How to improve the safety of polymer clips for vascular control during laparoscopic donor nephrectomy

To evaluate the use of a new modification of the technique for controlling the renal pedicle during laparoscopic donor nephrectomy (LDN) with Hem-o-Lok clips.

From July 2005 to January 2007, 241 candidates for left LDN were enrolled in the study. There were 175 men, and the mean age of the patients was 27.84 +/- 4.96 years. At the end of procedure for renal-artery closure, one 10-mm Hem-o-Lok clip was applied a few millimeters distal to the root from the aorta, and a medium-large titanium clip was applied distal to the Hem-o-Lok clip using a non-automatic firing applier to exert sufficient closing pressure to the titanium clip to ensure adequate tightness. Then the renal vein was doubly ligated with one 12-mm and one 10-mm Hem-o-Lok clip.

With these modifications, there were no intraoperative or perioperative bleeding complications, clip dislodgments, or slippages. The conversion rate was zero, and the mean warm-ischemia time was 7.50 +/- 0.71 minutes (range 3-17 minutes). Graft function was excellent, with a mean serum creatinine concentration of 1.42 +/- 0.46 mg/dL after 12 months of follow-up and no renal-artery or -vein thrombosis in any of the grafts.

With this technique, there is more security on the arterial closure, and sufficient pedicle length can be obtained for anastomosis. The warm-ischemia time is within an acceptable range. Also, this approach is less expensive than the use of endovascular staplers.