Liu K-L, Chiang Y-J, Wang H-H, Chu S-H
Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
Transplant Proc. 2008 Sep;40(7):2342-4. doi: 10.1016/j.transproceed.2008.06.016.
Laparoscopic donor nephrectomy has become the method of choice for removal of living donor kidneys. The ENDO GIA stapler is commonly used for division of the renal vessels, but it can lead to some loss of graft vascular length. Besides, stapler malfunction can occur. In this study, we report our experience using polymer locking clips for vascular control, compared with previous experience using the ENDO GIA stapler.
Eleven donors underwent laparoscopic donor nephrectomy from November 2005 to September 2007. Both renal artery and vein were divided after 2 or more polymer locking clips had been applied on the donor side. The operative times, warm ischemia times, graft function, and vascular complications were compared with the previous 33 donors using the ENDO GIA stapler for renal vein control.
The operative and warm ischemia times were similar. With the polymer locking clip technique, we harvested nearly the entire renal vein length. There were no vascular complications or graft loss with the use of polymer locking clips. In our series, malfunction of the ENDO GIA stapler device occurred in 1 patient requiring the surgery to be converted to an open procedure. Both donor and recipient outcomes were similar no matter whether polymer locking clips or the ENDO GIA stapler was used for vascular control during the laparoscopic donor nephrectomy.
In our series, there were no vascular complications and no device failure during vascular control using polymer locking clips. We believe that polymer locking clips are safe, yielding greater vessel length during laparoscopic donor nephrectomy.
腹腔镜供肾切除术已成为获取活体供肾的首选方法。ENDO GIA吻合器常用于离断肾血管，但这可能导致移植肾血管长度有所损失。此外，吻合器还可能出现故障。在本研究中，我们报告了使用聚合物锁定夹进行血管控制的经验，并与此前使用ENDO GIA吻合器的经验进行比较。
2005年11月至2007年9月期间，11名供者接受了腹腔镜供肾切除术。在供者侧应用2个或更多聚合物锁定夹后，离断肾动脉和肾静脉。将手术时间、热缺血时间、移植肾功能及血管并发症与此前33名使用ENDO GIA吻合器控制肾静脉的供者进行比较。
手术时间和热缺血时间相似。采用聚合物锁定夹技术，我们获取了几乎整个肾静脉长度。使用聚合物锁定夹未出现血管并发症或移植肾丢失。在我们的系列研究中，1例患者的ENDO GIA吻合器装置发生故障，手术被迫转为开放手术。无论在腹腔镜供肾切除术中使用聚合物锁定夹还是ENDO GIA吻合器进行血管控制，供者和受者的结局相似。
在我们的系列研究中，使用聚合物锁定夹进行血管控制时未出现血管并发症和器械故障。我们认为，聚合物锁定夹是安全的，在腹腔镜供肾切除术中可获得更长的血管长度。
