V1725: STAPLER MALFUNCTION ON RENAL VEIN DURING DONOR NEPHRECTOMY AND ITS LAPAROSCOPIC MANAGEMENT.
VideoIntroduction and Objectives
We present a case of stapler malfunction of Multifire Endo TAâ„¢ 30 Stapler (Covidien, USA) on right renal vein during donor nephrectomy.
A conventional 5 port approach for laparoscopic donor nephrectomy was employed. The dissection of the kidney was uneventful. A hand assist device was in placed prior to hilar clamping using a Pfannensteil incision. Hem-o-lock clip was applied on the artery and divided. Subsequently the Endo TA stapler was fired on the right renal vein. The stapler was fired, but could not be disengaged. After a minute of external manipulation to disengage the stapler, renal vein was divided and specimen extracted through the Gel port. The major obstacle for the surgeon was that he was deprived of his right upper quadrant port was occupied by the stapler, which reduced the working ports to four. Initially a Hem-o-Lockclip was placed anticipating dividing the vein above that and disengaging the stapler. But on application it was found that the clip was not going through the entire width of the renal vein. Subsequent endeavor was to transfix the vein by applying the 4.0 polypropylene sutures. But this only allowed the vein to bunch up, though it facilitated the application of another Hem-o-lock clip. This clip also did not traverse the entire width of the renal vein. As a next step laparoscopic Satinsky was applied on the inferior venecava and the stapler was detached by severing the intervening portion. Following this laparoscopic Satinsky was released which revealed a mild bleeding from inferior venecava. A figure of eight suture with 4.0 Polypropylene was placed to control the bleeding.
Patient had an uneventful postoperative period and a Doppler was performed which demonstrated a normal flow through inferior venecava.
Surgeons should be guarded while reusing the stapler handle and a thorough check should be made before every use. A laparoscopic Satinsky is a very important tool in the surgeon armamentarium while doing nephrectomy especially on the right side.