title: Ureteral clipping simplifies hand-assisted laparoscopic donor nephrectomy.
abstract: OBJECTIVE
  We describe a technique of doubly clipping the distal ureter during hand-assisted laparoscopic donor nephrectomy (HALDN) to prevent urine accumulation, thereby simplifying renal hilar division and potentially decreasing the graft warm ischemic time.
  
  
  METHODS
  A technique of placing polymer-locking clips across the distal ureter prior to division was developed to prevent urine accumulation and the need for suctioning during critical hilar vessel division.
  
  
  RESULTS
  We found that ureteral clipping and the elimination of urine accumulation simplified renal hilar division. Retrospective assessment of a series of 27 sequential HALDNs (15 without and 12 with clipping) demonstrated similar estimated blood loss, total operative and warm ischemic times (P 0.13 to 0.18). No adverse impact on graft viability or recipient outcome was observed.
  
  
  CONCLUSIONS
  Distal ureter clipping to prevent urine accumulation around the renal hilum during HALDN is safe and helpful.
authors: Division of Urology, Department of Surgery, Medical College of Georgia, Augusta, Georgia, USA. james-brown-2@uiowa.edu
authors: James A
authors: JA
authors: Brown
authors: Kamran P
authors: KP
authors: Sajadi
authors: James J
authors: JJ
authors: Wynn
references: Surg Endosc. 2004 Mar;18(3):417-20
references: 14752655
references: Surg Endosc. 2004 Nov;18(11):1625-30
references: 15931475
references: Urology. 2006 Oct;68(4):747-50
references: 17070346
references: Ann Surg. 2008 Jan;247(1):58-70
references: 18156924