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Chapter-27 Avoiding and Managing Hazards During Live Donor Nephrectomies

BOOK TITLE: Kidney & Pancreas Transplantation

Author
1. Marroquin Carlos E
ISBN
9789351523390
DOI
10.5005/jp/books/12547_28
Edition
1/e
Publishing Year
2015
Pages
6
Author Affiliations
1. Fletcher Allen Health Care; University of Vermont College of Medicine, Burlington, Vermont, USA
Chapter keywords
donor nephrectomy, pneumothorax, parenchymal injury, laparoscopic technique, bladder injury, kidney extraction

Abstract

This chapter discusses about avoiding and managing hazards during live donor nephrectomies, where huge disparity between organ supply and demand limits the ability to transplant every eligible patient. Unless one is performing a modified laparoscopic technique, most donor surgeons utilize the Veress needle technique to insufflate the abdomen. Supportive care is critical and placement of a central line may be, theoretically, both diagnostic and therapeutic by allowing aspiration of air. When CO2 is introduced into the venous circulation, cardiac collapse occurs because of obstruction of the pulmonary outflow tract. If diagnosed postoperatively and the pneumothorax is small and not symptomatic, conservative management is warranted as it should resolve since there has been no parenchymal injury and there is no positive pressure ventilation. Bladder injuries occur during the kidney extraction in patients who had previous pelvic surgeries that increase the risk of bladder injury.

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