Intended for healthcare professional education

Johnson & Johnson Institute

Laparoscopic donor nephrectomy

Stuart Geffner, MD

Operative steps

  • The patient is positioned, trocars such as ENDOPATH XCEL™ Trocars, placed as above.
  • A 30-degree laparoscope is inserted through the left subcostal port.
  • The left abdomen is inspected – any adhesions are taken down.
  • Attention is turned to the left colon. The left colon, including the splenic flexure, is mobilized by incising the lateral peritoneal reflection with endoscopic shears, or other energy modalities depending on surgeon preference.
  • The spleen is mobilized by incising the ligamentous attachments of the spleen.
  • Mobilization of the left colon and spleen will result in the colon falling medially. This will expose the left kidney.
  • The left kidney is identified.


Note – In cases of right nephrectomy, port placement is essentially a mirror image. The liver is retracted cephalad and the right colon – including the hepatic flexure – is mobilized to expose the right kidney. The duodenum may need to be mobilized (Kocher Maneuver) to expose the vena cava and the insertion of the right renal vein.


  • Gerota’s fascia is incised and dissected with an energy device such as HARMONIC™ 1100 Shears.
  • The ureter is identified in the retroperitoneum between the lower pole of the kidney and the hilum.
  • The ureter is traced along its course and dissected with an energy device until the point where it crosses the iliac artery. (This further mobilizes the left colon.) Care is taken to preserve sufficient tissue surrounding the ureter to maintain blood supply.

Left colon and splenic flexure mobilized

Spleen is mobilized

Left kidney identified

Left kidney identified

Gerota's fascia is incised

Ureter is identified

Ureter is traced and dissected

left colon, splenic flexure mobilized
spleen is mobilized
Left kidney identified
Gerota's fascia is incised
ureter is identified
ureter is traced and dissected

References

For complete indications, contraindications, warnings, precautions, and adverse reactions, please reference full package insert.


Stuart Geffner, MD prepared this procedure guide on behalf of Ethicon Inc. The procedure guide reflects the opinions of the individual presenter, and the steps described may not encompass the complete steps of the procedure. Additionally, other surgeons may prefer different techniques, approaches, etc., as individual surgeon experience in his/her clinical practice, as well as patient needs, may dictate variation in procedure steps.


Before using any medical device, review all labeling, including without limitation; the Instructions For Use (IFU), and relevant package inserts with particular attention to the indications, contraindications, warnings and precautions, and steps for use of the device(s).


This presentation is not accredited for CE/CME.

Stuart Geffner, MD is compensated by and presenting on behalf of Ethicon and must present information in accordance with applicable regulatory requirements.

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