Outcomes of laparoscopic donor nephrectomy in the presence of multiple renal arteries

Data of laparoscopic donor nephrectomy [LDN] with multiple renal arteries for donor and recipient outcomes were reviewed, with the aim of clarifying whether the laparoscopic approach is safe in the presence of multiple renal arteries. All donor nephrectomies performed at our institution from 2004 to 2008 were reviewed retrospectively. Results were compared between LDN kidneys with multiple arteries and those with a single renal artery. Out of 171 donor nephrectomies, 21 [12%] were performed for kidneys with multiple renal arteries. All of the 150 [88%] donor nephrectomies in the single vessel group were performed laparoscopically. In the multiple artery group, 9 [43%] underwent an open procedure while 12 [57%] underwent a laparoscopic procedure. The warm ischemia time was longer in the multiple artery group than the single artery group, but the difference was not statistically significant [4.25 +/- 0.87 min vs. 4.12 +/- 0.95 min, respectively]. Regarding transplant recipients, the vascular anastomosis time was similar in both groups [30 +/- 4.6 min vs. 29.5 +/- 3.7 min]. The operative blood loss in the transplant recipients was significantly more in the multiple artery group compared to the single artery group [339 +/- 292 ml and 130.7 +/- 44.8 ml, respectively; P=0.03]. The recipient renal function was similar for both the groups at postoperative day 7, 1 month, and at 1 year. The data support the fact that the laparoscopic approach to donor nephrectomy in the presence of multiple renal arteries can be performed safely with adequate laparoscopic experience

Port site metastasis by exfoliated cells from occult cholangiocarcinoma a case report

A forty year old man underwent laparoscopic cholecystectomy for symptomatic gall stones. The histological report of removed gall bladder was benign. The patient presented with a nodule at port site one year after the cholecystectomy. The nodule was removed and histopathology revealed adenocarcinoma. Histopathological review of the removed gallbladder again revealed a benign result. All investigations for diagnosis of primary remained equivocal. The patient again presented with obstructive jaundice three months after removal of the nodule. Investigations [CT Scan and ERCP] revealed a nodule at hilum of biliary ducts causing obstruction at that level with dilatation of intrahepatic Nary ducts. Brush cytology revealed hilar cholangiocarcinoma. This case illustrates that exfoliated cells of bile duct tumour metastasized by transluminal route and caused port site metastasis after laparoscopic cholecystectomy. The patient is referred to hepatobiliary surgeon for further treatment