none (0%) of kidneys with length to first branch of >7mm, 7 mm, 6 mm and 5 mm respectively could be implanted as single vessel. There was no significant difference in perioperative complications and graft function at 3 months in different groups. A good controlled stretch at hilum during arterial clipping was associated with successful single lumen implantation in most cases.
Conclusion: A main left renal artery length of more than or equal to 7 mm is highly likely to provide single artery to implant in experienced hands. To achieve this the hilum should be held at gentle and sustained traction applied both at lower and upper pole region.