I read with interest the case report described by Mo-hamed and colleagues (1) in which a living donor kidney was almost transected by the endocatch device (Endocatch, United States Surgical, Norwalk, CT) during extraction through a Pfannenstiel incision. I have used the endocatch technique during laparoscopic donor nephrectomy in 93 consecutive patients {conversion to open in three patients). With this technique the operation can be conducted without hand assist. At the point of vascular transaction, following complete mobilization of the donor kidney and ureter, the endocatch device is inserted through a Pfannenstiel or lower midline incision, the kidney is placed in the bag and suspended by it, the ureter and vessels are transected and the kidney is quickly withdrawn in the bag. This is a technique popularized by pioneers in laparoscopic donor nephrectomy at the University of Maryland (2). However, as the authors have pointed out, there are dangers to the use of the endocatch device. The collapsible metal ring can produce injuries to the renal parenchyma as it is reduced through the shaft of the endocatch device, and, on occasion, the bag can break, perhaps releasing the kidney to the peritoneal cavity.
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