Laparoscopic Simultaneous Nephrectomy and Distal Pancreatectomy from a Live Donor Rainer WG Gruessner, MD, FACS, Raja Kandaswamy, MD, Roger Denny, MD The first successful laparoscopic donor nephrectomy was not performed until 1995, 1 but now, worldwide, laparoscopic nephrectomy is increasingly replacing open nephrectomy as the procedure of choice for living kid- ney donation. Reasons for this widespread acceptance of the laparoscopic procedure include reduced length of hospital stay, reduced convalescence time, and reduced need for postoperative analgesic medications. The short- and longterm results of the laparoscopic procedure have been shown to be equivalent to the open technique in regard to donor safety and quality of the transplanted kidney. 2,3 Live donors have also been used for pancreas trans- plantation in patients with Type I (insulin-dependent) diabetes mellitus. In fact, the pancreas was the first ex- trarenal solid organ for which live donors were success- fully used. 4 But pancreas transplants using live donors have not become as popular as kidney transplants using live donors, primarily for two reasons: the magnitude and potential complications of the donor operation and the higher technical failure rate in recipients. In our series of 116 consecutive pancreas transplants using live donors, we used the conventional open technique for spleen-preserving distal pancreatectomy. But distal pan- createctomies (with and without splenectomy) to treat various diseases of the pancreas are now increasingly per- formed laparoscopically. As with laparoscopic nephrec- tomies, laparoscopic distal pancreatectomies are more cost-effective because of the reduced length of hospital stay and reduced recovery time. 5-7 Here we describe the first laparoscopic simultaneous nephrectomy and distal pancreatectomy with preserva- tion of the spleen in a live donor. Both organs were successfully transplanted into a uremic, Type I diabetic recipient. CASE REPORT The donor is a 55-year-old man with no history of sig- nificant medical problems. He underwent our standard workup for combined kidney and segmental pancreas donation, as previously described. 8 An MRI of his abdo- men revealed two renal arteries on each side and regular anatomy of the splenic artery (Fig. 1). The left kidney was chosen for donation because of its proximity to the distal pancreas and the presence of an upper pole artery. (The right kidney had a smaller lower pole artery; if it thrombosed, it could have compromised the blood sup- ply to the right ureter.) After induction of general endotracheal anesthesia, the patient was placed on the table, first in the supine position and then in the right lateral decubitus position. The table was then flexed at a point midway between the patient’s iliac crest and rib cage and rotated 45 degrees to allow easy access to the left kidney. Prophylactic antibi- otics, orogastric suction, Foley catheter bladder drain- age, and sequential compression devices were all used. The operating surgeon and the scrub nurse stood on the patient’s right, the assistant and the camera operator on the left. Standard laparoscopic instrumentation and two television monitors were used. A 7-cm midline incision (size of the surgeon’s wrist) was made 2 cm above the patient’s umbilicus, and the peritoneal cavity was en- tered. A HandPort System (Smith and Nephew Inc, An- dover, MA) 9 was applied to the patient’s midline inci- sion. The system’s external and internal rings were insufflated and the surgeon’s hand was placed inside the abdomen. After a pneumoperitoneum ( 15mmHg) was created, three trocars were placed: the first 12-mm trocar was placed 2 cm below the patient’s umbilicus for the 30-degree laparoscope and the camera; the second 12-mm trocar was placed in the left midabdomen (an- terior axillary line); the third 12-mm trocar was placed in No competing interests declared. Received March 2, 2001; Accepted May 24, 2001. From the Department of Surgery, University of Minnesota, Minneapolis, MN. Correspondence address: Rainer WG Gruessner, MD, FACS, Department of Surgery, University of Minnesota, Mayo Mail Code 90, 420 Delaware St SE, Minneapolis, MN 55455. 333 © 2001 by the American College of Surgeons ISSN 1072-7515/01/$21.00 Published by Elsevier Science Inc. PII S1072-7515(01)01010-9