Korean J Transplant.  2022 Dec;36(4):245-252. 10.4285/kjt.22.0045.

Prospective comparison of suture ligation and electrothermal sealing for the control of perivascular lymphatics in kidney transplant recipients

• Mehra K
• Kapashi K
• Khemchandani S
• Modi PR
• Rizvi SJ

• KMID: 2537535
• DOI: http://doi.org/10.4285/kjt.22.0045

Abstract

Background
The use of sutures as ligatures has proven to be safe and reliable for the control of lymphatic vessels. The electrothermal bipolar vessel sealer (EBVS) is a relatively new type of device that can be used to seal lymphatics. We conducted a study to evaluate the safety and efficacy of EBVS for preparation of the recipient vessel during renal transplantation.
Methods
In this prospective randomized controlled study, EBVS (Medtronic) was compared with conventional ligature for the control of perivascular lymphatics in kidney transplant recipients. A total of 52 kidney transplant recipients were randomly assigned to two groups. In group 1, EBVS was used to control perivascular lymphatics, while conventional silk ligatures were used in group 2. Demographic characteristics, as well as preoperative, perioperative, and postoperative variables, were noted and compared between the groups.
Results
The mean recipient vessel preparation time was 8.3±1.9 minutes in group 1 and 14.5±4 minutes in group 2 (P<0.001). The mean anastomosis time was 28.2±5.4 minutes in group 1 and 28.2±4.2 minutes in group 2 (P=1.000). The mean estimated blood loss was 101.54±44.60 mL in group 1 and 125.19±74.17 mL in group 2 (P=0.270), and the mean drain output was 51.42 mL per day and 57.50 mL per day in groups 1 and 2, respectively (P=0.590).
Conclusions
EBVS can be employed safely and effectively for recipient iliac lymphatic vessel dissection and sealing. EBVS is a fast, secure, and effective choice to permanently fuse the vessels and is a good option to avoid posttransplant lymphatic complications.

Keyword

Lymphocele; Renal transplant; Transplant recipient; Kidney transplantation

Figure

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  Fig. 1 Lymphatics sealed with LigaSure (Medtronic). (A) Lymphatics (arrow) over the external iliac vessels (asterisk) dissected with Mixter (Sklar) right-angle forceps. (B) Dissected lymphatic controlled with a small-jaw curved LigaSure (arrow). (C) Completely dissected external iliac artery (arrow) and vein (asterisk).

Reference

1. Abecassis M, Bartlett ST, Collins AJ, Davis CL, Delmonico FL, Friedewald JJ, et al. 2008; Kidney transplantation as primary therapy for end-stage renal disease: a National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (NKF/KDOQITM) conference. Clin J Am Soc Nephrol. 3:471–80. DOI: 10.2215/CJN.05021107. PMID: 18256371. PMCID: PMC2390948.

2. Campi R, Pecoraro A, Li Marzi V, Tuccio A, Giancane S, Peris A, et al. 2022; Robotic versus open kidney transplantation from deceased donors: a prospective observational study. Eur Urol Open Sci. 39:36–46. DOI: 10.1016/j.euros.2022.03.007. PMID: 35528789. PMCID: PMC9068739.

3. Furness PD 3rd, Houston JB, Grampsas SA, Karrer FM, Firlit CF, Koyle MA. 2001; Extraperitoneal placement of renal allografts in children weighing less than 15 kg. J Urol. 166:1042–5. DOI: 10.1016/S0022-5347(05)65915-0. PMID: 11490294.

4. Ebadzadeh MR, Tavakkoli M. 2008; Lymphocele after kidney transplantation: where are we standing now? Urol J. 5:144–8. PMID: 18825619.

5. Novitsky YW, Rosen MJ, Harrell AG, Sing RF, Kercher KW, Heniford BT. 2005; Evaluation of the efficacy of the electrosurgical bipolar vessel sealer (LigaSure) devices in sealing lymphatic vessels. Surg Innov. 12:155–60. DOI: 10.1177/155335060501200215. PMID: 16034506.

6. Khan TF, Baig MA. 2011; Post kidney transplant lymphoceles: meticulous ligation of lymphatics reduces incidence. Urotoday Int J. 4:art 64. DOI: 10.3834/uij.1944-5784.2011.10.07.

7. Lucan CV, Jurchis I, Suciu M, Selicean SE, Buttice S. 2017; Modern lymphatic dissection techniques for preventing post renal transplant lymphocele. Clujul Med. 90:416–9. DOI: 10.15386/cjmed-716. PMID: 29151791. PMCID: PMC5683832.

8. Hamza A, Fischer K, Koch E, Wicht A, Zacharias M, Loertzer H, et al. 2006; Diagnostics and therapy of lymphoceles after kidney transplantation. Transplant Proc. 38:701–6. DOI: 10.1016/j.transproceed.2006.01.065. PMID: 16647449.

9. Heniford BT, Matthews BD, Sing RF, Backus C, Pratt B, Greene FL. 2001; Initial results with an electrothermal bipolar vessel sealer. Surg Endosc. 15:799–801. DOI: 10.1007/s004640080025. PMID: 11443443.

10. Kennedy JS, Stranahan PL, Taylor KD, Chandler JG. 1998; High-burst-strength, feedback-controlled bipolar vessel sealing. Surg Endosc. 12:876–8. DOI: 10.1007/s004649900733. PMID: 9602010.

11. Panhofer P, Rothe S, Schütz M, Grohmann-Izay B, Dubsky P, Jakesz R, et al. 2015; Morbidity reduction using the vessel sealing device LigaSure™ in breast cancer surgery. Eur Surg. 47:150–6. DOI: 10.1007/s10353-015-0334-8.

12. Tsuda N, Ushijima K, Kawano K, Takemoto S, Nishio S, Sonoda G, et al. 2014; Prevention of lymphocele development in gynecologic cancers by the electrothermal bipolar vessel sealing device. J Gynecol Oncol. 25:229–35. DOI: 10.3802/jgo.2014.25.3.229. PMID: 25045436. PMCID: PMC4102742.

13. Nespoli L, Antolini L, Stucchi C, Nespoli A, Valsecchi MG, Gianotti L. 2012; Axillary lymphadenectomy for breast cancer. A randomized controlled trial comparing a bipolar vessel sealing system to the conventional technique. Breast. 21:739–45. DOI: 10.1016/j.breast.2012.08.003. PMID: 22959311.

14. Mok S, Park YJ, Park SC, Yun SS. 2021; Efficacy of lymphatic sealing using the LigaSure in kidney transplantation: a pilot study. Transplant Proc. 53:2278–84. DOI: 10.1016/j.transproceed.2021.07.020. PMID: 34404537.

15. Simforoosh N, Tabibi A, Rad HM, Gholamrezaie HR. 2019; Comparison between bipolar lymphatic vessels cautery and suture ligature in prevention of postrenal transplant lymphocele formation: a randomized controlled trial. Exp Clin Transplant. 17:26–30. DOI: 10.6002/ect.2017.0207. PMID: 29697354.