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Published on: April 4, 2025
En bloc stapler versus separate clip ligation for renal hilar control during robotic-assisted nephrectomy: A
Ibrahim A Khalil1, Fatima A Al-Jassim1, Yaser M Ata1
1Department of Urology Hamad Medical Corporation Doha Qatar.
Objectives:
This study aimed to compare en bloc endovascular stapler ligation (ENBLOC) with separate clip ligation (CLIPS) for renal hilar control during robotic-assisted nephrectomy, with emphasis on perioperative safety.
Patients And Methods:
This single-centre retrospective cohort included 193 consecutive adults undergoing robotic-assisted radical nephrectomy, simple nephrectomy or nephroureterectomy between January 2018 and December 2025. Patients were classified as CLIPS (n = 66) or ENBLOC (n = 127). Primary safety outcomes were intraoperative complications, postoperative complications and postoperative arteriovenous fistula (AVF) formation. Operative, renal functional and oncological outcomes were secondary or exploratory. Procedure-specific subgroup analyses were also performed.
Results:
Baseline characteristics were largely comparable, except for ASA III-IV status was more frequent in the CLIPS group (27.3% vs. 16.5%, p = 0.029). Operative time (206.5 vs. 218.0 min, p = 0.26), estimated blood loss (median 100 mL in both groups, p = 0.37) and transfusion rates (1.5% vs. 5.5%, p = 0.19) did not differ significantly. Intraoperative complications occurred in 3/66 (4.5%) CLIPS and 8/127 (6.3%) ENBLOC patients (OR 1.41, 95% CI 0.36-5.51; absolute risk difference 1.8 percentage points, 95% CI - 4.8 to 8.3; p = 0.752). Postoperative complications occurred in 5/66 (7.6%) and 9/127 (7.1%) patients, respectively (p = 0.91). No AVF was identified during follow-up. Exploratory subgroup analyses did not identify additional statistically significant between-group differences, although estimates were limited by small sample sizes and sparse events.
Conclusion:
En bloc stapler ligation was not associated with statistically significant differences in the evaluated safety outcomes compared with separate clip ligation. However, the observational design and limited number of events preclude conclusions regarding equivalence, and clinically relevant differences cannot be excluded.
