Techniques to optimize vascular control during laparoscopic donor nephrectomy.

Abstract

OBJECTIVES: To review our experience with laparoscopic donor nephrectomy for kidney transplantation and describe our technique of vessel ligation. METHODS: We retrospectively analyzed the method of renal artery and vein control during the 97 laparoscopic donor nephrectomies performed at the University of California, San Francisco, since November 1999. In addition, we examined both donor and recipient outcomes after nephrectomy and transplantation in this cohort. RESULTS: Currently, we ligate the renal artery and renal vein using a single Hem-o-lok polymer clip and a single Endo-TA stapler, respectively, and divide the vessels using scissors without securing the graft-side vessels. In contrast to using the Endo-GIA stapler, there is no need to trim staples (approximately 5 mm) from the vessels before anastomosis. Excellent vessel length was achieved in all cases without donor complications, and 99% of recipients had long-term graft function. The only major complications (blood transfusion, conversion to open surgery) occurred early in the series when we used the Endo-GIA stapler to control the vessels. CONCLUSIONS: Although adequate vessel length is typically obtained during left donor nephrectomy, additional length can be achieved using our modification. This may facilitate right donor nephrectomy and help reduce complications, potentially increasing the recovery of right kidneys for transplantation. In addition, performing vessel ligation and division in separate steps is simple, does not change ischemic time, and appears to increase safety.