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Revista do Colégio Brasileiro de Cirurgiões
On-line version ISSN 1809-4546
BRANCO FILHO, Alcides José et al. Control of renal vessels using titanium clips and cotton suture in hand-assisted laparoscopic live donor nephrectomy. Rev. Col. Bras. Cir. [online]. 2005, vol.32, n.1, pp. 36-40. ISSN 1809-4546. http://dx.doi.org/10.1590/S0100-69912005000100009.
BACKGROUND: Laparoscopic live donor nephrectomy has acquired an important role in the minimally invasive surgery era, decreasing morbidity to kidney donors, with an equivalent renal graft outcome compared with open surgery. The aim of this article is report our experience using the technique of renal vessels control with metallic clips and cotton suture. METHODS: Fourty-five nephrectomies were performed following the hand-assisted technique and using titanium clips (LT-300) and cotton suture for renal vessels ligatures. Operative data and postoperative courses were reviewed, including surgical time, estimated blood loss, warm ischemia time, length of hospital stay, conversion to laparotomy, and complications. RESULTS: The procedure was performed successfully in all cases, including 18 right nephrectomies and 27 left nephrectomies. The mean operative time in our series was 118 minutes, with an estimated blood loss of 84ml and warm ischemia time of 4.3 minutes. Two cases of postoperative ileus, one gonadal vein lesion, one metallic clip displacement and one ureteral necrosis were observed. The mean postoperative hospital stay was 3.7 days. The use of titanium clips and cotton suture reduced the loss of venous tissue compared to the technique using the Endo-GIA stapling device (4 to 6 mm vs. 10 to 15 mm) and showed to be associated with a cost reduction, saving about 700 US dollars per stapler. CONCLUSION: Hand-assisted nephrectomy using the above described technique is technically feasible and showed to be effective in reducing costs and decreasing the loss of vascular length.
Keywords : Kidney transplantation; Transplantation [methods]; Laparoscopy; Living donors; Nephrectomy.