How to improve the safety of polymer clips for vascular control during laparoscopic donor nephrectomy

Purpose: To evaluate the use of a new modification of the technique for controlling the renal pedicle during laparoscopic donor nephrectomy (LDN) with Hem-o-Lok clips. Patients and Methods: From July 2005 to January 2007, 241 candidates for left LDN were enrolled in the study. There were 175 men, and the mean age of the patients was 27.84 ± 4.96 years. At the end of procedure for renal-artery closure, one 10-mm Hem-o-Lok clip was applied a few millimeters distal to the root from the aorta, and a medium-large titanium clip was applied distal to the Hem-o-Lok clip using a non-automatic firing applier to exert sufficient closing pressure to the titanium clip to ensure adequate tightness. Then the renal vein was doubly ligated with one 12-mm and one 10-mm Hem-o-Lok clip. Results: With these modifications, there were no intraoperative or perioperative bleeding complications, clip dislodgments, or slippages. The conversion rate was zero, and the mean warm-ischemia time was 7.50 ± 0.71 minutes (range 3-17 minutes). Graft function was excellent, with a mean serum creatinine concentration of 1.42 ± 0.46 mg/dL after 12 months of follow-up and no renal-artery or -vein thrombosis in any of the grafts. Conclusion: With this technique, there is more security on the arterial closure, and sufficient pedicle length can be obtained for anastomosis. The warm-ischemia time is within an acceptable range. Also, this approach is less expensive than the use of endovascular staplers.