title: Comparative analysis of pedicular vascular control techniques during laparoscopic nephrectomy: en bloc stapling or separate ligation?
abstract: OBJECTIVE
  To compare the safety and efficacy of en bloc stapling and separate ligation techniques for renal vascular control during laparoscopic nephrectomy.
  
  
  METHODS
  Clinical data were collected from 60 patients who underwent laparoscopic nephrectomies using en bloc stapling (n = 27, group 1) or the separate ligation method (n = 33, group 2). Comparative analysis was carried out between the two groups, examining operative times, blood loss, intra- and postoperative complications and hospital stay.
  
  
  RESULTS
  Compared with the separate ligation method, the en bloc hilar control technique was associated with a shorter total operating time (98 vs. 121 min, p = 0.029). However, both groups were similar in terms of estimated blood loss, hemoglobin drop, changes in creatinine level and postoperative hospital stay. The total complication rates in group 1 and 2 were 3.7 and 15.1%, respectively, with a statistically significant difference. There were no complications related to the use of the endo-GIA stapler and no patients required conversion to open surgery in group 1. In group 2, 2 patients required conversion to open surgery, including 1 due to renal vein bleeding secondary to inaccurate vascular control and the other due to bleeding from the vena cava during dissection. In addition, 1 patient had a superficial bowel injury that was repaired laparoscopically and another had a superficial liver tear that was managed without conversion or transfusion.
  
  
  CONCLUSIONS
  En bloc ligation of the renal hilum is an easy and reliable technique that allows safe and fast control of the renal pedicle.
authors.affiliation: Department of Urology, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey.
authors.forename: Berkan
authors.initials: B
authors.lastname: Resorlu
authors.forename: Ural
authors.initials: U
authors.lastname: Oguz
authors.forename: Fazli
authors.initials: F
authors.lastname: Polat
authors.forename: Suleyman
authors.initials: S
authors.lastname: Yesil
authors.forename: Ali
authors.initials: A
authors.lastname: Unsal
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008026:Ligation; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D061646:Operative Time; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D012077:Renal Artery / Q000601:surgery*; D012082:Renal Veins / Q000601:surgery*; D012086:Reoperation; D017792:Surgical Stapling / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome