经腹腔手辅助腹腔镜活体供肾摘取术

目的：介绍经腹腔手辅助腹腔镜活体供肾摘取术（HLDN）。方法：供肾者5例，行经腹腔的手辅助腹腔镜活体供肾摘取术，总结手术方法。结果：平均手术时间116min，供肾平均热缺血时间2．8min，平均供肾动脉长度1．8cm，平均供肾静脉长度2．7cm。未发生任何手术并发症。术后7d供者恢复出院，3例受者术后第3－12天血肌酐恢复正常，2例受者发生肾功能延迟恢复（DGF）。结论：HLDN结合了单纯腹腔镜供肾摘取术（LDN）和开放供肾摘取术（ODN）的优点。既有切口小，痛苦小和恢复快的微创手术特点，又减少了单纯腹腔镜器械操作的难度，使外科医师更易掌握，显著缩短了手术时间和供肾热缺血时间，保证了供肾质量；同时有利于迅速处理一些紧急情况，减少并发症，提高了供者安全性和手术成功率。     

Hand-assisted and conventional laparoscopic live donor nephrectomy: a comparison of two contemporary techniques

BACKGROUND AND PURPOSE: Laparoscopic nephrectomy may make kidney donation more attractive. Modifications such as hand assistance may improve surgical outcomes. We compared our initial experience with hand-assisted laparoscopic nephrectomy with that of the conventional laparoscopic technique. PATIENTS AND METHODS: Two series of similar patients underwent conventional laparoscopic donor nephrectomy (LDN; N = 15) or hand-assisted laparoscopic donor nephrectomy (HLDN; N = 29). Operative time, warm ischemia time, estimated blood loss, complications, analgesic use, postoperative recovery, and serum creatinine concentration were compared. RESULTS: Open conversion was required in one HLDN patient because of intra-abdominal adhesions, and this patient was excluded from further analysis. The operative time, time to kidney extraction, and warm ischemia time were significantly shorter in the HLDN group, averaging 204.8 v 275.7 minutes, 173.4 v 239.3 minutes, and 2 minutes 21 seconds v 3 minutes 45 seconds, respectively. The intraoperative complication rates were 3.6% and 13.3%, respectively (P = 0.07). The postoperative complication rates were 6.8% and 6.7%. All grafts were functioning at the end of the study period, and there were no differences in rejection episodes, need for dialysis, complications, or nadir creatinine concentration according to the method of harvest. CONCLUSIONS: Hand-assisted laparoscopic donor nephrectomy provides shorter operative and warm ischemia times without a significant increase in donor morbidity.     

手辅助腹腔镜在亲属活体供肾切取中的应用25例报告

目的 探讨手辅助腹腔镜在亲属活体供肾切取中的应用.方法 回顾性分析25名亲属活体供肾者的资料.25名供者中,男性6名,女性19名,年龄(42±17)岁.23例为亲属血缘关系供肾,2例为夫妻间供肾.分析供者选择手辅助腹腔镜下取肾术的原因、供者的手术时间、供肾热缺血时间、术中出血量、肾脏及周围脏器损伤情况、术后恢复情况及移植肾功能恢复情况,评价手辅助腹腔镜下取肾术的临床应用效果.结果 对25名亲属供者应用手辅助腹腔镜下取肾术均获成功,无中转开放手术;24例取左肾,1例取右肾;手术时间(138±42)min,供肾热缺血时间为(145±22)s,术中出血量(53±32)m1;无供肾损伤,无切口相关并发症,仅有1例发生脾包膜撕裂;术后住院时间为(7.2±1.7)d,供者均满意.调查显示,供者选择手辅助腹腔镜下取肾术的主要原因是手术损伤小、切口对外观影响较小、心理负担轻.亲属活体供肾移植后,仅有1例受者发生移植肾功能恢复延迟,其余受者的血肌酐水平均在1周内下降至正常.结论 手辅助腹腔镜下取肾术综合了传统腹腔镜技术和开放性手术取肾的优点,微创,操作方便,供肾损伤机会少,切口对外观影响较小,供者易于接受.     

