Polyglactin Tie Added to Nonabsorbable Polymer Locking Clips to Control Artery in Laparoscopic Living Donor Nephrectomy: Better Safe Than Sorry

Abstract As Teleflex Medical contraindicates the use of Hem-O-Lok clips in laparoscopic living donor nephrectomy (LLDN), we report the feasibility of a simple surgical artifice that aims to preserve the advantages of lockable clips with increased safety while respecting the manufacturer's legal...

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Bibliographic Details
Published in:Transplantation proceedings 2009-12, Vol.41 (10), p.4044-4046
Main Authors: Timsit, M.-O, Barrou, B, Rouach, Y, Terrier, N, Haffner, J, Legendre, C, Mejean, A
Format: Article
Language:English
Subjects:
Humans
Kidney Transplantation
Laparoscopy - methods
Laparoscopy - standards
Ligation - methods
Living Donors
Nephrectomy - methods
Nephrectomy - standards
Polyglactin 910
Renal Artery - surgery
Safety
Surgery
Surgical Instruments
Sutures
Tissue and Organ Harvesting - methods
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Summary:Abstract As Teleflex Medical contraindicates the use of Hem-O-Lok clips in laparoscopic living donor nephrectomy (LLDN), we report the feasibility of a simple surgical artifice that aims to preserve the advantages of lockable clips with increased safety while respecting the manufacturer's legal recommendations. Since January 2009, a polyglactin-0 tie was placed on the renal artery in addition to the two usual Hem-O-Lok clips in LLDN at our institution (n = 10) using a pre-tied loop suture (Endoloop ligature, Ethicon) placed on the artery stump, proximally to the aorta, after kidney removal. This artifice increased operating time of 65 seconds (range, 35–85 seconds) with no modification of warm ischemia time and led to visually decreased aortic pulsation transmitted to the clips. Without evidence of increased safety, we assume that this ruse may protect surgeons from prosecution in cases of clip displacement. It certainly decreases the risk of clip slippage and should be considered as a cheap, easy artifice to reduce the already low-risk of hemorrhage in LLDN.
ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2009.08.064