title: Endovascular gastrointestinal stapler device malfunction during laparoscopic nephrectomy: early recognition and management.
abstract: OBJECTIVE
  Controlled ligation and division of the renal hilum are critical steps during any nephrectomy procedure. The use of the endovascular gastrointestinal anastomosis (GIA) stapling device for control of the renal vessels during laparoscopic nephrectomy has become standard practice. However, malfunction can lead to serious consequences which require emergency conversion to an open procedure. We report our experience with GIA malfunction during laparoscopic nephrectomy.
  
  
  METHODS
  From July 1993 to September 1999, 565 patients underwent laparoscopic nephrectomy at 2 institutions for benign and malignant diseases, and for live renal donation. Retrospective chart reviews and primary surgeon interviews were conducted to determine etiology of failure, intraoperative management and possible future prevention.
  
  
  RESULTS
  Malfunction occurred in 10 cases (1.7%). In 8 cases the renal vein was involved and malfunctions affected the renal artery in 2. The estimated blood loss ranged from 200 to 1,200 cc. Open conversions were necessary in 2 cases (20%). The etiology of the failure included primary instrument failure in 3 cases and preventable causes in 7. Open surgery was required in 2 patients and laparoscopic management was possible in 8.
  
  
  CONCLUSIONS
  The endovascular GIA stapler is useful in performing laparoscopic nephrectomy. However, malfunctions may occur, and can be associated with significant blood loss and subsequent need for conversion to an open procedure. The majority of errors could be avoided with careful application and recognition. Many failures, especially when recognized before release of the device, can be managed without conversion to an open procedure.
authors.affiliation: Department of Urology, Wilford Hall Medical Center, Lackland Air Force Base, Texas, USA.
authors.forename: D
authors.initials: D
authors.lastname: Chan
authors.forename: J T
authors.initials: JT
authors.lastname: Bishoff
authors.forename: L
authors.initials: L
authors.lastname: Ratner
authors.forename: L R
authors.initials: LR
authors.lastname: Kavoussi
authors.forename: T W
authors.initials: TW
authors.lastname: Jarrett
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation*; D016063:Blood Loss, Surgical; D013505:Digestive System Surgical Procedures; D004632:Emergency Medical Services; D004868:Equipment Failure; D006801:Humans; D010535:Laparoscopy; D009392:Nephrectomy / Q000379:methods*; D012077:Renal Artery / Q000601:surgery; D012082:Renal Veins / Q000601:surgery; D012189:Retrospective Studies; D013528:Surgical Staplers