手助腹腔镜活体供肾切取术21例报告

目的评价手助腹腔镜活体供肾切取术(HLDN)的手术效果和近期疗效。方法回顾性分析2004年4月至2005年7月采用HLDN方法获取活体供肾21例的临床资料。供者男13例,女8例。年龄31～60岁,平均43岁。其中18例供者为血缘关系亲属供肾,3例为非血缘关系夫妻供肾。通过受者移植后肾功能恢复情况,评价HLDN的效果。结果手术皆取左肾,手术时间100～150 min,失血量30～100 ml。供肾热缺血时间2～3 min,冷缺血时间45～60 min。平均供肾动脉长度2.3 cm,静脉长度3.5 cm。HLDN手术全部成功,无中转开放,无手术并发症,术后6～7 d出院。21例受者肾移植后未发生肾功能延迟恢复,术后1周内肾功能均达到正常值。结论HLDN结合了腹腔镜活体供肾切取术和开放手术活体供肾切取术的优点,既保证了对供者的微创,又保证了供肾质量,有利于推动活体供肾移植的开展。     

Comparison of laparoscopic versus hand-assisted live donor nephrectomy

BACKGROUND: The aim of the present study was to compare hand-assisted laparoscopic live donor nephrectomy with the classic laparoscopic method, using meta-analytical techniques. METHODS: A literature search was performed for studies comparing hand-assisted laparoscopic nephrectomy with classic laparoscopic nephrectomy for live kidney donation between 1999 and 2005. The following end points were evaluated: operative time, warm ischemia time, intraoperative adverse events, donor and recipient postoperative complications, and length of hospital stay. RESULTS: Nine comparative studies matched the selection criteria, reporting on 376 patients, of whom 202 (53.7%) had hand-assisted laparoscopic nephrectomy and 174 (46.3%) had the classic laparoscopic technique. Conversion to open surgery was 2.97% in the hand-assisted group and 4.60% in the laparoscopic group (P=0.35). Total operative and warm ischemia times were significantly shorter for hand-assisted laparoscopy by 30.03 minutes (P=0.02) and 1.14 minutes (P<0.001), respectively. The intraoperative blood loss was less for the hand-assisted laparoscopy group by 34.16 mL (P=0.008), although intraoperative (3.46% vs. 7.47%; P=0.24) and postoperative (5.94% vs. 10.34%; P=0.30) donor complications and recipient complications (including delayed graft function and primary nonfunction, 8.41% vs. 7.42%; P=0.32) were similar between the hand-assisted and laparoscopic groups. CONCLUSION: Hand-assisted laparoscopic nephrectomy appeared to have the same donor and recipient complication rate with standard laparoscopy but offered substantial advantages in terms of shortened operative and warm ischemia time as well as decreased intraoperative bleeding.     

Retroperitoneoscopic donor nephrectomy: donor outcome and complication rate in comparison with three different techniques

Four surgical techniques for living donor nephrectomy were analyzed retrospectively in terms of perioperative outcome and early complication rate. A total of 182 donor nephrectomies including 69 open (OLDN), 14 fully laparoscopic (LDN), 34 hand-assisted laparoscopic (HLDN) and 65 retroperitoneoscopic (RLDN) nephrectomies were analyzed. There was a significant difference in mean operating time (OPT) between the OLDN (160 min) and RLDN (150 min) as compared to the LDN (212 min) and HLDN group (192 min) (P<0.001). Mean warm ischemia time (WIT) was significantly shorter with OLDN (114 s), RLDN (121 s) and HLDN (128 s) when compared to LDN (238 s) (P<0.001). Major complication rate was comparable among the groups. Independent of the preferred technique, donor nephrectomy is associated with complication rates. RLDN is comparable to OLDN in terms of OPT, WIT. Learning endoscopic donor nephrectomy could be associated with a higher complication rate.     

