title: Is There a New Alternative for a Safer Kidney Artery Ligation in Laparoscopic Donor Nephrectomy?
abstract: Controlled ligation and division of the renal hilum are critical steps during laparoscopic living donor nephrectomy. Major hemorrhage from technical failure, although an infrequent occurrence, can cause significant, yet preventable, morbidity or death. Polymer-secured nontransfixion clips are used worldwide for renal pedicle control during laparoscopic nephrectomy, but their use is contraindicated for renal artery ligation during laparoscopic living donor nephrectomy. Laparoscopic staplers are reliable transfixion systems for controlling kidney pedicle. However, stapler malfunction is not negligible, reaching up to 1.7%. A new double shank (DS) titanium-secured nontransfixion clip can dodge legal concerns on polymer-secured clips, while maintaining most of their advantages, without technical failures that may be seen in laparoscopic staplers. New alternatives must be proposed and explored to reach an agreement of the urological community. The new DS-titanium-secured clips could be a step forward toward a safer surgery for kidney donors, at least equivalent to hand ties to occlude the renal artery.
authors.affiliation: Department of Urology, Hospital Universitario Fundación Jiménez Díaz , Madrid, Spain .
authors.forename: Ramiro
authors.initials: R
authors.lastname: Cabello
authors.affiliation: Department of Urology, Hospital Universitario Fundación Jiménez Díaz , Madrid, Spain .
authors.forename: Juan Vicente
authors.initials: JV
authors.lastname: García
authors.affiliation: Department of Urology, Hospital Universitario Fundación Jiménez Díaz , Madrid, Spain .
authors.forename: Cristina
authors.initials: C
authors.lastname: Quicios
authors.affiliation: Department of Urology, Hospital Universitario Fundación Jiménez Díaz , Madrid, Spain .
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Bueno
authors.affiliation: Department of Urology, Hospital Universitario Fundación Jiménez Díaz , Madrid, Spain .
authors.forename: Carmen
authors.initials: C
authors.lastname: González
mesh_terms: D016063:Blood Loss, Surgical; D006801:Humans; D016030:Kidney Transplantation; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods; D008026:Ligation / Q000295:instrumentation / Q000379:methods; D019520:Living Donors; D009392:Nephrectomy / Q000295:instrumentation* / Q000379:methods; D011183:Postoperative Complications; D012077:Renal Artery / Q000601:surgery*; D013525:Surgical Instruments; D020858:Tissue and Organ Harvesting / Q000379:methods
keywords: kidney transplantation; laparoscopy; living donor; nephrectomy; renal artery