Safety of Polymer Clips in Laparoscopic Living Donor Nephrectomy: Indonesian Experience

Abstract

To assess the reliability and safety of polymer clips for vascular control in laparoscopic living donor nephrectomy. We collected data retrospectively from all laparoscopic living donor nephrectomy performed in Ciptomangunkusumo Hospital, Jakarta, Indonesia. Polymer clips was applied for both renal artery and renal vein ligation. The incidence of polymer clip failure was recorded accordingly. Between November 2011 and August 2015, we evaluated 260 patients of laparoscopic living donor nephrectomy in a center. The left kidney was harvested from 219 (84.5%) patients. Multiple renal arteries was discovered in 25 (9.6%) patients. For all cases we used polymer clips to control the renal artery (XL and L) and renal vein (XL). We placed 2 clips as proximal as possible to the aorta or caval vein. The median estimated blood loss was 100 (20–2000) ml. A blood loss of 2000 ml occurred in one/case of clip dislodgement. The median time to clip (the length of time from first incision to renal artery clamping) was 155 (68–318) minutes. The median warm ischemic time (the length of time from clamping to cold ischemic time) was 3.01 (1.22–30.43) minutes. There were 10 cases with warm ischemic time of more than 10 minutes. Three cases (1.2%) of clip failures occurred. One patient needed conversion to open surgery to achieve adequate vascular control. Two patients experienced improper locking of the polymer clips, necessitating clips reapplication. The use of polymer clips for vascular control in laparoscopic living donor nephrectomy is reliable and safe when properly applied. However the evaluation of renal vascular stump after harvesting donor kidney is an important step to ensure the right placement and safety of polymer clips.