Vascular Control of the Renal Pedicle Using Non-Absorbable Polymer Ligating Clips in Hand-Assisted Living Donor Laparoscopic Nephrectomies

Different vascular control devices have been widely used in laparoscopic donor nephrectomy (LDN); within those, we find the non-absorbable polymer ligating (NPL) clip and vascular stapler (VS). Although some warnings have been reported due to hemorrhagic events secondary to the use of NPL clips, some transplant groups have shown studies that support the safe use of NPL clips for renal artery and vein control during LDN (1).

This study aimed to describe the experience of a transplant center where we evaluate the safety of the use of NPL clips in LDN.

A total of 500 nephrectomies were performed in our center from July 2003 to July 2017. In all procedures, vascular control was done by placing two proximal NPL clips both in the artery and left renal vein or two NPL clips in the renal artery and a VS in the right renal vein. The data were obtained retrospectively from the records of clinical data. Demographic analysis and perioperative variables were described separately for both of the NPL and VS groups.

Vascular control was performed with VS in 68 patients (13.6%) and with NPL clips in 431 patients (86.3%). Operating room time, intra-operative bleeding, and hospital stay were similar in both groups without finding a significant difference in the proportion of complications. There was no bleeding or donor loss caused by NPL clips at intraoperative, perioperative, and postoperative periods in the cases who underwent nephrectomy using the two methods.

Our results support the advantages, security, efficacy, and low cost of the use of NPL to control renal vessels during laparoscopic nephrectomy.