laparoscopic donor nephrectomy is rapidly becoming the standard of care for kidney retrieval during live kidney transplantation .
however vascular anomalies can increase difficulty of the operation and lead to an increase in complications .
we report a case of left retroperitoneoscopic donor nephrectomy in a donor with a duplicated inferior vena cava ( ivc ) .
a 48-year - old woman was evaluated as a potential kidney donor for her son .
blood and urine investigations were within normal limits and ultrasound revealed normal sized kidneys without any abnormality .
a diethylene triamine pentaacetic acid renal scan revealed a glomerular filtration rate of 51 ml / min on the right side and 44 ml / min on the left . computed tomography ( ct )
the left renal vein inserted to the normally located right side ivc , and the left ivc was draining into the left renal vein [ figure 1 ] .
both gonadal and lumbar veins were opening into the left ivc , whereas the adrenal vein was opening into the left renal vein .
there were one left and two right renal arteries . due to the presence of multiple renal arteries and a better function on the right side ,
the left renal vein and cephalic portion of the duplicated ivc just below its confluence with the renal vein were dissected .
two hem - o - loc clips were applied to control the left ivc just below its confluence with the left renal vein [ figure 2 ] .
gonadal and lumbar tributaries of the left ivc were preserved to allow for collateral drainage .
subsequently , the artery and renal vein were controlled and the kidney was removed . at bench surgery ,
the hem - o - loc clip was removed and the large opening in the left renal vein was repaired by continuous running suturing of 6/0 polypropylene .
the renal allograft was uneventfully transplanted into the right iliac fossa of the recipient using external iliac vessels for revascularization .
the length of the graft renal vein with segment of ivc was adequate and allowed easy anastomosis with the external iliac vein .
the donor made an uneventful recovery requiring minimal analgesics and was discharged on the second postoperative day .
serum creatinine achieved was 1.21 mg % on day 7 and 1.08 mg % at 1 month .
venous phase of ct angiography showing confluence of the duplicated left ivc and left renal vein intraoperative view of clips on proximal portion of the left ivc .
a  renal artery , v  renal vein , ivc - duplicated inferior vena cava , ao 
, the adoption of ct angiography for donor evaluation instead of conventional angiography has allowed the delineation and thus detection of venous anomalies .
although a venous anomaly was present , its accurate anatomical assessment allowed us to proceed with retroperitoneoscopic donor nephrectomy .
however , we have not encountered this anomaly previously in over 1000 consecutive ct renal angiographies performed in potential renal donors .
anomalies of the ivc include transposition of the ivc , duplication of the ivc , circumaortic renal collar , and retroaortic renal vein .
we have described previously the successful procurement of kidney by the retroperitoneoscopic approach when an anomalous renal vein was opening into the common iliac vein .
three sets of paired venous channels , the posterior cardinal , supracardinal , and subcardinal veins , develop and regress , leading to the formation of the ivc , renal , adrenal , and gonadal veins .
the venous phase of angiography delineates the anatomy of tributaries of the left renal vein .
most bleeding during laparoscopic donor nephrectomy occurs due to injury of tributaries of the left renal vein rather than injury to the vein itself .
two earlier reports describe hand - assisted laparoscopic donor nephrectomy in donors with duplicated ivc .
ours is the first report of pure retroperitoneoscopic left donor nephrectomy in a donor with a duplicated ivc .
we favored the retroperitoneoscopic approach because of direct access it provides to the left - sided ivc , left renal vein , and their tributaries . with suitable laparoscopic experience and adequate imaging ,
donors with anomalous venous anatomy may safely be offered retroperitoneoscopic donor nephrectomy . in the case of duplicated ivc , the left component of the ivc may be divided without deleterious effect to the donor .
 vascular anomalies increase the difficulty during live donor nephrectomy . we herein report a left - sided retroperitoneoscopic living donor nephrectomy performed in a donor with a duplicated inferior vena cava ( ivc ) . 
 computed tomography angiography provided accurate delineation of the venous anatomy and allowed preoperative planning . 
 the duplicated ivc was clipped and divided just below its confluence with the left renal vein . 
 the length of the left renal vein was sufficient for anastomosis in the recipient , and the recipient 's serum creatinine was 1.21% on day 7 . 
 the donor made an uneventful recovery . 
 duplicated ivc is not a contraindication for left retroperitoneoscopic donor nephrectomy . 
Introduction
Case Report
Discussion