title: Efficacy and safety of en bloc ligation of renal hilum during laparoscopic nephrectomy.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Urologic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
authors.forename: Erik
authors.initials: E
authors.lastname: Kouba
authors.forename: Angela M
authors.initials: AM
authors.lastname: Smith
authors.forename: J Eric
authors.initials: JE
authors.lastname: Derksen
authors.forename: Kris
authors.initials: K
authors.lastname: Gunn
authors.forename: Eric
authors.initials: E
authors.lastname: Wallen
authors.forename: Raj S
authors.initials: RS
authors.lastname: Pruthi
mesh_terms: D001164:Arteriovenous Fistula / Q000517:prevention & control; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008026:Ligation / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D011336:Probability; D012189:Retrospective Studies; D013528:Surgical Staplers; D014025:Titanium; D016896:Treatment Outcome
chemical_list: D014025:Titanium