Objectives
To evaluate the feasibility, efficacy, and safety of en bloc ligation of the renal
hilum with titanium vascular staplers during laparoscopic nephrectomy. En bloc ligation
of the renal hilum has historically been associated with the very rare complication
of arteriovenous fistula (AVF) formation, primarily in inflammatory renal pathologic
features. Currently, no evidence exists of AVF development in human nephrectomies
after ligating the hilum en bloc with titanium staplers.
Methods
A total of 161 consecutive patients underwent planned laparoscopic radical nephrectomy
or nephroureterectomy. A retrospective review was performed to evaluate the operative
variables, including the method of hilar ligation, estimated blood loss, and final
pathologic findings. The additional postoperative outcomes of diastolic blood pressure,
heart rate, and other cardiovascular sequelae were evaluated.
Results
Of the 161 patients, 90 underwent en bloc hilar ligation and 71 underwent individual
hilar vessel ligation with the stapler. The blood loss and open conversion rate trended
lower in the en bloc group. Postoperatively, no differences were found in blood pressure
or heart rate between the two groups, and no instances of bruits or other clinical
evidence of AVF were found after mean follow-up of 34 months.
Conclusions
This series found no evidence of AVF or other adverse clinical events in patients
undergoing en bloc ligation of the renal hilum and laparoscopic nephrectomy. En bloc
ligation may provide for more secure, expeditious control of the hilum without an
increased operative time or the added potential of vascular injury that can be associated
with the individual dissection of the vessels.
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Article info
Publication history
Published online: January 31, 2007
Accepted:
September 21,
2006
Received:
May 3,
2006
Identification
Copyright
© 2007 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