手助腹腔镜与开放手术活体供肾切取术的临床研究

目的比较手助腹腔镜活体供肾切取术（HLDN）和开放手术活体供肾切取术（ODN）的临床疗效,观察术后受者移植肾近期存活情况。方法回顾性分析中南大学湘雅三医院移植中心2004年1月至2013年11月完成的341例亲属活体肾移植供、受者资料。根据供者手术方式的不同,将其分为HLDN组（103例）和ODN组（238例）。比较两组受者手术时长、切口长度、供肾热缺血时间、肾动脉长度、肾静脉长度、术中失血量、围手术期芬太尼用量、术后非甾体抗炎药（NSAIDs）用量和术后恢复劳动天数。术后48h使用视觉模拟评分（VAS）法评估两组供者疼痛程度。术后随访供、受者恢复情况,并于术后7d、1个月复查受者肾功能。连续变量采用t检验进行比较,分类变量采用Fisher确切概率法进行比较。结果HLDN组和ODN组供者切口长度分别为（6．0±0．4）cm和（13．5±1．0）cm,术中失血量分别为（45±12）mL和（151±24）mL,差异均有统计学意义（t=73．56和42．56,P均〈0．05）。两组手术时长、供肾热缺血时间、肾动脉长度、肾静脉长度相比,差异均无统计学意义（t=1．39,1．70,0．00和1．85,P均〉0．05）。103例HLDN组供者中有102例顺利完成手术,1例主动中转开放,术后发生肺部感染1例,无术后切口感染及其他严重并发症。238例ODN组供者均成功完成手术,术后切口感染1例、脂肪液化2例,术后出血通过外科止血2例,无其他手术相关并发症。HLDN组和ODN组供者术后48hVAS分别为（2．3±0．6）分和（3．9±0．9）分,围手术期芬太尼用量分别为（1．7±0．2）mg和（1．9±0．2）mg,术后NSAIDs用量分别为（22±33）mg和（47±42）mg,术后恢复劳动天数分别为（23±10）d和（44±15）d,差异均有统计学意义（t=16．52,8．48,5．37和13．00,P均〈0．05）。两组供者术后7d、1个月血清肌酐水平相比,?     

Laparoscopic nephrectomy: safe and comfortable surgical alternative for living donors and for good results of graft function

Laparoscopic nephrectomy for kidney donation from living related donors has the advantages of a less invasive surgical access, better cosmesis, and a shorter hospital stay for the donor. However, some workers have reported up to 10% life-threatening complications for the donor using this technique. The purpose of our study was to evaluate hand-assisted laparoscopic nephrectomy for living donors of kidney transplants in terms of graft function. Thirty donors who underwent open nephrectomy (ON) were compared with 27 who had hand-assisted nephrectomy (HALN). Surgery and ischemia times, hospital stay, bleeding, graft function, remaining kidney function, and complications were compared in both groups. Mean surgery time was 126.9 minutes for ON and 98 minutes for HALN (P = .0005), warm ischemia time was 3 minutes versus 6 for ON vs HALN, respectively (P = .02). Hospitalization stay was 6.3 days for ON versus 4.8 days for HALN (P = .0015). Differences in change in hematocrit and in serum creatinine levels were not significant; graft outcomes were also similar. Complications were minimal. We conclude that HALN is a valid, safe technique to obtain kidneys from living related donors, significantly reducing the hospital stay and allowing return to normal activities sooner, with risks falling within those reported in the literature.     

手助腹腔镜肾切取术在活体供肾移植中的应用体会(附30例报告)

目的:评价手助腹腔镜活体供肾切取术的安全性及临床效果。方法:分析2013年8月至2016年8月采用手助腹腔镜活体供肾切取术获取30例活体供肾的临床资料。供者男7例,女23例,均取左肾,供受体关系为:父—子5例,母—子13例,母—女2例,兄弟2例,兄—妹4例,妻—夫3例,叔—侄1例。供肾者32~63岁,平均(51.8±8.5)岁。血型相同29例,相容1例,群体反应性抗体、淋巴毒均为阴性。30例患者均行手助腹腔镜活体供肾切取,切取后常规移植给受者,记录手术时间、出血量、供体冷热缺血时间、供者住院时间、术中副损伤及供受者术后恢复情况。结果:供者均切取左肾,手术成功,无一例中转开腹,供肾切取时间105~160 min,平均(100.4±19.5)min;失血量50~110 ml,平均(52.5±24.5)ml;供肾热缺血时间2.0~3.8 min,平均(2.4±0.5)min;冷缺血时间60~90 min,平均(68.2±26.7)min。供者术后1~3 d即可进食并下床活动,平均(2.5±0.6)d;住院3~6 d,平均(4.0±1.6)d。供受体无任何手术并发症发生,受者手术均获成功。随访3个月~3年,供体肾功能均正常。2例受者分别于肾移植术后1年8个月、1年2个月因自行减药,发生排斥反应,导致移植肾肾功能丢失,恢复透析,其余受体肾功能均正常。结论:手助腹腔镜活体供肾切取术结合了腹腔镜活体供肾切取术与开放手术的优点,既减轻了手术对供者的创伤,又保证了供肾质量,是安全、可靠的手术方法。     

