Hilar control during laparoscopic donor nephrectomy: Practice patterns in Canada

  • Thomas B. McGregor Queen's University
  • Premal Patel University of Manitoba
  • Gabriel Chan Université de Montréal
  • Alp Sener Western University

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 1 2 (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.

Author Biographies

Thomas B. McGregor, Queen's University

MD, FRCSC, Director of Renal Transplant, Assistant Professor, Department of Urology, Queen's University

Premal Patel, University of Manitoba
MD, Section of Urology, Department of Surgery, University of Manitoba
Gabriel Chan, Université de Montréal

Hepatobiliary, Transplant and General Surgery, Hôpital Maisonneuve-Rosemont

Chirurgien Chercheur, Centre de Recherche de l’ Hôpital Maisonneuve-Rosemont

Professeur adjoint de clinique, Faculté de Médicine – Chirurgie, Université de Montréal

Professeur accrédité au Département de Nutrition, Université de Montréal

Chirurgien Transplanteur, Faculté de Médicine, Université de Sherbrooke

Alp Sener, Western University

Program Director, UrologyAssistant Professor of Surgery and Microbiology & ImmunologyDirector, Renal Transplant Fellowship ProgramSchulich Clinician Scientist, Western University

Published
2017-10-12
How to Cite
McGregor, T. B., Patel, P., Chan, G., & Sener, A. (2017). Hilar control during laparoscopic donor nephrectomy: Practice patterns in Canada. Canadian Urological Association Journal, 11(10), 321-4. https://doi.org/10.5489/cuaj.4490
Section
Original Research