Re: JSLS 2006;10:135–140 The Development of a Laparoscopic Donor Nephrectomy Program in a De Novo Renal Transplant Program: Evolution of Technique and Results in Over 200 Cases & JSLS 2006;10:141–144 Laparoscopic Vascular Control Techniques in Donor Nephrectomy: Effects on Vessel Length

The April-June 2006 edition of JSLS contained 2 disturbing papers addressing technical aspects of vascular control in laparoscopic donor nephrectomies. Lallas et al report an algorithm developed during a series of 200 cases performed at the Mayo Clinic in Scottsdale, Arizona in which “early vessel branching or a potential for inadequate vessel length” prompted the use of Hem-o-lok clips on the renal artery. They also report 4 postoperative retroperitoneal hematomas (an incidence of 2%), 2 of which required transfusions (incidence of 1%). Bernie et al report an anatomic study in cadavers, in which use of 2 nonabsorbable polymer ligating clips placed on the “patient” side of the artery and sharp transection leaving a 1-mm cuff of tissue preserves a significantly longer vessel than a GIA stapler. The authors also point out, however, their own direct observation of a clip dislodgement in human surgery, with use of this technique.