Current status of en bloc stapling of the renal hilum during laparoscopic nephrectomy.
BACKGROUND
Increasing literature has been published lately addressing the safety and efficacy of en bloc stapling of the renal hilum during laparoscopic nephrectomy and nephroureterectomy. The aim of this review was to analyze the available literature on en bloc stapling of the renal hilum and to complement it with technical issues that are required, according to our vast experience in en bloc and separate stapling, to safely control the hilum with this technique.


METHODS
A PubMed search using the terms "en bloc," "nephrectomy," and "laparoscopy" was conducted. We identified seven publications that have looked into hilar stapling technique.


RESULTS
Seven publications were found, which included a total of 434 patients who underwent en bloc stapling of the renal hilum. No complications specifically ascribable to this type of hilar control were encountered. No cases of postoperative arteriovenous fistula have been reported.


CONCLUSIONS
En bloc stapling has become an established method to secure the renal hilum during laparoscopic nephrectomy and laparoscopic nephroureterectomy. Although no cases of postoperative arteriovenous fistula formation have been reported with the use of modern titanium staplers, longer follow-up is necessary to ascertain that it does not occur in the late postoperative period. We believe that well-trained laparoscopic surgeons should master this technique in both emergency and elective situations.
Schatloff
Oscar
O
Department of Urology, Assaf Harofeh Medical Center , Zerifin, Israel. oscar.schatloff@gmail.com
Lindner
Uri
U
Lindner
Arie
A
D006801:Humans; D007668:Kidney / Q000601:surgery*; D010535:Laparoscopy; D009392:Nephrectomy / Q000379:methods*; D017792:Surgical Stapling