Comparison of Bipolar vascular sealing and conventional back-table dissection in terms of post-renal transplant drainage and back-table preparation times.
Eren, E., et al.European Review for Medical & Pharmacological Sciences 2023; 27(13): 6223-6228.
Aims
To assess if using bipolar sealing reduces kidney transplant back-table preparation time and if it affects drain volumes or duration.
Interventions
The intervention group has bipolar vessel sealing for the back-table preparation of the kidney after living donation vs the standard care group in which traditional ligation was used.
Participants
98 adult living-donor kidney recipients.
Outcomes
Their primary outcome measure was back-table duration. Their secondary outcome measures were: total drainage, surgical drainage duration, surgical site infection and cold ischaemic time.
Follow-up
Not specified
CET Conclusions
This is a small, low-quality trial assessing bipolar vascular sealing vs tradition ligation for kidney back-table in the context of live-donor transplantation. They found this decreased back table duration in their cohort on average from 28 minutes to 15 minutes, but no difference in total volume from drain, duration drain was kept in place or surgical site infection. Overall, there is limited value to the results, decreasing the back-table duration by around 10 minutes in live-donor transplantation isn’t of any benefit, especially given the dissection was haemostatic in-vivo and the back-table required is never extensive. The back-table is not the rate limiting step in the transplantation process and the save 10 minutes of cold ischaemic time is of no consequence. The technique could be of benefit in deceased donor transplant when there is more peri-renal tissue and the back-table more extensive, but this would solely be for surgeon ease, given the modest time saving would likely not result in reperfusion occurring any sooner, and in the context of more extensive tissue with sharp dissection in the cold phase of a retrieval the sealing needed would be greater and has not been assessed here. Their hypothesis focuses on lymphatic sealing, and they found no significant increase in drain outputs or duration, the implication being the sealing of the bipolar is equivalent, which given the routine use of such devices in pancreas transplant back-table is reasonable, but the peri-vascular lymphatics of the iliac vessels are much more significant than those peri-renal structures dissected from live donation, which as mentioned are usually sealed with bipolar in-vivo and are thus less likely to be the root cause than the iliac lymphatics. They found no increased adverse outcomes of using bipolar sealing in the context of live donation, but the sample size and limited follow-up are insufficient to recommend its use.
Data analysis
Per protocol analysis
Trial registration
ClinicalTrials.gov - NCT00552604