Electrothermal Lymphatic Sealing (LigaSure) Versus Conventional Hand-Tie Ligation for Control of Perivascular...

Ligation of iliac vessel lymphatics is essential for preventing lymphocele in kidney transplant (KT) recipients. Electrothermal bipolar vessel sealer (EBVS) such as LigaSure (Medtronic) may offer technical advantages. This study aimed to evaluate the safety and efficacy of lymphatic sealing using LigaSure in KT recipients compared to conventional hand-tie ligation.

A mixed prospective-retrospective cohort study was conducted at a single center. The 'hand-tie group' included data collected from 300 KT recipients transplanted between May 2017 and May 2020 using hand-tie lymphatic ligation. The "LigaSure group" included 100 patients prospectively enrolled and transplantation done between April 2023 and December 2024 during which retroperitoneal dissection was done using LigaSure. Outcomes included postoperative drain volume, retroperitoneal dissection time, operation time, transfusion requirements, lymphocele formation, and bleeding complications.

Retroperitoneal dissection time was significantly shorter in the LigaSure group compared to the hand-tie group (34.5 ± 12.4 vs 45 ± 19.3 minutes, p < .001). While the LigaSure group had slightly higher drain output volume, the difference was not clinically significant. However, the LigaSure group required more frequent Viscum album extract injections (p < .001). Lymphocele requiring intervention was observed in one patient in the LigaSure group and 2 patients in the hand-tie group. Postoperative hemoglobin levels were significantly lower in the LigaSure group, while transfusion rates and bleeding-related interventions did not differ significantly.

Using LigaSure is safe in terms of bleeding control and lymphocele prevention and can effectively shorten the retroperitoneal dissection time during kidney transplantation compared to the hand-tie technique.