Step-by-Step Approach

Preoperative Preparation and Evaluation

Prior to this procedure, all patients should undergo the comprehensive donor workup, which has been discussed in the previous chapters. Surgeons need to familiarize themselves with the vascular anatomy on the CT angiography prior to start of the procedure. The CT scans should be displayed in the operating room throughout the procedure. The site of the surgery should be marked, the consent form reviewed, and patient’s questions addressed prior to the start of the case. Patients should be well hydrated with satisfactory urine output. Needless to say, it is the responsibility of the surgeon to perform the final check to ensure all safety parameters are addressed prior to initiation of the procedure. Furthermore, the open nephrectomy surgical tray should be available in the operating room during the procedure, and nursing staff should be well trained and familiar with emergent conversion protocols should the need arise. Major bleeding from the right renal vein and IVC are catastrophic events, and all precautions should be taken to be well prepared should this happen.