Living Donor Nephrectomy Operative Note (Laparoscopic/Robotic)

Date of Surgery: [Date]

Procedure Start/End Times: [Start time] – [End time]

Primary Surgeon: [Name, credentials]

Assistant(s): [Name(s), role(s)]

Laterality: [left / right]

Approach: [laparoscopic / robotic]; [transperitoneal / retroperitoneal]; hand-assist [yes / no]

Immediate Operative Summary

Pre-op Diagnosis: Living kidney donor (elective donation). [Relevant donor vascular or ureteral anatomy if it influenced intraoperative decisions]

Post-op Diagnosis: [Unchanged / updated diagnosis]

Procedure Performed: [Full procedure name with laterality]. [Additional procedures if any, e.g., adhesiolysis, incidental repairs, conversion to open]

Renal Artery Anatomy: [Number of arteries]; accessory/polar artery [present / absent]; early branching [yes / no / unknown]

Renal Vein Anatomy: [Number of veins]; anomaly [none / retroaortic / circumaortic / other]

Ureter: [single / duplicated]; periureteral tissue preserved [yes / no]

Estimated Blood Loss: [mL]

Complications: [None / description of event, immediate management, and status at case end]

Graft Extraction and Ischemia Times: [Extraction method]; [Incision site]. Arterial clamp/division: [time]; Graft out: [time]; Cold perfusion initiated: [time]; Warm ischemia time: [calculated duration]

Graft Disposition: For transplantation. Handoff to [transplant team member name/role] at [time]. [Biopsy submitted if applicable]

Counts: Sponge/needle/instrument counts [correct / incorrect]. (If incorrect, describe discrepancy and resolution including confirmatory imaging if used.)

Donor Condition and Disposition: [Condition at case end, e.g., stable, extubated]; disposition to [PACU / ICU]. [Lines/drains at transfer if applicable]

Indications and Consent

[Brief statement confirming elective living donor nephrectomy for kidney donation]. Informed consent obtained and verified. Laterality confirmed per institutional protocol and surgical time-out completed. (Do not include recipient identifying information in the donor chart unless institutionally required.)

Operative Technique

Setup and Positioning: [Patient position, e.g., modified flank with table flexion]; [padding and securing]; Foley catheter placed. [Antibiotic and VTE prophylaxis if not documented elsewhere]

Access: [Port placement: number, size, and approximate locations]; [Planned extraction incision site]; [Adhesiolysis if performed]. [Robotic docking details if applicable]

Dissection: [Mobilization according to laterality: colon reflection; spleen or liver retraction as applicable]. [Identification of ureter with preservation of periureteral tissue]. [Management of gonadal vessels, adrenal vein, lumbar veins, or other tributaries as encountered]

Hilar Dissection: Renal artery: [anatomy confirmed; dissection, control, and division method, e.g., stapler, clips]. Renal vein: [anatomy confirmed; technique to optimize vein length, particularly for right-sided cases]. (Document any accessory vessels and how they were managed.)

Ureteral Division: [Division point relative to iliac vessels]; periureteral blood supply preserved.

Graft Extraction: [Extraction method, e.g., EndoCatch bag, hand-assist retrieval]; [Incision used]. (Ischemia times as documented in Immediate Operative Summary.)

Back-table and Preservation: [Preservation solution used]; [Flush adequacy, e.g., clear effluent]. [Packaged per transplant protocol if transported / immediate custody transfer to transplant team if direct handoff]

Closure: Hemostasis confirmed. [Port site closure technique including fascial closure for ≥10 mm sites]; [Extraction incision fascial closure]; [Skin closure method]. Final counts correct.

(If conversion to open occurred, state the indication, timing, and steps taken.)

Postoperative Plan

• Diet: [Clear liquids advancing as tolerated / other]
• Foley: [Maintain until POD#1 / remove in OR / other]
• Activity: [Early ambulation POD#0–1; incentive spirometry]
• Analgesia: [Multimodal regimen; regional blocks if placed]
• VTE Prophylaxis: [Continue mechanical and/or pharmacologic per protocol]
• Labs/Monitoring: [CBC, BMP with creatinine; urine output goals]
• Wound Care: [Keep incisions clean/dry; dressing removal timing]
• Restrictions: [No lifting > specified weight for duration]; [Driving restrictions while on opioids]
• Follow-up: [Living donor program / transplant surgery clinic] in [timeframe, e.g., 1–2 weeks]

Signature

Surgeon Signature: [Name, credentials] — [Date, Time]

(If conversion to open occurred, include brief statement of reason for conversion.)