ArticleSurgical endoscopy2025
Evaluation of automatic staplers for renal artery division in laparoscopic donor nephrectomy: impact of vessel diameter on hemostatic outcomes.
Article in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLaparoscopic donor nephrectomy requires precise renal artery management for optimal outcomes. This study evaluates the performance and safety of automatic staplers in dividing renal arteries of various diameters.
methodsExperimental tests were conducted using porcine arteries (3, 5, and 7 mm) to compare double- and triple-row staplers in terms of stapling completeness and pressure resistance. Clinically, 371 renal artery resections from 276 donors were analyzed to compare hemostatic outcomes between stapler types, grouping arteries according to diameter (≤ 3, 4-6, and ≥ 7 mm).
resultsIn 7 mm vessels, both stapler types achieved complete stapling with consistent pressure resistance up to 750 mm Hg. In 5 mm vessels, both types showed comparable results, although pressure resistance was slightly higher with the double-row stapler. In 3 mm vessels, incomplete stapling was common and double-row staplers achieved a maximum pressure resistance of 700 mm Hg. Clinically, hemostatic conditions at the artery stump did not significantly differ between the stapler types for any vessel size group; however, for vessels ≥ 7 mm, the incidence of oozing, pulsatile bleeding, or bleeding requiring additional clips was higher with the triple-row stapler. The incidence of bleeding was significantly higher in vessels ≤ 3 mm (p = 0.01).
conclusionAutomatic staplers are effective for renal artery management in laparoscopic donor nephrectomy; however, when used on smaller arteries, supplemental hemostatic measures may be required. Advancing stapler technology and careful device selection are crucial for improving surgical outcomes.
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