Laparoscopic donor nephrectomy has gained wide acceptance among transplant surgeons as it proved to be safe and provides similar graft function to open nephrectomy. Minimally invasive donor nephrectomy can be performed either totally laparoscopic or Hand-assisted. Hand-assisted donor nephrectomy is thought to be safer with regards to immediate control of intra-operative bleeding. In this video we show clips of emergency intra-operative arterial and venous bleeding during nephrectomy that were controlled by the hand. DVD recordings of all donor nephrectomy patients that had intra-operative bleeding were reviewed and representative clips were collected in one DVD for presentation. This video demonstrates emergency intra-operative arterial and venous bleeding during nephrectomy, and maneuvers used for the control of bleeding by the surgeon’s hand. No patient required blood transfusion and blood loss was minimal as control was immediate. Most bleeding was controlled by compression only (either by the hand or by inserting gauze) and dissection was carried out uneventfully thereafter. Only one patient required conversion to open, but with the surgeon’s finger controlling bleeding from the renal artery stump as the team was preparing for the conversion. In conclusion, Hand-assisted donor nephrectomy approach provides immediate control of bleeding which gives the surgeon ample time to reassess the situation and manage accordingly. Therefore blood loss, the need for blood transfusion, and the need to convert to open nephrectomy is minimized.
Volume : 6
Issue : 4
Pages : 22
Saad Specialist Hospital, Alkhobar, Saudi Arabia.