En Bloc Stapling of the Renal Hilum During Laparoscopic Nephrectomy: A Double-institutional Analysis of Safety and Efficacy

Urology. 2017 Jul:105:69-75. doi: 10.1016/j.urology.2017.01.051. Epub 2017 Mar 30.


Objective: To explore the safety and efficacy of en bloc stapling of the renal hilum (EBSH) during laparoscopic nephrectomy (LNx) in a large double-institution cohort with an extended follow-up period.

Methods: We performed a retrospective review of patients undergoing LNx with EBSH between 2008 and 2014 at 2 academic medical centers. Data analyzed included tumor size, tumor pathology, operative time, estimated blood loss, and perioperative or postoperative complications. Evaluation of arteriovenous fistula (AVF) formation was assessed by postoperative imaging studies, physical examination, or new-onset diastolic hypertension.

Results: A total of 428 patients (mean age: 63 years) underwent LNx, of which there were a total of 433 renal units with EBSH (226 left renal units, 207 right renal units). Mean operative time was 169 minutes (range: 51-489 minutes). Mean estimated blood loss was 155 mL (range: 5 mL-2000 mL). Mean tumor size was 5.6 cm (range: 0.9-14.5 cm). EBSH was performed on 69 patients with chronic infectious and inflammatory benign conditions. Three hundred (70%) patients received post-procedural imaging. No patients developed clinical or radiographic evidence of AVF at a mean follow-up of 51 months.

Conclusion: EBSH during LNx is efficient, effective, and safe. This large series lends further support that EBSH during LNx may not be associated with any significant risk of AVF formation at extended follow-up. We advocate that this technique is a safe alternative to ligating the renal artery and vein during LNx.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arteriovenous Fistula / epidemiology
  • Humans
  • Kidney Neoplasms / surgery
  • Laparoscopy / adverse effects*
  • Ligation / adverse effects
  • Middle Aged
  • Nephrectomy / adverse effects*
  • Operative Time
  • Postoperative Complications / epidemiology*
  • Renal Artery / surgery*
  • Renal Veins / surgery*
  • Retrospective Studies
  • Surgical Stapling / adverse effects*
  • Treatment Outcome
  • Young Adult