DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Healthy kidney donor.
POSTOPERATIVE DIAGNOSIS: Healthy kidney donor.
OPERATION PERFORMED: Laparoscopic left donor nephrectomy.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None.
SPONGE AND NEEDLE COUNTS: Correct.
INDICATION FOR OPERATION: This is a healthy kidney donor. After undergoing the preoperative evaluation, the patient was found to have no contraindication to surgery. He was fully counseled on the risks and benefits of the procedure and agreed to proceed with the left-sided kidney donation.
DESCRIPTION OF OPERATION: After appropriate operative consent was obtained, the patient was taken to the operating room, and general endotracheal anesthesia was induced without any hemodynamic compromise or complication. At this point in time, the patient was put into a right decubitus position with padding at all pressure points with the bed in full flexion. The abdomen and left flank were prepped and draped in sterile fashion using DuraPrep.
We placed a 12 mm port in the left upper quadrant. This was approximately 7 cm below the costal margin. This was done using an open technique and in the midclavicular line. Great care was taken to avoid injury to any hollow viscus structures upon insertion of this port. At this point, pneumoperitoneum was carried out using CO2 insufflation of 15 mmHg. A second 10 mm port was carefully placed approximately 10 cm below this. This was again done under direct visualization. A 5 mm port was carefully placed in the left upper quadrant in the midaxillary line, again under direct visualization.
At this point in time, we began with full mobilization of the left colon. This was done using sharp and blunt technique using a Harmonic scalpel and the colon was brought over to the midline. This allowed access to the kidney. The hilar structures were carefully identified, and the renal vein was carefully identified and dissected free of surrounding tissue to pass the aorta. The adrenal vein was carefully identified, doubly clipped and divided. In a similar fashion, the gonadal vein was carefully identified, doubly clipped and divided as well. At this point in time, the renal artery was carefully identified and circumferentially dissected free of surrounding tissue. It was noted to be a single artery. The upper pole was then carefully dissected from surrounding tissue using the Harmonic scalpel. The renal vein was carefully preserved.
The lateral attachments of the kidney were carefully taken down using the Harmonic scalpel and the kidney was brought over medially. The lateral sides of the artery and vein were carefully dissected free of surrounding tissue. There was noted to be a large lumbar vessel directly coming off the renal vein. This was doubly clipped and divided. Next, the ureter complex along with its vascular supply was carefully dissected free of surrounding tissue with great care being taken to avoid injury to the vascular supply of the ureter with the iliac vessels.
It should be noted that at this point in time a separate incision was carefully made in the left lower quadrant. This incision was taken carefully down through fascial layers using electrocautery, and a hand port was carefully put into position. The patient was given additional fluid as well as diuretics. The pneumoperitoneum was released for approximately 25 minutes. At that time, we proceeded with recreating a pneumoperitoneum. The arteries were then carefully stapled using a vascular staple load followed by the renal vein. The kidney was carefully removed from the hand port site and placed on ice. The ureter was carefully divided to the level of the iliac vessels. and the kidney was then removed from the field as specimen for transplantation. The remaining portion of the ureter was carefully ligated using a 0 silk tie.
The peritoneal cavity was carefully examined again. There was no immediate evidence of any bleeding as hemostasis had been maintained. The peritoneal cavity was carefully irrigated and the irrigant aspirated. The pneumoperitoneum was then carefully removed and then all ports were carefully removed. Both donor fascial sites were carefully reapproximated using 0 Vicryl figure-of-eight stitch. The hand port incision was carefully reapproximated in two layers of running #1 PDS suture. All wounds were carefully irrigated and a Marcaine pain pump was carefully put into position, and the skin of all incisions was carefully approximated using a 4-0 Monocryl running subcuticular stitch. Appropriate sterile dressings were applied. The patient tolerated the procedure well with normal vital signs throughout the entirety of the case. The patient was extubated in the operating room and taken to postop recovery in stable condition.
