Is Postoperative Arteriovenous Fistula Still a Concern After <i>En Bloc</i> Stapling of the Renal Hilum During Laparoscopic Nephrectomy?

Schatloff, Oscar; Ramon, Jacob; Lindner, Uri; Kitrey, Noam D.; Dotan, Zohar; Nahtomi-Shick, Orit; Nadu, Andrei

doi:10.1089/end.2008.0528

Cited by 9 publications

(3 citation statements)

References 8 publications

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“…None of the patients in this study developed AVF. [ 11 ] A meta-analysis by Lai and Rais-Bahrami that reviewed 595 patients, none of whom showed evidence of AVF (mean follow-up: 26 months). As such, Lai and Rais-Bahrami concluded that en bloc control resulted in significant improvements in surgery duration.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of en bloc renal hilum control during laparoscopic nephrectomy and nephroureterectomy

et al. 2022

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Objective: The objective of the study is to evaluate the safety, efficacy, and long-term outcome of en bloc renal pedicle control during laparoscopic nephrectomy and nephroureterectomy. Patients and Methods: A total of 126 nephrectomies and nephroureterectomies that underwent en bloc renal pedicle control using the endovascular stapler (45 or 60 mm vascular reload) were retrospectively analyzed. Perioperative outcomes, including the risk of arteriovenous fistula (AVF), hospital stay, and estimated blood loss, were recorded. Complications were reported using Clavien classification. Results: En bloc pedicle control was employed in 126 laparoscopic nephrectomies and nephroureterectomies on 126 patients with a mean age of 55.7 years (range: 18–94) and a mean body mass index of 29.2 kg/m2 (range: 17–42). All laparoscopic nephrectomies were performed or supervised by one of three minimally invasive surgeons using identical surgical techniques, even in cases of multiple hilar vessels. During follow-up with a mean 23.3 months (range: 12–48), no patients presented with radiological or clinical signs of AVF (91 patients where followed up with either Doppler ultrasound, computed tomography with contrast, or magnetic resonance imaging for different indications). The mean operative time was 91.8 min (range: 45–215). Intraoperative blood transfusion was required in two cases. Diaphragmatic injury occurred in one case but was repaired laparoscopically. Open conversion occurred in two cases with severe colonic adhesions and injury, with one requiring primary repair, and the other managed with a colostomy. One patient developed fever; two patients developed paralytic ileus. Hospital stay mode was 5 days, ranging from 3 to 10 days. Conclusion: En bloc renal pedicle control during laparoscopic nephrectomies is safe with reasonable operative time, and there were no indications of AVF with this technique over the long term.

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of en bloc renal hilum control during laparoscopic nephrectomy and nephroureterectomy

et al. 2022

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“…Some surgeons prefer to use stapler owing to the allowance of staplers to en bloc ligation of renal hilum even with the theoretical risks of arteriovenous fistula (AVF) [ 45 ] which is associated with flank pain, cardiomegaly, and cardiac failure with high output. However, several retrospective studies [ 46 , 47 ] had confirmed that en bloc ligation was safe with no AVF postoperatively. Hemal and Mishra [ 48 ] preferred using Endo-GIA stapler when resecting pyonephrotic nonfunctioning kidneys to avoid high risk of adhesion, inadequate space, and inadvertent injury to surrounding tissue.…”

Section: Discussionmentioning

confidence: 99%

Staplers or clips?

