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  • Open minimal incision technique

  • 6-8 cm flank incision over the tip of the 12th rib (Figure 112-194)

  • Tip of the 12th rib is resected

  • Peritoneum reflected anteriorly and the kidney mobilized starting with release of upper pole

  • Ureter is mobilized after mobilization of the lower pole

  • Hilar dissection performed once the entire kidney has been circumferentially mobilized

  • Ureter is clamped/clipped/tied and transected

  • Artery, vein, and ureter are controlled with a Hendren vascular clamp

  • Kidney is removed via the incision used for dissection (Figure 112-195)

  • Vascular stumps manually oversewn after the kidney is removed

  • Secure individual-layer muscle closure for all three layers of the abdominal wall

  • Preferentially offered for right donor nephrectomies and/or kidneys with multiple vessels with early bifurcation

FIGURE 112-194

The open minimal incision living donor nephrectomy approach entails a 6-8 cm mini laparotomy above the tip of the 12th rib.

FIGURE 112-195

The kidney is removed through the incision after the vessels (and ureter) are clamped and transected.


  • Completely retroperitoneal approach

  • Single flank incision

  • Diminished costs (no disposable laparoscopic instruments)

  • Optimized vessel length [for both artery (Figure 112-196) and vein cuff for right vein (Figure 112-197)]

  • Shorter operative time

FIGURE 112-196

Optimization of vessel length in this living donor with 3 renal arteries allowed for the independent implantation of all 3 arteries (arrows). Note that while 2 arteries (white arrows) were anastomosed in an end-to-side fashion to the external iliac artery, the third one (yellow arrow) was sewn end-to-end onto the recipient inferior epigastric artery.

FIGURE 112-197

In this living donor right kidney with two renal veins, a patch of donor IVC (arrow) was obtained to allow for better implantation onto the recipient external iliac vein.


Shenoy  S, Lowell  JA, Ramachandran  V, Jendrisak  M. The ideal living donor nephrectomy ‘Mini-Nepherctomy’ through a posterior transcostal approach. J Am Col Surg. 2002;194:240–246.
Subramanian  T, Dageforde  LA, Vachharajani  N, Wellen  J, Doyle  MBM, Lin  Y, Khan  A, Senter-Zapata  M, Chapman  W, Shenoy  S. Mini-incision versus hand-assisted laparoscopic donor nephrectomy in living-donor kidney transplantation: A retrospective cohort study. Int J Surg. 2018 May;53:339–344. doi: 10.1016/j.ijsu.2018.04.003. Epub 2018 Apr 11. PMID:
[PubMed: 29654968]

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