Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada.
Division of Urology, Department of Surgery, Mackenzie Health, University of Toronto, Vaughan, Canada.
Urology. 2021 Jan;147:150-154. doi: 10.1016/j.urology.2020.10.038. Epub 2020 Nov 7.
To review our experience using clips to control the renal vessels during laparoscopic donor nephrectomy (LDN) and determine the safety of this practice.
We performed a retrospective review of patients who underwent LDN at our centre January 1, 2007-September 17, 2019. The primary outcome was the rate of complication associated with vascular control of the renal vessels, which included (1) conversion to open to manage bleeding, (2) additional procedures for bleeding, and (3) major bleeding requiring blood transfusion. Secondary outcomes included the rate of renal artery/vein clip dislodgement or crossing, change in hemoglobin, warm ischemia time and the incidence of intra-operative complications and postoperative in-hospital complications.
We included 503 patients who underwent LDN, of which 497 were left sided. The main renal artery was controlled with 3 titanium clips in 489 (97%) cases. The main renal vein was controlled with 2 polymer-locking clips in 478 (95%) cases. For our primary outcome, there were no conversions to open to manage bleeding, no secondary procedures due to bleeding and no major bleeding requiring blood transfusion. Additionally, there were no donor deaths. Regarding our secondary outcomes, there were 5 intraoperative events related to the titanium clips being placed on the renal artery and 1 intraoperative event related to the polymer-locking clips on the renal vein, none of which resulted in any morbidity.
Using 3 titanium clips on the renal artery and 2 polymer-locking clips on the renal vein during left LDN is safe and provides excellent vascular control.
回顾我们在腹腔镜供肾切取术（LDN）中使用夹子控制肾血管的经验，并确定这种操作的安全性。
我们对 2007 年 1 月 1 日至 2019 年 9 月 17 日在我们中心接受 LDN 的患者进行了回顾性分析。主要结局是与肾血管血管控制相关的并发症发生率，包括（1）转为开放手术以处理出血，（2）因出血而进行的其他处理，以及（3）需要输血的严重出血。次要结局包括肾动脉/静脉夹移位或交叉、血红蛋白变化、热缺血时间以及术中并发症和术后住院并发症的发生率。
我们纳入了 503 例接受 LDN 的患者，其中 497 例为左侧。489 例（97%）采用 3 个钛夹控制主肾动脉，478 例（95%）采用 2 个聚合物锁定夹控制主肾静脉。对于我们的主要结局，没有因出血而转为开放手术，没有因出血而进行的二次处理，也没有因需要输血而发生严重出血。此外，没有供体死亡。关于我们的次要结局，有 5 例与钛夹放置在肾动脉相关的术中事件和 1 例与聚合物锁定夹放置在肾静脉相关的术中事件，均未导致任何发病率。
在左侧 LDN 中使用 3 个钛夹控制肾动脉和 2 个聚合物锁定夹控制肾静脉是安全的，可提供良好的血管控制。
