Thomas B Mcgregor1, Premal Patel2, Gabriel Chan3, Alp Sener4. 1. Department of Urology, Queen's University, Kingston, ON, Canada. 2. Section of Urology, University of Manitoba, Winnipeg, MB, Canada. 3. Faculté de Médicine - Chirurgie, Université de Montréal, Montreal, QC, Canada. 4. Division of Urology, Western University, London, ON, Canada.
Abstract
INTRODUCTION: In recent years, the method of vascular control during laparoscopic donor nephrectomy (LDN) has come under scrutiny due to catastrophic consequences of a device failure. This study sought to examine the surgical preferences of Canadian donor surgeons with regards to vascular control and their perception on the safety of these modalities. We also surveyed the experience with device malfunction and their subsequent management during LDN. METHODS: An online survey was sent out to donor surgeons registered with the Canadian Society of Transplantation. Surveys were anonymous and voluntary. Descriptive statistics were used to analyze the collected responses. Recollection of the sequelae and outcomes from device malfunction were also queried. RESULTS: Twenty-eight of 37 surgeons (76% response rate) responded to the survey. At least one surgeon from every institution in Canada performing LDN responded to the survey. Laparoscopic stapler is the most commonly used device for securing the renal artery (61%) and renal vein (67%). Overall, surgeons felt the stapler was the safest method of securing the renal artery. Stapler misfire and clip slippage were reported by eight (28.5%) and 12 (43%) surgeons, respectively. Most cases were salvageable: laparoscopically (30%), open conversion (30%), and by hand port (5%). Slippage of a plastic locking clip resulted in one emergent laparotomy on POD#1 and one stapler misfire was converted to open resulting in donor death. CONCLUSIONS: Although rare, hemorrhagic complications can occur from device malfunction resulting in poor outcomes for healthy volunteers undergoing LDN. Surgeons need to remain vigilant when selecting the appropriate modality for vascular control.
INTRODUCTION: In recent years, the method of vascular control during laparoscopic donor nephrectomy (LDN) has come under scrutiny due to catastrophic consequences of a device failure. This study sought to examine the surgical preferences of Canadian donor surgeons with regards to vascular control and their perception on the safety of these modalities. We also surveyed the experience with device malfunction and their subsequent management during LDN. METHODS: An online survey was sent out to donor surgeons registered with the Canadian Society of Transplantation. Surveys were anonymous and voluntary. Descriptive statistics were used to analyze the collected responses. Recollection of the sequelae and outcomes from device malfunction were also queried. RESULTS: Twenty-eight of 37 surgeons (76% response rate) responded to the survey. At least one surgeon from every institution in Canada performing LDN responded to the survey. Laparoscopic stapler is the most commonly used device for securing the renal artery (61%) and renal vein (67%). Overall, surgeons felt the stapler was the safest method of securing the renal artery. Stapler misfire and clip slippage were reported by eight (28.5%) and 12 (43%) surgeons, respectively. Most cases were salvageable: laparoscopically (30%), open conversion (30%), and by hand port (5%). Slippage of a plastic locking clip resulted in one emergent laparotomy on POD#1 and one stapler misfire was converted to open resulting in donor death. CONCLUSIONS: Although rare, hemorrhagic complications can occur from device malfunction resulting in poor outcomes for healthy volunteers undergoing LDN. Surgeons need to remain vigilant when selecting the appropriate modality for vascular control.
Authors: S Janki; D Verver; K W J Klop; A L Friedman; T G Peters; L E Ratner; J N M Ijzermans; F J M F Dor Journal: Am J Transplant Date: 2015-04-01 Impact factor: 8.086
Authors: Forrest C Jellison; Satyan K Shah; Joe W Mashni; Lesli I Nicolay; Okechukwu K Ojogho; D Duane Baldwin Journal: J Endourol Date: 2008-05 Impact factor: 2.942
Authors: Maximilian Brunotte; Sebastian Rademacher; Justine Weber; Elisabeth Sucher; Andri Lederer; Hans-Michael Hau; Jens-Uwe Stolzenburg; Daniel Seehofer; Robert Sucher Journal: Ann Transl Med Date: 2020-03