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  • Parenchymal injuries can occur when attempting to remove laparoscopically procured live donor kidneys through incisions that are too small for the size of the organ.

FIGURE 112-213

Laparoscopically procured live donor kidney that showed a subcapsular fluid collection on the dorsal aspect of the kidney after flushing it with preservation fluid during the back-table preparation. It was decided to preserve the capsule intact since sometimes hemorrhage can be self-limiting. Note that there is minimal blood within the collection. Most of its content is clear fluid, representing preservation solution that likely extravasated into the subcapsular space via a parenchymal injury sustained at the time of removal of the organ from the body (via an incision too small to accommodate it).

FIGURE 112-214

After implantation and reperfusion, the collection expanded rapidly (white arrow).

FIGURE 112-215

The subcapsular hematoma continued to expand, and the renal capsule developed increasing tension. The capsule was incised with a cautery, and blood (green arrows) was released under pressure.

FIGURE 112-216

The capsule was further incised, and the hematoma started to evacuate spontaneously (arrow).

FIGURE 112-217

The hematoma was fully evacuated (arrow).

FIGURE 112-218

When the capsule was further opened to address the ongoing hemorrhage (arrow), a parenchymal tear was identified.

FIGURE 112-219

The site was repaired with resorbable 4-0 running sutures (arrows). The injury was most likely sustained when the organ was removed in a bag through an abdominal incision too small for its size.

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