Techniques of vascular control in laparoscopic donor nephrectomy

Area of Science:

• Minimally Invasive Surgery
• Transplant Surgery
• Surgical Devices

Background:

• Laparoscopic donor nephrectomy is standard for living donor kidney removal.
• ENDO GIA staplers are commonly used for renal vessel division but can reduce graft vascular length and malfunction.
• Alternative vascular control methods are sought to optimize outcomes.

Purpose of the Study:

• To evaluate the safety and efficacy of polymer locking clips for vascular control during laparoscopic donor nephrectomy.
• To compare outcomes using polymer locking clips versus the ENDO GIA stapler.
• To assess the impact on graft vascular length and complications.

Main Methods:

• Eleven laparoscopic donor nephrectomies utilized polymer locking clips for renal artery and vein division.
• Vascular control was achieved with at least two polymer locking clips on the donor side.
• Outcomes were compared to 33 prior cases using the ENDO GIA stapler for renal vein control.

Main Results:

• Operative and warm ischemia times were comparable between the two techniques.
• Polymer locking clips allowed for harvesting of nearly the entire renal vein length.
• No vascular complications or graft loss occurred with polymer locking clips; one stapler malfunction required conversion to open surgery.

Conclusions:

• Polymer locking clips are a safe and effective method for vascular control in laparoscopic donor nephrectomy.
• This technique yields greater renal vessel length compared to stapler devices.
• No device failures were observed with polymer locking clips in this series.