title: Safety of en bloc ligation of the renal hilum during laparoscopic radical nephrectomy for renal cell carcinoma: a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate the safety of en bloc stapler ligation of the renal vascular pedicle during laparoscopic radical nephrectomy for renal cell carcinoma.
  
  
  METHODS
  Clinical data were collected prospectively from 70 patients who underwent either en bloc stapling of the renal hilum (n=35) (Group A) or the separate ligation method (n=35) (Group B) to treat renal cell carcinoma. To evaluate the incidence of arteriovenous fistula (AVF), blood pressure and heart rate were measured, and abdominal auscultation was performed at 1 month, 3 months, 6 months, and 12 months post-surgery. Abdominal computed tomography was also performed at 6 and 12 months post-surgery. In addition, preoperative characteristics and postoperative outcomes (such as operation time and estimated blood loss [EBL]) were examined.
  
  
  RESULTS
  Both operation time and EBL were lower for Group A: operative time, Group A versus Group B, 60.26±10.94 minutes versus 67.51±10.49 minutes (P=.007); EBL, Group A versus Group B, 33.53±13.46 mL versus 49.14±32.21 mL (P=.011). No statistically significant differences were noted in either of the postoperative variables (blood pressure and heart rate), and there was no clinical evidence of bruit or AVF at 12 months post-surgery.
  
  
  CONCLUSIONS
  No AVF was observed after en bloc ligation upon clinical follow-up or on radiological evaluation.
authors.affiliation: Department of Urology, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Chung
authors.forename: Seung Wook
authors.initials: SW
authors.lastname: Lee
authors.forename: Ki Soo
authors.initials: KS
authors.lastname: Lee
authors.forename: Won Yeol
authors.initials: WY
authors.lastname: Cho
authors.forename: Tae Hyo
authors.initials: TH
authors.lastname: Kim
mesh_terms: D002292:Carcinoma, Renal Cell / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care; D007668:Kidney / Q000601:surgery*; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008026:Ligation / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011446:Prospective Studies; D012077:Renal Artery; D012082:Renal Veins; D017792:Surgical Stapling / Q000009:adverse effects / Q000379:methods*