V9-02: Left Laparoscopic Donor Nephrectomy: Gonadal Artery Sparing Techniques
VideoIntroductions and Objectives
Individuals electing to donate a kidney take the risk of surgery without any benefit to their own physical health. As surgeons we have a responsibility in the development of precise surgical techniques to minimize any potential complication or discomfort. Over 49,000 male donors have undergone nephrectomy, with at least 2100 procedures in 2012. Studies have shown that ipsilateral orchialgia occurs in 5 – 10% of men undergoing laparoscopic donor nephrectomy, a common complaint and source of discomfort. The etiology of orchialgia, however not known, has been suspected with gonad vessel dissection. In this video abstract we aim to demonstrate the feasibility of gonadal artery preservation during laparoscopic donor nephrectomy and to identify any particular variations in the anatomy that lends to preservation.
We performed a focused literature review of gonad vessel artery and the variations. Understanding this anatomy, attention during our routine laparoscopic donor nephrectomies was made to identify and to spare the gonadal artery. Video recordings were made and reviewed to characterize specific techniques utilized to spare the gonadal artery and situations in which the artery could not be spared.
At the time of abstract submission, more than 10 gonadal artery vessels were successfully spared. We identified three main types of vessel insertions, and variations. Type I insertions into the aorta below the renal vein, were capable of being spared with minimal increase in operative time or dissection. When direct insertion into the renal artery was encountered the artery could never be spared.
Routine gonadal artery preservation is feasible during laparoscopic donor nephrectomy without much increased dissection or operative time requirement in our experience. Future studies will need to assess whether or not sparing the vessels truly preserves its function and if it leads to decreased postoperative orchialgia and pain in patients.