Use of ETS-FLEX endoscopic linear vascular cutter in donor nephrectomy and transplantation surgery: a single institution's experience.
OBJECTIVE
We describe our experience with the use of ETS-FLEX endoscopic linear vascular cutter from January 2000 to October 2004 in live-donor nephrectomy and pancreatic bench work.


METHODS
In live-donor nephrectomy, ETS-FLEX endoscopic linear vascular cutter (ELVC) is used for the stapling and division of renal vessels and ureter. When positioned on a vessel, the vascular cutter applies 3 staple lines proximally and 3 distally, and the vessel in between them is divided. In pancreatic graft bench work, ELVC is applied in 3 steps: the splenectomy, ligation of the mesenteric root, and the ligation of any peripancreatic lymphatic tissue or small vessels.


RESULTS
From October 2000 to October 2004, we performed 80 living-donor nephrectomies in 56 men and 24 women (mean age, 39 years; range, 24-63 years). Thirty-one grafts were with multiple vessels. Mean warm ischemia time was 60+/-5 seconds. Mean operative time was 60+/-10 minutes. In all cases, there was no need for further hemostasis after removal of the kidney. There were no operative complications. All grafts were successfully revascularized with 100% graft survival (range of follow-up, 1-48 months). Patients' length of stay in hospital was 3+/-1 days. We have used the ETS-FLEX ELVC in 30 pancreatic graft preparations since January 2000. Mean time taken for the bench work preparation including Y-graft anastomosis was 45 +/- 10 minutes. Following revascularization, there was excellent perfusion with minimal and easily controllable bleeding that did not require blood transfusion.


CONCLUSIONS
We believe that our use of the laparoscopic instrument, ETS-FLEX ELVC, with a mini-incision technique in live-donor nephrectomy and pancreatic graft preparation makes these complex and time-consuming procedures simple and fast, minimizing the chances of postoperative complications and resulting in excellent patient and graft survival.
Hakim
Nadey S
NS
Transplant Unit, St Mary's Hospital, London, United Kingdom. nadey@globalnet.co.uk
Dosani
Muhammad Tariq
MT
Papalois
Vassilios
V
D000328:Adult; D004724:Endoscopy; D004867:Equipment Design; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D016035:Pancreas Transplantation; D011300:Preoperative Care / Q000295:instrumentation; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000295:instrumentation*