Comparison of changes in tissue oxidative-stress markers in experimental model of open, laparoscopic, and retroperitoneoscopic donor nephrectomy

PURPOSE: We evaluated the oxidative stress in renal tissue during three types of surgery: open donor nephrectomy (ODN), laparoscopic donor nephrectomy (LDN), and retroperitoneoscopic donor nephrectomy (RDN). The aim was to find out which is the appropriate procedure for harvesting a donor kidney. MATERIALS AND METHODS: Twenty-four New Zealand White rabbits were randomized to four groups, each consisting of six rabbits. Group I (control) was subjected to 180 minutes of anesthesia, and transperitoneal nephrectomy was performed without creation of warm ischemia. In group II (ODN), after 180 minutes of anesthesia, warm ischemia was created for 5 minutes, and nephrectomy was performed. Group III (LDN) was subjected to 5 minutes of warm ischemia after 180 minutes of pneumoperitoneum at 12 mm Hg, and the kidney was removed. In group IV (RDN), after pneumoretroperitoneum at 12 mm Hg for 180 minutes, warm ischemia was created for 5 minutes, and nephrectomy was performed. Renal tissues were analyzed to determine malondialdehyde (MDA) and reduced glutathione (GSH) as oxidative-stress markers. RESULTS: Renal tissue GSH levels were decreased, whereas MDA levels were increased in groups II through IV compared with the control group (p<0.05). There was no statistically significant difference between the ODN, LDN, and RDN groups in the renal oxidative-stress markers. CONCLUSION: No differences were detected in oxidative-stress markers in renal tissue samples between ODN, LDN, and RDN. Therefore, we believe LDN and RDN can be used for live donor kidney harvesting as effectively as ODN without creating greater oxidative stress, which can have deleterious effects on a donor kidney.     

Retroperitoneoscopic live donor nephrectomy in a patient with a double inferior vena cava

BACKGROUND: Vascular anomalies are considered a contraindication for laparoscopic live donor nephrectomy. We report a successful hand-assisted retroperitoneoscopic live donor nephrectomy from a donor with a double inferior vena cava. MATERIALS AND METHODS: A 37-year-old woman wanted to donate a kidney to her 44-year-old boyfriend who had hypertensive nephropathy. Preoperative donor imaging showed a double inferior vena cava. Each renal vein drains into the ipsilateral inferior vena cava division, making the left renal vein short. A single renal artery, vein, and ureter were noted on both sides. A hand-assisted retroperitoneoscopic left nephrectomy was performed. Blood loss was minimal and the warm ischemia time was 2 minutes. Renal transplantation was performed with good initial perfusion and urine output. Cold ischemia and rewarming time was 25 minutes. RESULTS: The donor postoperative period was uneventful with infrequent need for pain relief. The donor was discharged in good condition 3 days postoperatively. The donor's kidney functions were within the normal range at follow-up 4 months postoperatively. The recipient was discharged in good condition 7 days postoperatively. The recipient is alive with good graft function and unremarkable complications at 4 month follow-up. CONCLUSION: Although vascular anomalies present a surgical challenge, we have shown the feasibility of performing hand-assisted retroperitoneoscopic live donor nephrectomy in a donor with a double vena cava and short renal vein. With comprehensive preoperative assessment, laparoscopic live donor nephrectomy can be done safely in donors with anatomical anomalies. This may increase the number of living donor kidney transplants as it offers lower postoperative morbidity and economic disincentives for potential donors.     

Laparoscopic live donor nephrectomy: the University of Maryland 3-year experience

