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En-Bloc Stapler versus Clips for Hilar Vascular Control in Laparoscopic Nephrectomy.

Abdullah Golbasi1, Burak Elmaagac1, Ali Yasin Ozercan2

  • 1Department of Urology, University of Health Sciences Medical Faculty of Kayseri, Kayseri City Hospital, Kayseri, Turkiye. (Drs. Golbasi, Elmaagac, and Karadag).

JSLS : Journal of the Society of Laparoendoscopic Surgeons
|March 16, 2026
PubMed
Summary

En-bloc stapling and separate clipping are safe for laparoscopic nephrectomy hilar control. En-bloc stapling may reduce operative time and complications, supporting its wider use in kidney surgery.

Keywords:
LaparoscopyNephrectomyRenal arteryRenal veins

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Area of Science:

  • Urology
  • Minimally Invasive Surgery
  • Surgical Techniques

Background:

  • Laparoscopic nephrectomy is preferred over open surgery.
  • Secure hilar control is crucial in laparoscopic nephrectomy.
  • Limited studies compare stapler ligation versus clipping for hilar control.

Purpose of the Study:

  • To evaluate the safety and effectiveness of en-bloc stapler ligation versus separate arterial and venous clipping for hilar control.
  • To compare operative time, blood loss, and complication rates between the two techniques.

Main Methods:

  • Retrospective study of 171 patients (aged 18-80) undergoing laparoscopic nephrectomy.
  • Hilar control achieved via en-bloc stapling (EndoGIA) or separate clipping.
  • Data collected: demographics, perioperative, and postoperative outcomes.
  • Complications classified using Clavien-Dindo system; statistical analysis performed.

Main Results:

  • En-bloc stapling group (80 patients) showed reduced operative time (122 vs 135 min) and blood loss (175 vs 198 mL).
  • Overall complication rates were similar (30% vs 28.5%), predominantly Clavien-Dindo grade I-II.
  • No arteriovenous fistulas observed with en-bloc stapling; major complications were rare.

Conclusions:

  • Both en-bloc stapler ligation and separate clipping are safe for hilar control in laparoscopic nephrectomy.
  • En-bloc stapling may offer benefits by reducing operative time and complications.
  • En-bloc stapling is a viable option, especially for complex cases or when minimizing surgery duration is key.