Clip or staple in laparoscopic live donor nephrectomy? A systematic literature review.

Autor:	Lachkar S; Department of Urology A, Ibn Sina University Hospital, avenue Bettouga, 10000 Rabat, Morocco. Electronic address: lachkar.sa@gmail.com., Boualaoui I; Department of Urology A, Ibn Sina University Hospital, avenue Bettouga, 10000 Rabat, Morocco. Electronic address: imadboualaoui@gmail.com., Ibrahimi A; Department of Urology A, Ibn Sina University Hospital, avenue Bettouga, 10000 Rabat, Morocco. Electronic address: ahmed.ibrahimi@um5s.net.ma., El Sayegh H; Department of Urology A, Ibn Sina University Hospital, avenue Bettouga, 10000 Rabat, Morocco. Electronic address: hachemsayegh@yahoo.fr., Nouini Y; Department of Urology A, Ibn Sina University Hospital, avenue Bettouga, 10000 Rabat, Morocco. Electronic address: ynouini@yahoo.fr.
Jazyk:	angličtina
Zdroj:	The French journal of urology [Fr J Urol] 2024 Jul; Vol. 34 (7-8), pp. 102656. Date of Electronic Publication: 2024 May 29.
DOI:	10.1016/j.fjurol.2024.102656
Abstrakt:	Introduction: Ligation of the renal pedicle is a crucial step in laparoscopic renal harvesting. Currently, two devices are widely used: Hem-o-Lok® clips and staplers. Each has its advantages and disadvantages. Methods: A systematic literature review was conducted following the PRISMA methodology on PubMed, EMBASE, and Cochrane databases with no time restrictions. Registered in the PROSPERO database (CRD42023460585), the study's primary outcome measures include the failure rate of the ligation tool, conversion to open surgery, rate of severe bleeding, and device-related death. Other secondary variables are also explored. An assessment of the quality of included comparative studies was performed using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. Results: Out of 393 articles identified using our keywords, 32 were included. Overall, clips have a lower failure rate during application, elongate graft vessel length, and are more cost-effective. Staples are associated with a shorter warm ischemia time and lower blood loss. There is no significant difference between the two devices in terms of conversion, severe bleeding, death, and blood transfusion. Conclusion: There is no perfect modality for renal pedicle control during laparoscopic harvesting, as each instrument has its pros and cons. Hem-o-Lok® clips are a safe and cost-effective option, particularly suitable for right-sided harvesting or in cases of vascular variations. However, they are still associated with a risk of secondary displacement with potentially serious consequences. Certain technical tricks can mitigate this risk. (Copyright © 2024 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)
Databáze:	MEDLINE
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