PURPOSE: We determined whether laparoscopic living donor nephrectomy decreases the morbidity of renal donation for the donor, while providing a renal allograft of a quality comparable to that of open donor nephrectomy. MATERIALS AND METHODS: In a 3-year period laparoscopic donor nephrectomy was performed via the transperitoneal approach. We evaluated donor and recipient medical records for preoperative donor characteristics, intraoperative parameters and complications, and postoperative recovery and complications. RESULTS: Of the 320 laparoscopic donor nephrectomies performed the left kidney was removed in 97.5%. Intraoperative complications, which developed in 10.4% of cases, tended to occur early in the experience and required conversion to open nephrectomy in 5. Average operative time was 31/2 hours and warm ischemia time was 21/2 minutes. As the series progressed, blood loss as well as laparoscopic port size and number decreased but extraction site size remained constant at 7 cm. Urinary retention, prolonged ileus, thigh numbness and incisional hernia were the most common postoperative complications. Postoperative analgesic requirements were low and average hospitalization was 66 hours. CONCLUSIONS: Laparoscopic donor nephrectomy appears to be safe and decreases morbidity in the renal donor. Allograft function is comparable to that in open nephrectomy series. The availability of laparoscopic harvesting may be increasing the living donor volunteer pool.     

Hand-assisted laparoscopic nephrectomy versus transperitoneal anterior approach in living donors for renal transplantation

The objective of this study was to compare two surgical approaches for living donor nephrectomy: transperitoneal anterior approach and the hand-assisted laparoscopic nephrectomy. Between January 2001 and October 2003 we performed 63 kidney transplantations from living donors. The transperitoneal anterior approach was used in 36 cases and the hand-assisted laparoscopic nephrectomy in 27. Outcomes were compared in terms of hospital stay, postoperative analgesia, and graft quality. Mean hospital stay was 4.7 days in the transperitoneal anterior approach group and 3.7 days in the hand-assisted laparoscopic group (P < .005). Postoperative analgesia dosage was significantly lower in the hand-assisted laparoscopic group (P < .001). Surgical complications and graft quality were similar. We concluded that hand-assisted laparoscopic nephrectomy patients had shorter hospital stays and less pain in the postoperative period, with better cosmetic results and equivalent graft quality compared to transperitoneal anterior approach patients.     

Right laparoscopic live donor nephrectomy: a single institution experience

BACKGROUND: Laparoscopic live donor nephrectomy (LLDN) is increasingly used by transplantation centers worldwide. As in open live donor nephrectomy, the left kidney is preferred for LLDN; however, not all potential donors have anatomy conducive to left nephrectomy. The purpose of our study, therefore, was to report on a large, single-institution experience with right LLDN performed using a hand-assisted, transperitoneal approach. METHODS: We performed a retrospective review of 40 consecutive patients who underwent transperitoneal right hand-assisted LLDN at our institution. Information on donor age, relation to recipient, and indication for right-sided donation was collected. Surgical demographics included operative time, warm ischemia time, and estimated blood loss. Recipients were followed for graft loss and for long-term renal allograft function. RESULTS: The indications for right-sided donor nephrectomy were a difference in split renal function of greater than 10%, multiple left renal vessels, and right renal cysts. The mean surgical time in our series was 115.8 min, with a mean estimated blood loss of 85.7 mL and a warm ischemia time of 116.0 seconds. Surgical and postoperative complications were limited. Mean serum creatinine levels in the recipients were 1.6 mg/dL on day 7, 1.4 mg/dL on day 30, and 1.4 mg/dL at 1 year after transplantation. CONCLUSIONS: Right LLDN using a hand-assisted, transperitoneal technique was performed with minimal morbidity and favorable graft function. We believe that offering hand-assisted LLDN to patients with an indication for right-sided donation can safely and effectively increase the pool of donor organs available to patients with end-stage renal disease.     

Transperitoneal, hand-assisted laparoscopic donor nephrectomy: surveillance of renal function by immune monitoring

The history of living donor nephrectomy has undergone several development phases with respect to medical, immunologic, and operative aspects. Due to the shortage of postmortem organ donations and the rising number of patients with terminal renal insufficiency who are awaiting kidney transplantation, living kidney donation has become increasingly important during recent years. METHODS: From December 2004 to May 2005, we performed hand-assisted laparoscopic donor nephrectomies on 15 female and 9 male patients of median age 37 years. Our immunosuppressive regimen included tacrolimus, mycophenolate mofetil, methylprednisolone, and a monoclonal antibody. RESULTS: The median operative time was 138 minutes (113-180 minutes), and the median warm ischemia time was 87 seconds (63-150 seconds); results comparable to those of open donor nephrectomy. The hospitalization periods of the donors were between 5 and 7 days. The renal function and acute-phase parameters showed a transient increase during and after the operation. Most of the patients reached baseline levels by postoperative day 3 or 4. CONCLUSION: Together with the clinical data, these findings confirmed the efficacy and minimal invasiveness of laparoscopic donor nephrectomy. It is thus possible that in the future this operative method will become the procedure of choice.     

