Use of ETS-FLEX Endoscopic Linear Vascular Cutter in Donor Nephrectomy and Transplantation Surgery: A Single Institution’s Experience

Abstract

Objectives: We describe our experience with the use of ETS-FLEX endoscopic linear vascular cutter from January 2000 to October 2004 in live-donor nephrectomy and pancreatic bench work. Materials and Methods: In live-donor nephrectomy, ETS-FLEX endoscopic linear vascular cutter (ELVC) is used for the stapling and division of renal vessels and ureter. When positioned on a vessel, the vascular cutter applies 3 staple lines proximally and 3 distally, and the vessel in between them is divided. In pancreatic graft bench work, ELVC is applied in 3 steps: the splenectomy, ligation of the mesenteric root, and the ligation of any peripancreatic lymphatic tissue or small vessels.

Results: From October 2000 to October 2004, we performed 80 living-donor nephrectomies in 56 men and 24 women (mean age, 39 years; range, 24-63 years). Thirty-one grafts were with multiple vessels. Mean warm ischemia time was 60 ± 5 seconds. Mean operative time was 60 ± 10 minutes. In all cases, there was no need for further hemostasis after removal of the kidney. There were no operative complications. All grafts were successfully revascularized with 100% graft survival (range of follow-up, 1-48 months). Patients’ length of stay in hospital was 3 ± 1 days.

We have used the ETS-FLEX ELVC in 30 pancreatic graft preparations since January 2000. Mean time taken for the bench work preparation including Y-graft anastomosis was 45 ± 10 minutes. Following revascularization, there was excellent perfusion with minimal and easily controllable bleeding that did not require blood transfusion.

Conclusions: We believe that our use of the laparoscopic instrument, ETS-FLEX ELVC, with a mini-incision technique in live-donor nephrectomy and pancreatic graft preparation makes these complex and time-consuming procedures simple and fast, minimizing the chances of postoperative complications and resulting in excellent patient and graft survival.