Transplant Trial Watch

Modern lymphatic dissection techniques for preventing post renal transplant lymphocele.

Lucan CV, Jurchis I, et al.

Clujul Medical 2017; 90(4): 416-419.


Aims
To investigate whether the use of the electrothermal bipolar sealing device (LigaSureTM) decreases postoperative lymphatic complications in kidney transplant recipients compared to electrocautery vessel sealing.

Interventions
Participants were randomised to undergo either right iliac fossa transplant using LigaSureâ„¢ dissection devices (LigaSure Atlasâ„¢ 20 cm Hand Switching Open Instrument, LigaSureâ„¢ Dolphin Tip 20 cm Open Instrument and LigaSure Preciseâ„¢ Open Instrument) versus left iliac fossa transplant using conventional ligation and monopolar coagulation.

Participants
48 patients admitted for kidney transplantation.

Outcomes
Measured outcomes included the development of lymphocele and postoperative lymphatic drainage volumes.

Follow-up
30 days post-operatively and 14 days after the end of the hospital stay

CET Conclusions
This study compared Ligasureâ„¢ dissection to standard dissection of the iliac vessels for kidney transplantation. Ultrasonography at 14 days and clinical review at 30 days was used to assess the primary outcome (which we have assumed to be lymphocoele, although this is not specified in the paper, nor defined). The Ligasureâ„¢ group had a significantly reduced chance of lymphocoele (4% vs 21%). Lymphatic drainage was measured for 30 days post-operatively, but how this was done is not explained. Lympatic drainage volumes were significantly lower in the Ligasureâ„¢ group (100ml vs 131ml). No power calculation is presented to establish the required size of the study. There is no description of blinding, allocation concealment, method of randomisation, or withdrawals from the study, so the overall quality score is therefore low.

Jadad score
1

Data analysis
Per protocol analysis

Allocation concealment
No

Trial registration
None

Funding source
Non-industry funded