Abstract
BACKGROUND: Right-sided living donor nephrectomy presents a challenge because of the shorter renal vein length, which may complicate vascular anastomosis during transplantation. We hypothesized that the use of a narrow anvil stapler could optimize vein preservation by allowing safer and more effective transection closer to the inferior vena cava. This study aimed to compare the effectiveness of the Signia Small Diameter Reload Short with Curved Tip (SDR) and the Tri-Staple 2.0 Reload (TSR) in preserving renal vein length and to evaluate their impact on donor and recipient outcomes. METHODS: We conducted a retrospective observational cohort study of 39 right-sided donor nephrectomies performed at 2 institutions between May 2019 and December 2024. Patients were divided into 2 groups based on the stapler used: TSR (n = 16) and SDR (n = 23). Inverse probability of treatment weighting was applied to adjust for baseline differences, resulting in a final analysis of 11 TSR and 23 SDR cases. We evaluated renal vein length and overall surgical outcomes. RESULTS: The SDR group had significantly longer renal vein lengths than the TSR group (23.0 ± 4.0 versus 17.5 ± 3.9 mm, P < 0.001). However, there were no significant differences in operative time, estimated blood loss, or perioperative complications in both donors and recipients. Warm ischemia time, rewarming time, and total ischemia time were also comparable between groups. Early postoperative serum creatinine levels did not differ significantly between recipient groups. CONCLUSIONS: The SDR stapler provided a significant technical advantage in preserving renal vein length in right-sided donor nephrectomy. However, this did not translate into improved recipient outcomes, suggesting that surgical precision and vascular adaptation play a more critical role in transplantation success than vein length alone. Nonetheless, the ability to preserve greater vein length remains a potential advantage, particularly in challenging cases.