Use of the LigaSure vessel sealing device in laparoscopic living-donor nephrectomy

Laparoscopic living-donor nephrectomy has gained acceptance within the transplant community. The technique requires advanced laparoscopic techniques, and great care must be taken to ensure safety of the operation for the donor and transplantability of the donor kidney. Minimizing the risk of bleeding and trauma to the kidney are important features of a successful living-donor nephrectomy. Improved laparoscopic instrumentation has afforded greater safety and efficacy through technical advances. The LigaSure device was used in 124 consecutive living-donor nephrectomies beginning in 1999. A transplant database was reviewed for operative statistics including intraoperative blood loss and operating time. The LigaSure device was used to dissect and seal all venous and arterial branches. Estimated blood loss was 90 +/- 53 mL. A suction device was required in only 40 (32%) of the cases. No patient experienced postoperative bleeding. There were two donor complications: one incisional hernia and one ileus. All kidneys functioned immediately upon reperfusion. The LigaSure device is an extremely effective tool for obtaining hemostasis by sealing both venous and arterial branches of the major renal vessels. This is also effective in sealing lymphatic tissues and thereby facilitating dissection. Avoiding the use of metallic clips simplified final division of the renal artery and vein. As with any laparoscopic instrument, the anatomic geometry of the operative field may limit use based upon port placement.