Use of titanium staples during upper tract laparoscopic reconstructive surgery: initial experience

Area of Science:

• Urology
• Minimally Invasive Surgery
• Surgical Technology

Background:

• Nonabsorbable titanium staples have demonstrated safety in the lower urinary tract.
• Prior laboratory studies indicated favorable outcomes for titanium staples in the upper urinary tract.

Purpose of the Study:

• To evaluate the safety and efficacy of titanium Endo-GIA staples for laparoscopic reduction pelvioplasty during pyeloplasty.
• To compare outcomes between stapled closure and absorbable suture closure.

Main Methods:

• Retrospective analysis of 17 laparoscopic pyeloplasty cases.
• Closure was achieved with absorbable sutures (12 cases) or titanium Endo-GIA staples (5 cases).
• Follow-up included clinical assessment and radionuclide renal scans.

Main Results:

• The Endo-GIA stapler group had a shorter average operative time (5.5 hours vs. 6.8 hours).
• No postoperative extravasation occurred in the stapled group, compared to 2 cases in the sutured group.
• No symptomatic nephrolithiasis was observed in the stapled group at a median follow-up of 27 months.
• All patients experienced pain reduction, and renal scans confirmed unobstructed ureteropelvic junction repairs.

Conclusions:

• Titanium staples provide rapid and secure closure of the renal pelvis in laparoscopic pyeloplasty.
• While stone formation is a theoretical concern, it has not materialized in this study cohort.
• Stapled closure appears to be a safe and efficient alternative to sutures for this procedure.