Arterial anastomosis without sutures using ring pin stapler for clinical renal transplantation: comparison with suture anastomosis.
OBJECTIVE
The metal ring pin stapler was initially developed for microvascular surgery and there has been little experience of their use in larger vessels. We determined if the titanium ring pin coupling system could be safely and rapidly applied for arterial reconstruction in clinical renal transplantation.


METHODS
The donor renal artery was end-to-end anastomosed to the internal iliac artery with titanium ring pin staplers in 36 patients. Anastomotic, clamp and total operative time and vascular problems were compared with those in the control group of sutured anastomosis in 39 transplant recipients.


RESULTS
The completion of mechanical anastomosis required half the time of suture anastomosis. Mean clamp time was 17.8 minutes in the nonsuture group and 28.1 minutes in the control group. There was no significant difference in total operative time between the 2 groups. A small anastomotic line leak was noted in each group, which was temporary and self-limited. There were no postoperative anastomotic failures, postoperative bleeding episodes or need to revise the anastomosis (100% patency rate) in the 2 groups. Of the patients 61 were followed for 2 to 5 years. Transplant renal artery stenosis was observed in 1 patient in the nonsuture group but 3 in the control group.


CONCLUSIONS
The anastomotic technique with the ring pin system is safe and simple, permitting an expeditious and everting anastomosis with a smooth intima-to-intima junction. Application of this technique may decrease warm ischemia time and the incidence of anastomotic artery stenosis, thus, improving outcomes.
Ye
Gang
G
Department of Urology, Center of Nephrology, Xinqiao Hospital, Third Military Medical University, Chongqing, People's Republic of China. gangye@cta.cq.cn
Mo
Hua-Gen
HG
Wang
Ze-Hou
ZH
Yi
Shan-Hong
SH
Wang
Xiang-Wei
XW
Zhang
Yin-Fu
YF
D000328:Adult; D000714:Anastomosis, Surgical; D004867:Equipment Design; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D012077:Renal Artery / Q000601:surgery*; D013528:Surgical Staplers; D014656:Vascular Surgical Procedures / Q000379:methods