Comparison of renal artery occlusion techniques in hand-assisted laparoscopic living donor nephrectomy

Purpose: This study assessed differences in outcomes between left renal artery clipping and stapling techniques in hand-assisted laparoscopic living donor nephrectomy (HALDN). Patients and Methods: From 2003 to 2007, 55 HALDN procedures were performed by one laparoscopy-trained urologist. During the first 30 months, 27 consecutive HALDN patients underwent renal artery occlusion with two nonabsorbable polymer locking clips (group 1). The subsequent 18 months saw 28 consecutive HALDN patients receive three-row vascular stapling to occlude the renal artery (group 2). The preoperative patient factors were age, sex, body mass index, serum creatinine (Cr), and presence of supernumerary left renal artery. Intraoperative factors included estimated blood loss (EBL), operative time (OT), and warm ischemia time (WIT). Postoperative data were 24-hour Cr and hemoglobin concentration, transfusion requirement, hospitalization time, and complications. Data are presented as mean ± standard deviation and analyzed using parametric tests (α= 0.05). Results: No significant difference was found between groups with respect to preoperative factors, OT, and EBL; however, WIT was shorter in group 2 (3.6 ± 0.2 vs 2.6 ± 0.3, P = 0.048). Within-group comparisons revealed longer WIT for patients with supernumerary renal artery compared with those with a single artery (group 1, P =0.044; group 2, P = 0.042). Moreover, no major between-group variations were seen in postoperative donor outcomes. Conclusions: Left renal artery ligation during HALDN using a three-row vascular stapler is safe and yields donor outcomes comparable to dual polymer clips. In addition, left renal artery stapling may decrease WIT compared with dual clipping.