Re: JSLS 2006;10:254–256 Laparoscopic Management of Giant Ovarian Cyst

As surgeons, we should continue to strive to do what is best for the donor without compromising graft function. The laparoscopic approach is the preferred approach in the vast majority of US transplant centers. The options for laparoscopic control of the renal vessels are staplers or clips. If clips are not used, we must rely on staplers. The vascular staplers and multiple locking clips were given the same safety rating in the authors’ report (reference 3 in the letter). Vascular staplers are also known to malfunction. Vascular stapler malfunction rate was 1.7%, in a report of 565 patients who underwent laparoscopic nephrectomy including donor nephrectomy. In our own experience, vascular stapler malfunction resulted in significant bleeding despite immediate conversion to open surgery.