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

Laparoscopic nephrectomy is widely preferred for its advantages over open surgery, and secure hilar control is a critical procedural step. Although both clips and staplers are commonly used, studies comparing these techniques outside the setting of donor nephrectomy remain limited. This study evaluates the safety and effectiveness of en-bloc stapler ligation versus separate arterial and venous clipping.

This retrospective study included patients aged 18-80 who underwent laparoscopic nephrectomy between 2020 and 2025. Demographic, perioperative, and postoperative data were collected, and complications were classified using the Clavien-Dindo system. Hilar control was performed either by en-bloc stapling or separate clipping. Statistical analyses included comparative tests and logistic regression, with significance set at P < .05.

A total of 171 patients were analyzed (80 EndoGIA, 91 clip). Baseline characteristics were comparable. Operative time (122 vs 135 minutes; P = .004) and blood loss (175 vs 198 mL; P = .025) were lower in the EndoGIA group. Overall complication rates were similar (30% vs 28.5%; P = .500), with mostly grade I-II. Major complications were rare in both groups. No arteriovenous fistulas were detected after en-bloc stapling. Multivariate analysis identified prolonged operative time and chronic obstructive pulmonary disease (COPD) as independent predictors of postoperative complications.

Both en-bloc stapler ligation and separate clipping are safe methods for hilar control in laparoscopic nephrectomy. En-bloc stapling may reduce operative time and associated complications, offering particular advantages in complex dissections or when minimizing surgery duration is critical, thereby supporting its broader adoption in clinical practice.