Laparoscopic live donor right nephrectomy: a new technique to maximize the length of the renal vein using a modified Endo GIA stapler

OBJECTIVES: To report the utilization of a modified Endo GIA vascular stapler to obtain the full length of the renal vein during transperitoneal laparoscopic live donor right nephrectomy. METHODS: We used a modified Endo GIA stapler, in which the triple staggered rows of staples were removed from the kidney donor side to obtain the full length of the right renal vein. This technique has currently been used in nine consecutive transperitoneal laparoscopic right donor nephrectomies. RESULTS: With this technique, the entire right renal vein length was harvested in all cases, without vascular complications. Mean renal warm ischemia time from clamping of the renal vessels to cold perfusion was 135s, and mean receptor postoperative glomerular filtration rate after 30 d was 67.3 ml/min. There were no graft losses. CONCLUSIONS: A novel technique for laparoscopic live donor right nephrectomy is described. It allows harvesting the full length of the right renal vein in a safe and feasible way without compromising warm ischemia time.     

Anatomic Diversity Encountered During Laparoscopic Hand-Assisted Transperitoneal Donor Nephrectomy: A Case Report of Complete Caval Duplication

Introduction

Laparoscopic donor nephrectomy is widely used to retrieve a kidney for transplantation. Preoperative evaluation of the donor is of crucial importance to the recipient. In particular, vascular anatomy should be assessed with the help of modern imaging modalities. We present a hand-assisted laparoscopic nephrectomy of a kidney donor with a complete duplex vena cava.

Hand-assisted laparoscopic live donor nephrectomy

BACKGROUND: Hand-assisted laparoscopic donor nephrectomy (HLDN) may have advantages over laparoscopic donor nephrectomy, such as shorter learning curve, operation and warm ischaemia times. The aim of this study was to evaluate the feasibility and safety of HLDN. METHODS: Between January 2000 and October 2002, 50 consecutive HLDN procedures were performed through a low transverse abdominal incision, 23 right sided and 27 left sided. RESULTS: The median age of the donors was 44 years. No HLDN required conversion to an open procedure. The median operating time for HLDN was 153 min. The median warm ischaemia time was 3 (range 1.0-4.5) min and the median blood loss was 50 (range 20-500) ml in both left- and right-sided procedures. Eight patients suffered ten minor complications during their admission. The duration of hospital stay was 5 days for donors. Three recipients developed graft failure owing to acute rejection, renal vein thrombosis and ischaemic necrosis. CONCLUSION: Both left- and right-sided HLDN procedures were feasible and safe through a low transverse abdominal incision.     

Laparoscopic live donor nephrectomy in a patient with duplex inferior vena cava

BACKGROUND: Modern imaging, such as CT and MRI, improves the preoperative assessment for variants of renal vasculature. We present a kidney donor with a duplex inferior vena cava. In conjunction with CT and hand-assisted laparoscopic surgery, live donor nephrectomy was performed successfully. METHODS: A 35-year-old woman wished to donate a kidney to her son. Preoperative CT showed normal functional kidneys without uretal duplication. A duplex inferior vena cava was noted below the level of the left renal vein. A hand-assisted transperitoneal laparoscopic left nephrectomy was performed. Blood loss was minimal and the warm ischemia time was 3 minutes. Renal transplantation was performed with good initial perfusion and urine output. RESULTS: The donor was discharged in good condition at 3 days postoperatively. Both donor and recipient are alive with good renal function and without late surgical complications at 9 months. CONCLUSIONS: Live donor nephrectomy is unique as it involves two different patients. Benefits from laparoscopic operation include less pain, shorter hospital stay, earlier resumption of normal food intake, and earlier return to full activity. Graft function was not deleteriously affected and the survival of graft and recipient was not affected. Vascular anomalies, although uncommon, had a significant influence on live renal transplantation. Our patient represents a case of a rare venous anomaly, which has an an incidence rate of 0.5% to 3%. Helical CT with reconstruction of vascular anatomy helped in evaluating donor vasculature. In conjunction with modern imaging techniques and laparoscopic operation, live donor nephrectomy can be performed safely, even in patients with vascular anomalies.