The safety of en-bloc-resection of renal pedicle during laparoscopic nephrecotmy and nephroureterectomy

Purpose: As a previous perception, renal hilum en bloc ligation may increase the risk of renal arteriovenous fistula (AVF). We evaluated the safety and effectiveness of en bloc ligation of renal pedicale using endo-gastrointestinal anastomosis stapler (endo-GIA) during laparoscopic nephrecotmy and nephroureterectomy.

Materials and Methods: Medical records were reviewed of 243 patients underwent laparoscopic nephrecotmy and nephroureterectomy from January, 2002 to May, 2015. Preoperative evaluation include estimate blood loss (EBL), operative time (OP time), the method to ligate renal pedicle (en bloc versus separate) are documented. Comparison of EBL and op time are only performed among patients received laparoscopic nephrectomy. Postoperative evaluation include newly diagnosis of heart failure and we also use the CT (computerized tomography) scan for evaluating the possibility of formation of AVF.

Results: Average age of our patients was 65.42 years (range 12 to 89 yrs) including nephrectomy: 80 patients; nephroureterectomy: 143 patients; nephroureterectomy plus cystectomy: 19 patients. 103 patients have adequate out patient clinic medical records for evaluation and the mean follow-up is 5.3 months (1938.7 days, 15–6033 days). 70 patients have accurate record for the method of renal hilum ligation. (Group A: en bloc, n = 58; Group B: separate, n = 12) Among these two groups, there are no significant deference in EBL (p = 0.343) and OP time (p = 0.635). In our follow up, only 4 patients have newly diagnosis of heart failure. One of them eventually loss follow-up. The rest of 3 patients have no evidence of AVF formation under image and physical examination.

Conclusion: En bloc ligation of renal pedicle during laparoscopic nephrecotmy and nephroureterectomy using endo-GIA is safe with no evidence of AVF formation with average follow up for 5.3 months (longest follow-up for 20 years)