Routine Electrothermal Bipolar Vessel Sealing for Recipient Iliac Lymphatic Control in Kidney Transplantation: A Prospective Initial Experience.

BACKGROUND: Lymphocele remains a frequent surgical complication after kidney transplantation and depends largely on meticulous control of recipient iliac lymphatics. Electrothermal bipolar vessel-sealing systems (EBVS) achieve permanent fusion of vessels and lymphatics and are widely adopted in other surgical disciplines, yet transplant-specific implementation data remain limited. METHODS: We prospectively evaluated 25 consecutive adults first kidney transplant recipients undergoing recipient iliac vessel dissection using LigaSure. Standardized postoperative ultrasound surveillance was performed at postoperative days 14, 60, and 90. The primary outcome was lymphocele within 90 days. Secondary outcomes included recipient iliac dissection time, drain output kinetics, drain duration, and perioperative complications. RESULTS: Mean recipient iliac dissection time was 16.9 ± 6.7 minutes (95% CI 14.1-19.7). Mean total drain output was 985.8 ± 869.6 mL and demonstrated substantial interpatient variability. Three patients required prolonged drainage due to reoperation or peritoneal breach. No lymphocele was detected during structured 90-day surveillance (0/25; 95% CI 0-11.3%). No device-related complications occurred. CONCLUSION: In this prospective initial experience, routine electrothermal bipolar sealing for recipient iliac lymphatic control was feasible and safe, with no observed lymphocele through 90 days. While underpowered to exclude modest lymphocele rates, the findings support EBVS as a reproducible technical approach in kidney transplantation.