Anatomical and clinical significance of lumbar veins in left laparoscopic donor nephrectomy: A novel classification based on intraoperative findings.

INTRODUCTION Laparoscopic donor nephrectomy (LDN) is the gold standard, but lumbar veins on the left side are highly variable and may cause bleeding or difficulty during dissection if not anticipated. This study examines lumbar vein drainage patterns using preoperative computed tomography (CT) and intraoperative findings, proposes a new classification and evaluates their clinical relevance. PATIENTS AND

Methods

This prospective observational study assessed the incidence and intraoperative anatomy of lumbar veins in consecutive LDN cases, correlated findings with preoperative CT angiography, classified lumbar veins by anatomical pattern and measured the time needed to secure them.

Results

One hundred consecutive LDN procedures were analysed. Lumbar veins were identified in 81 donors. Two anatomical types were defined: Type 1, a single vein draining directly into the left renal vein; and Type 2, two or more branches forming a single trunk before entering the renal vein. Type 1 veins were found in 56 donors and Type 2 in 25. Nineteen donors showed no intraoperative lumbar veins. Concordance between CT angiography and intraoperative findings was 97% (Discordance in n = 2). The mean lumbar vein dissection time was 13.22 ± 5.89 min, with nearly identical times for both types.

Conclusions

This study shows the importance of preoperative CT imaging in identifying and classifying lumbar veins during LDN. There was excellent concordance between preoperative CT imaging and intraoperative findings. Recognising the type of lumbar vein preoperatively using CT enables surgeons to anticipate technical challenges, if any. This classification potentially can enable case triage for resident training, which requires further multicentric study.