Unexpected surgical difficulties leading to XXXX and gas embolus during laparoscopic donor nephrectomy: a case report.

@entity1 @entity3728 @entity3018 @entity548 @entity190 @entity2318 @entity26 @entity3810
PURPOSE: To report the case of a laparoscopic donor nephrectomy in which the preoperative evaluation of the @entity1 gave no indication of the surgical difficulties that were encountered intraoperatively, resulting in @entity548 , a suspected @entity3728 , and emergency conversion of the procedure from laparoscopic to open donor nephrectomy. CLINICAL FEATURES: A 59-yr-old @entity1 - height: 175 cm, weight: 85.5 kg, American Society of Anesthesiologists physical status I - presented as kidney donor for laparoscopic donor nephrectomy. He was healthy, on no medication, and had no previous abdominal surgery or diseases of the urinary tract. The preoperative computed tomography (CT) scan evaluation of his kidneys confirmed this by reporting a normal bilateral renal and renal vascular anatomy. In contradiction to the preoperative CT scan findings, the surgeon discovered abnormalities in the operative field. This included extensive @entity2318 surrounding the left kidney, @entity3018 near the right hilum, and a large branch lumbar vein entering the renal vein. The large branch lumbar vein was clipped but the clips dislodged, causing significant @entity190 , and a suspected gas embolus. The procedure was converted to an emergency open donor nephrectomy. Postoperatively the @entity1 made a full recovery. CONCLUSION: Laparoscopic donor nephrectomies, though usually performed on healthy individuals, have their pitfalls, and complications during this procedure can be sudden and serious. As shown in this case, although CT scan results are regarded as reliable, they can be misleading. As an anesthetic precaution for @entity3728 during laparoscopic procedures, @entity3810 should be avoided and the @entity1 be ventilated with 100% @entity26 .
