Pedicular vascular control in laparoscopic living donor nephrectomy: The use of clips instead of stapler in 341 donors.
OBJECTIVE
To demonstrate a less expensive approach for laparoscopic donor nephrectomy.


METHODS
Left donor nephrectomy was done transperitoneally in flank position. Renal vein and artery were exposed and prepared for nephrectomy. Nondisposable trocars and instruments were used. The adrenal vein was clipped and its arteries were bipolar coagulated. Both renal artery and vein were clip-ligated using three medium large nonautomatic metallic clips and divided, instead of using rather expensive vascular endostapler. Kidney was hand-extracted from suprapubic incision (no Endobag was used).


RESULTS
Donor nephrectomy was performed in 341 donors. Mean warm ischemia time was 8.17 minutes. Mean operative time was 260.3 minutes. Conversion and reoperation was required in 2.1% and 3.8% of donors, respectively. Ureteral complications were observed in 2.1% of recipients. No vascular accident occurred from pedicular vessels. One-year graft survival in recipients was 92.6%. By this approach, at least $600 was saved in each nephrectomy.


CONCLUSIONS
Laparoscopic donor nephrectomy can be performed with a less expensive setup without adverse effects on graft outcome. Vascular control using nonautomatic clips instead of more costly vascular endostapler and also hand extraction of the kidney is safe, practical, and economical.
Department of Kidney Transplantation, Shaheed Labbafinejad Medical Center, Urology and Nephrology Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran. simforoosh@iurtc.org.ir
N
N
Simforoosh
A
A
Basiri
A
A
Tabibi
M R
MR
Fattahi
M N
MN
Semnani
K N
KN
Mahdavi
H S
HS
Majdpour
S
S
Behjati
D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D019520:Living Donors; D009392:Nephrectomy / Q000379:methods*; D012077:Renal Artery / Q000601:surgery; D012079:Renal Circulation; D012082:Renal Veins / Q000601:surgery; D012189:Retrospective Studies; D012449:Safety; D013525:Surgical Instruments; D013537:Sutures; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000379:methods*