Objectives: 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.
Patients and methods: 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.
Results: 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.
Conclusions: 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.