Utility of the endovascular stapler for right-sided laparoscopic donor nephrectomy: a 7-year experience at Mayo Clinic.
BACKGROUND
Management of the renal vasculature during right laparoscopic donor nephrectomy (LDN) to maximize vessel length has been controversial. The endovascular gastrointestinal anastomosis (GIA) stapler has been used for renal vascular control for our donors since the inception of our LDN program. We evaluated and compared the outcomes of right and left LDNs using a single method for hilar control.


METHODS
A retrospective review was performed of the first 400 LDNs and respective recipients at our institution. Patient demographics, perioperative variables, graft function, and complications were analyzed.


RESULTS
Four hundred LDNs were performed between 1999 and 2007. Forty-one were on the right. There were no statistically significant differences between the donor groups or their respective recipients. There were 4 (1%) stapler malfunctions, all occurring on the left side; 2 of these procedures were converted to open to obtain hemostasis. There were nearly equal rates of vascular complications, 4.9% and 4.7%, in the right and left groups, respectively. The overall immediate graft failure rate was 2.3%. Right and left recipient creatinine levels up to 24 months demonstrated no statistically significant differences.


CONCLUSIONS
We propose that the endovascular GIA stapler for left and right laparoscopic donor nephrectomy is safe for the donor. It standardizes the process, minimizes the need for additional maneuvers in securing the renal hilum, and produces similar outcomes for the recipient. The transplant team also plays an equally large role in favorable graft outcomes.
Ko
Edmund Y
EY
Department of Urology, Mayo Clinic, Phoenix, AZ 85054, USA.
Castle
Erik P
EP
Desai
Premal J
PJ
Moss
Adyr A
AA
Reddy
Kunam S
KS
Mekeel
Kristin L
KL
Mulligan
David C
DC
Andrews
Paul E
PE
D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000295:instrumentation* / Q000379:methods; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000295:instrumentation*; D016896:Treatment Outcome