Bleeding Control and Vascular Preservation in Laparoscopic Living Donor Nephrectomy. Powered vs. Mechanical Vascular Stapler: A Possible Real Advantage

Kidney transplantation (KTx) is the treatment of choice for end stage renal disease (ESRD), improving both quality, and quantity of life in the recipients. Living Donor Kidney Transplantation (LDKT) is both related to a longer patient and graft survival, and laparoscopic donor nephrectomy (LDN) is the procedure of choice by most transplants Centers. Even though many techniques have been used to secure both the renal artery and vein during laparoscopic nephrectomy (Hem-o-lock clips, titanium clips or Vascular Stapler), ligation and division of the renal hilum remain two critical steps, entailing a certain risk of serious complications. Mechanical EndoGIA vs. iDrive™ Ultra Powered Stapling System (Autosuture; Covidien Surgical, Mansfield) have been compared. iDrive™ is a reusable, handled stapler computer-controlled stapling systems that runs on battery and can be used on multiplepatients. It comprises a hand-held control unit, and a loading unit, which consists in a powered EndoGIA cartridge. We evaluated safety, efficacy, maneuverability and ergonomics for renal vascular control during LDN. Moreover, the differences in costs between the two procedures were also analyzed. There were no malfunctions or complications related to the use of iDrive™ requiring conversion to open procedure. Advantages in maneuverability and costs were also observed. The total timing related to the use of the devices was statistically significant shorter for the iDrive™ than for the EndoGIA being respectively 3.4 ± 0.4 minutes vs. 4.2 ± 0.4 minutes (p=0.0014). In our experience, iDrive™ is safe and feasible for separate ligation and accurate division of renal artery and vein during LDN. The system also helps to minimize the need for additional maneuvers to secure the renal hilum. Furthermore, it allows greater precision of cutting on the kidney vessels that will have to be used for transplantation.