En bloc stapler ligation of the renal vascular pedicle during laparoscopic nephrectomy.

Abstract

To evaluate, in a prospective series of laparoscopic nephrectomies (LNs), the safety and feasibility of en bloc stapling for resection and occlusion of the vascular renal pedicle. Between October 2003 and March 2006, we investigated the intra- and postoperative outcomes in patients undergoing planned en bloc stapling of the renal vein and artery during LN. We also assessed complications at 6 and 12 months. In all, 57 patients, with a mean (range) age of 59.8 (10-83) years, were enrolled. The indications for LN were: renal cell carcinoma (RCC) in different stages in 66.7%, transitional cell carcinoma in 3.5% and oncocytoma in 5.2%. In a further 19.2% the patients presented with nontumoral lesions and the remaining 5.4% consisted of several rarer entities. The mean (sd) tumour size was 4.7 (1.75) cm. In one case (1.8%) a conversion to open nephrectomy was necessary because of a stapling device failure. Three patients (5.4%) underwent revision for bleeding. The median (range) blood loss was 100 (50-1000) mL. The median operating duration was 145 (95-410) min; in 19.3% this included additional surgical or diagnostic procedures. At 6 and 12 months after LN, there were no complications related to the surgical technique, in particular there was no arterio-venous fistula. We conclude that in our prospective series, en bloc stapling of the renal vascular pedicle during LN was a safe technique and that it was feasible in a time at the lower limit of the range of reported durations for similar procedures.