Polymer clips (Hem-o-lok®) for Renal Vessel Control in Laparoscopic Living Donor Nephrectomy: 12 years of experience in a Tertiary Care Center
DOI:
https://doi.org/10.48193/revistamexicanadeurologa.v82i1.819Keywords:
Kidney transplantation, Living donor, Laparoscopy, Nephrectomy, Vascular closure devicesAbstract
Objective: To describe our experience using polymer clips (Hem-o-lok®) for renal vessel control in laparoscopic living donor nephrectomy (LLDN).
Materials and methods: We conducted a retrospective and descriptive analysis from our database of all minimally invasive living donor nephrectomies (hand-assisted and pure laparoscopic) performed from 2008 to 2020 in our institution. We included patients who underwent LLDN using polymer clips (Hem-o-lok®) for vascular control of renal arteries and veins, and whose clinical records were complete.
Results: 330 LLDN were performed, 183 (55.5%) were hand-assisted nephrectomies and 147 (44.5%) were pure laparoscopic nephrectomies. Mean warm ischemia time (WIT) was 3.98 minutes and median of estimated blood loss (EBL) was 100±140 ml. Four patients (1.2%) required conversion to an open procedure due to vascular injury. 31 complications (9.3%) were registered, of which 23 (6.9%) were non-life-threatening complications. No deaths nor loss of renal grafts were reported.
Limitations: the main drawbacks of this study are its retrospective nature, and that it is limited to only one center.
Originality and value: It is a study that questions the contraindication issued by the FDA for the use of polymer clips for vascular control in LLDN, demonstrating its use is a safe and effective option.
Conclusion
The use of polymer clips, specifically Hem-o-lok®, is a safe method for vascular control of the renal hilum vessels in laparoscopic living donor nephrectomies.
References
Gupta N, Raina P, Kumar A. Laparoscopic donor nephrectomy. J Minim Access Surg. 2005;1(4):155–64. doi: https://doi.org/10.4103/0972-9941.19262
Fonouni H, Mehrabi A, Golriz M, Zeier M, Müller-Stich BP, Schemmer P, et al. Comparison of the laparoscopic versus open live donor nephrectomy: an overview of surgical complications and outcome. Langenbecks Arch Surg. 2014;399(5):543–51. doi: https://doi.org/10.1007/s00423-014-1196-4
Villeda-Sandoval CI, Rodríguez-Covarrubias F, Cortés-Aguilar G, Alberú-Gómez J, Vilatobá-Chapa M, Sotomayor M, et al. Hand-assisted laparoscopic versus open donor nephrectomy: a retrospective comparison of perioperative and functional results in a tertiary care center in Mexico. Transplant Proc. 2013;45(9):3220–4. doi: https://doi.org/10.1016/j.transproceed.2013.03.055
Razón-Gutiérrez JE, Villeda Sandoval C, Rodríguez-Covarrubias F. Experiencia en nefrectomía laparoscópica de donador en un centro de tercer nivel. Rev Mex Urol. 2011;71(3):151–5.
McGregor TB, Patel P, Chan G, Sener A. Hilar control during laparoscopic donor nephrectomy: Practice patterns in Canada. Canadian Urological Association Journal. 2017;11(10):321–4. doi: https://doi.org/10.5489/cuaj.4490
Kwazneski D, Six C, Stahlfeld K. The unacknowledged incidence of laparoscopic stapler malfunction. Surg Endosc. 2013;27(1):86–9. doi: https://doi.org/10.1007/s00464-012-2417-y
Friedman AL, Peters TG, Ratner LE. Regulatory failure contributing to deaths of live kidney donors. Am J Transplant. 2012;12(4):829–34. doi: https://doi.org/10.1111/j.1600-6143.2011.03918.x
Hsi RS, Ojogho ON, Baldwin DD. Analysis of techniques to secure the renal hilum during laparoscopic donor nephrectomy: review of the FDA database. Urology. 2009;74(1):142–7. doi: https://doi.org/10.1016/j.urology.2008.11.010
Cabello R, García JV, Quicios C, Bueno G, González C. Is There a New Alternative for a Safer Kidney Artery Ligation in Laparoscopic Donor Nephrectomy? Journal of Laparoendoscopic & Advanced Surgical Techniques. 2017;27(7):715–6. doi: https://doi.org/10.1089/lap.2016.0271
Kocak B, Koffron AJ, Baker TB, Salvalaggio PRO, Kaufman DB, Fryer JP, et al. Proposed classification of complications after live donor nephrectomy. Urology. 2006;67(5):927–31. doi: https://doi.org/10.1016/j.urology.2005.11.023
Chan D, Bishoff JT, Ratner L, Kavoussi LR, Jarrett TW. Endovascular gastrointestinal stapler device malfunction during laparoscopic nephrectomy: early recognition and management. J Urol. 2000;164(2):319–21. doi: https://doi.org/10.1016/S0022-5347(05)67349-1
Deng DY, Meng MV, Nguyen HT, Bellman GC, Stoller ML. Laparoscopic linear cutting stapler failure. Urology. 2002;60(3):415–9; discussion 419-420. doi: https://doi.org/10.1016/s0090-4295(02)01778-8
Dekel Y, Mor E. Hem-o-lok clip dislodgment causing death of the donor after laparoscopic living donor nephrectomy. Transplantation. 2008;86(6):887. doi: https://doi.org/10.1097/tp.0b013e31818620b1
Ponsky L, Cherullo E, Moinzadeh A, Desai M, Kaouk J, Haber G-P, et al. The Hem-o-lok clip is safe for laparoscopic nephrectomy: a multi-institutional review. Urology. 2008;71(4):593–6. doi: https://doi.org/10.1016/j.urology.2007.11.015
Baumert H, Ballaro A, Arroyo C, Kaisary AV, Mulders PFA, Knipscheer BC. The Use of Polymer (Hem-o-lok) Clips for Management of the Renal Hilum During Laparoscopic Nephrectomy. European Urology. 2006;49(5):816–9. doi: https://doi.org/10.1016/j.eururo.2005.12.073
Bittner JG, Sajadi K, Brown JA. Comparison of renal artery occlusion techniques in hand-assisted laparoscopic living donor nephrectomy. J Endourol. 2009;23(6):933–7. doi: https://doi.org/10.1089/end.2008.0297
Siqueira TM, Mitre AI, Simoes FA, Maciel AF, Ferraz AM, Arap S. A cost-effective technique for pure laparoscopic live donor nephrectomy. Int Braz J Urol. 2006;32(1):23–8; discussion 28-30. doi: https://doi.org/10.1590/s1677-55382006000100004
Vinson AJ, Rose C, Kiberd BA, Odutayo A, Kim SJ, Alwayn I, et al. Factors Associated With Prolonged Warm Ischemia Time Among Deceased Donor Kidney Transplant Recipients. Transplant Direct. 2018;4(5):e342. doi: https://doi.org/10.1097/txd.0000000000000781
Liu Y, Huang Z, Chen Y, Liao B, Luo D, Gao X, et al. Staplers or clips?: A systematic review and meta-analysis of vessel controlling devices for renal pedicle ligation in laparoscopic live donor nephrectomy. Medicine (Baltimore). 2018;97(45):e13116. doi: https://doi.org/10.1097/md.0000000000013116
Chan D, Fabrizio M, Ratner L, Kavoussi L. Complications of laparoscopic live donor nephrectomy: The first 175 cases. Transplantation proceedings. 2000;32:778. doi: https://doi.org/10.1016/S0041-1345(00)00979-9
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