Vascular Clips Are Safe and a Great Cost-Effective Technique for Arterial and Venous Control in Laparoscopic Nephrectomy: Single-Center Experience with 1834 Laparoscopic Nephrectomies

Simforoosh, Nasser; Sedaghat, Reza; Basiri, Abbas; Ziaee, Seyed Amir Mohsen; Sharifiaghdas, Farzaneh; Tabibi, Ali; Nouralizadeh, Akbar; Kashi, Amir Hossein; Moosanejad, Nadali

doi:10.1089/end.2011.0619

Cited by 39 publications

(34 citation statements)

References 19 publications

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“…Equally strong arguments have been published for the use of Hemolok clips. [14,15] Endovascular transfixing stapler devices are not without problems. Chan et al [16] and Deng et al [17] reviewed their own cases and the literature and found two donor deaths as a consequence of stapler failure.…”

Section: Discussionmentioning

confidence: 99%

Retroperitoneoscopic live donor nephrectomy: Review of the first 50 cases at Tygerberg Hospital, Cape Town, South Africa

Merwe¹,

Cf²

2014

S Afr J Surg

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Background.Changing from an open to a laparoscopic live renal donor programme poses challenges and may affect donor and graft outcomes. Objectives. To evaluate donor safety and graft outcomes for the first 50 retroperitoneoscopic live donor nephrectomies performed at Tygerberg Hospital, Cape Town, South Africa. Methods. The procedures were performed by a single surgeon from 8 April 2008 to 3 April 2012. Operative and anatomical data were prospectively collected. A flank approach with lateral and posterior placements was used. Vascular control was achieved with Hemolok clips in the majority of cases. Results. The mean age of the donors was 31.5 years (range 18 50), 28 (56.0%) were male, and the left kidney was harvested in 28 (56.0%) of cases. The mean operating time was 149.8 minutes (range 75 250), mean warm ischaemic time (WIT) 181.3 seconds (107 630), mean blood loss 139.7 ml (5 700) and mean hospital stay 3.2 days (2 5). Mean WIT was significantly longer for rightsided than leftsided nephrectomy (213 v. 162 seconds). In two rightsided cases the renal vein was too short and vena profunda femoris was used to create length. No donor received a blood transfusion. Comparing the last 25 with the first 25 cases showed a significant decrease in mean WIT (158 v. 204 seconds, respectively) and operating time (128 v. 172 minutes, respectively). No major complications occurred. Conclusion. Our initial 50 retroperitoneoscopic live donor nephrectomies were performed without major complications. Donor safety was maintained during the early learning curve of the transition to minimalaccess donor nephrectomy.S Afr J Surg 2013;52(2):5356.

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Section: Discussionmentioning

confidence: 99%

Retroperitoneoscopic live donor nephrectomy: Review of the first 50 cases at Tygerberg Hospital, Cape Town, South Africa

Merwe¹,

Cf²

2014

S Afr J Surg

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“…Many techniques have been used to secure the renal artery and vein during laparoscopic nephrectomy (like Hem-o-lock clips, titanium clips or Vascular Stapler) [14][15][16], but ligation and division of the renal hilum are critical steps during any procedure with any techniques of vascular control for the risks of serious complications [17,18]. EndoGIA staplers are widely used to manage vessels in laparoscopic nephrectomy because of their feasibility and safety and their use has become standard practice [19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Bleeding Control and Vascular Preservation in Laparoscopic Living Donor Nephrectomy. Powered vs. Mechanical Vascular Stapler: A Possible Real Advantage

Gl¹,

Baccarani²,

Cherchi³

et al. 2017

J Kidney

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Kidney transplantation (KTx) is the treatment of choice for end stage renal disease (ESRD), improving both quality, and quantity of life in the recipients. Living Donor Kidney Transplantation (LDKT) is both related to a longer patient and graft survival, and laparoscopic donor nephrectomy (LDN) is the procedure of choice by most transplants Centers. Even though many techniques have been used to secure both the renal artery and vein during laparoscopic nephrectomy (Hem-o-lock clips, titanium clips or Vascular Stapler), ligation and division of the renal hilum remain two critical steps, entailing a certain risk of serious complications. Mechanical EndoGIA vs. iDrive ™ Ultra Powered Stapling System (Autosuture; Covidien Surgical, Mansfield) have been compared. iDrive ™ is a reusable, handled stapler computer-controlled stapling systems that runs on battery and can be used on multiplepatients. It comprises a hand-held control unit, and a loading unit, which consists in a powered EndoGIA cartridge. We evaluated safety, efficacy, maneuverability and ergonomics for renal vascular control during LDN. Moreover, the differences in costs between the two procedures were also analyzed. There were no malfunctions or complications related to the use of iDrive ™ requiring conversion to open procedure. Advantages in maneuverability and costs were also observed. The total timing related to the use of the devices was statistically significant shorter for the iDrive ™ than for the EndoGIA being respectively 3.4 ± 0.4 minutes vs. 4.2 ± 0.4 minutes (p=0.0014). In our experience, iDrive ™ is safe and feasible for separate ligation and accurate division of renal artery and vein during LDN. The system also helps to minimize the need for additional maneuvers to secure the renal hilum. Furthermore, it allows greater precision of cutting on the kidney vessels that will have to be used for transplantation.

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“…staplers) (12). When staplers were compared to Hem-o-lok 1 clips in a center in Iran, the clips cost $20 per donor, while a stapler cost $690 per donor (10). However, from a societal perspective, the laparoscopic procedure is cost-efficient 2 Any kind of re-intervention such as re-stapling, re-clipping, oversew.…”

Section: Discussionmentioning

confidence: 99%

“…They reported that no complication was clearly related to failure of vascular clips. They concluded that clips, when applied by trained surgeons and according to published safety guidelines, provide a safe and cost-saving option for vascular control in LDNs (10). However, the most recent published article in 2009 on FDA reported technical failures of vascular control techniques suggests the opposite.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Vascular Management During Live Donor Nephrectomy: An Online Survey Among Transplant Surgeons

Janki

Verver

Klop

et al. 2015

American Journal of Transplantation

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Vascular Clips Are Safe and a Great Cost-Effective Technique for Arterial and Venous Control in Laparoscopic Nephrectomy: Single-Center Experience with 1834 Laparoscopic Nephrectomies

Abstract: Hem-o-lok and metallic vascular clips applied properly by trained surgeons according to published safety measures provide a safe and considerable cost-saving option for vascular control in laparoscopic nephrectomy.

Cited by 39 publications

References 19 publications

Retroperitoneoscopic live donor nephrectomy: Review of the first 50 cases at Tygerberg Hospital, Cape Town, South Africa

Retroperitoneoscopic live donor nephrectomy: Review of the first 50 cases at Tygerberg Hospital, Cape Town, South Africa

Bleeding Control and Vascular Preservation in Laparoscopic Living Donor Nephrectomy. Powered vs. Mechanical Vascular Stapler: A Possible Real Advantage

Vascular Management During Live Donor Nephrectomy: An Online Survey Among Transplant Surgeons

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