title: En bloc ligation of renal vessels is safe and reduces duration of surgery.
abstract: BACKGROUND
  Conventionally, individual ligation of the renal vessels with clips is performed during laparoscopic nephrectomy (LN). Concomitant ligation of the vessels is not a standard procedure due to an expected risk of stapler dysfunction and the development of arteriovenous fistulas (AVF). Using the EndoGIA stapler 45/2.5 mm, we compared en bloc ligation with individual ligation during LN and nephroureterectomy (LNU) with a special focus on the development of AVF and technique safety.
  
  
  METHODS
  This was a retrospective study of all patients undergoing LN or LNU at the Department of Urology, Roskilde Hospital, Denmark, between January 2010 and April 2014. The follow-up period was minimum six months.
  
  
  RESULTS
  A total of 228 patients underwent LN and 56 patients underwent LNU. In the LN group, 77 patients underwent en bloc ligation. The mean surgical time was significantly reduced to 89 minutes in the en bloc group compared to 109 minutes in the conventional group (p = 0.0001). The difference remained significant with multivariate analysis. In the LNU group, seven patients underwent en bloc ligation. There was no significant difference between conventional ligation and en bloc ligation with respect to surgical time in either the univariate or the multivariate analyses. None of the patients needed blood transfusion. With a mean follow-up of 13.5 months, no AVF were found.
  
  
  CONCLUSIONS
  En bloc ligation appears to be safe and can reduce the surgical time during LN without increased risk of blood transfusion and without development of AVF. Further studies are needed to assess any advantages associated with use of the method during LNU.
  
  
  BACKGROUND
  none.
  
  
  BACKGROUND
  not relevant.
authors.affiliation: nesa@regionsjaelland.dk.
authors.forename: Nessn Htum
authors.initials: NH
authors.lastname: Azawi
authors.forename: Mariam Annalisa Skibsted
authors.initials: MA
authors.lastname: Hult
authors.forename: Claus
authors.initials: C
authors.lastname: Dahl
authors.forename: Mikkel
authors.initials: M
authors.lastname: Fode
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001164:Arteriovenous Fistula / Q000209:etiology*; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008026:Ligation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D061646:Operative Time; D012077:Renal Artery / Q000601:surgery*; D012082:Renal Veins / Q000601:surgery*; D012189:Retrospective Studies; D014513:Ureter / Q000601:surgery*; D055815:Young Adult