et al. 2018

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Background:Controlling of the renal vessels is a critical step in live donor nephrectomy (LDN). Currently, mainly 2 devices, Hem-o-Lok clips and staplers, are utilized to control vessels during LDN. Both of them have advantages and disadvantages.Methods:This systematic review and meta-analysis was aimed to compare the safety and the efficacy of the 2 devices and to identify the better one in LDN. A systematic search for related publications in the databases of PubMed, Medline, Embase, the Cochrane Library, and Web of Science through February 2018 was performed. Eight studies were selected and evaluated with the Newcastle-Ottawa Scale (NOS).Results:The meta-analysis result showed that utilization of Hem-o-Lok clips resulted in greater amount of estimated blood loss (mean differences [MD]: 40.10; 95% confidence interval [CI] 4.37–75.84) and longer time of warm ischemia (WIT) (MD: 55.61; 95% CI 36.79–74.43) than using staplers. Residual vascular length of grafts in clip group was longer than that in stapler group (MD: 2.51; 95% CI 0.78–4.24). However, the differences in primary outcomes such as device failure rate, death rate, and severe hemorrhage rate, were not significant between these 2 groups. In addition, utilization of Hem-o-Lok clips costed approximate $400 lower than staplers per patient.Conclusion:This study revealed that Hem-o-Lok clips and staplers have the similar function in LDN renal ligation, regarding the device failure rate, death rate, and severe hemorrhage rate. However, the surgeons would benefit from the clips in terms of the residue length of vessels, these outstanding features provide operation convenience and flexibility, such as right-sided donor nephrectomies, early vascular bifurcation, and rare vascular variation. In addition, the clips have potential economic advantages. In some developing countries, it would reduce the healthcare expenditure.

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“…After firing, a nice staple line that includes the vein and the artery is usually observed. Our preferred technique for hilar control is en bloc stapling 5 ; however, if the thickness of the hilum does not allow safe en bloc stapling, a plane is created between the renal vein and all posterior elements to allow the entrance of one of the jaws of the stapler. One load is used to staple all posterior hilar tissue and another to staple the remaining renal vein.…”

Section: Methodsmentioning

confidence: 99%

Simplifying Laparoscopic Nephrectomy: The Inferior Approach with En Bloc Stapling of the Renal Hilum

Schatloff

Nadu

Lindner

et al. 2014

JSLS

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Introduction:Laparoscopic nephrectomy (LN) is likely the most common laparoscopic procedure performed by general urologists without formal laparoscopic training. The traditional technique is cumbersome because it entails making an early approach to the hilum with the risk of bleeding and need for conversion. We perform a different technique that we believe is simpler to learn and to teach. It consists of a complete dissection of the inferior and posterior aspects of the kidney, followed by en bloc stapling of the renal hilum. The present report is a detailed description of our technique including outcomes and complications.Materials and Methods:Perioperative data of 129 consecutive patients who underwent LN between November 2003 and September 2007 were prospectively collected and retrospectively reviewed. Complications were reported using the Clavien classification system, and follow-up was performed according to our institution's protocol and included physical examination, blood count, blood chemistry, and renal function tests at every visit, in addition to abdominal computed tomography scan six months after surgery. Additional imaging was scheduled according to disease stage and grade.Results:Mean patient age, tumor size, and operative time were 63 ± 15.6 years, 6.3 ± 2.4 cm, and 128 ± 41.4 minutes, respectively. Median estimated blood loss was 0 mL (0.200). Conversion to open surgery occurred in 3.1% of patients, and 8% of the patients had a blood transfusion. Complications were recorded in 26% of the patients; 91% of them had Clavien grade scores of 1 or 2.Conclusion:We present a standardized technique for LN. Its main advantage is that postpones any manipulation of the hilum to a later step during the procedure when it is easy to identify and control. This decreases early bleeding and main vascular complications.

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Is Postoperative Arteriovenous Fistula Still a Concern After En Bloc Stapling of the Renal Hilum During Laparoscopic Nephrectomy?

Abstract: En bloc stapling of the renal hilum is as safe and effective as individual stapling. Arteriovenous fistula after LN does not seem to be a concern with the use of modern inorganic titanium staplers.

Cited by 9 publications

References 8 publications

Safety and efficacy of en bloc renal hilum control during laparoscopic nephrectomy and nephroureterectomy

Safety and efficacy of en bloc renal hilum control during laparoscopic nephrectomy and nephroureterectomy

Staplers or clips?

Simplifying Laparoscopic Nephrectomy: The Inferior Approach with En Bloc Stapling of the Renal Hilum

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