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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
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.
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.
